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| CASE REPORT |
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| Year : 2017 | Volume
: 9
| Issue : 2 | Page : 82-84 |
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Nonsyndromic supernumerary bilateral parapremolars
Vineeta Singhal, D Deepa
Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| Date of Web Publication | 26-Jul-2017 |
Correspondence Address:
D Deepa
Department of Periodontology, Subharti Dental College and Hospital, Delhi-Haridwar By-Pass Road, Meerut - 250 005, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jorr.jorr_46_16
Supernumerary teeth are a rare finding in dental arch, which are mostly reported in association with syndromes. However, they can be seen in the absence of systemic disease. They may be single, multiple, unilateral, or bilateral with a predilection for the mandible, especially in nonsyndromic patients. Due to its different form and position in dental arch, it is observed to be associated with various periodontal problems. This case report presents a case of bilateral parapremolars in the maxillary arch in a nonsyndromic patient, which led to food lodgment and consequently led to caries and periodontal problem on the left maxillary arch. Keywords: Nonsyndromic patients, parapremolars, periodontal problems, supernumerary teeth
How to cite this article:
Singhal V, Deepa D. Nonsyndromic supernumerary bilateral parapremolars. J Oral Res Rev 2017;9:82-4 |
| Introduction | |  |
A supernumerary tooth can be defined as one that is additional to the normal series and can be found in almost any region of the dental arch. Mesiodens is defined as a supernumerary tooth located in the maxillary central incisor region. However, parapremolars or paramolars are present in the premolar and molar region, respectively. The most common localization for multiple supernumerary teeth is the premolar region (62.1%) and especially in the lower premolar region in case of nonsyndrome multiple supernumerary teeth.[1] According to Kaya et al., the prevalence rates of supernumerary premolars vary in different population, age, ethnicity. It is seen that they are more frequent in males than females and the presentation of multiple supernumerary teeth in the absence of association with other systemic diseases or syndromes is rare.[2]
Supernumeraries may erupt normally or may remain impacted or inverted in the jaw or reach heterotopic position or show abnormal eruptive patterns. They may cause various pathological conditions such as delayed eruption or noneruption, displacement of permanent teeth, resorption or malformation of adjacent roots, and cystic formation.[1] Supernumerary teeth are usually asymptomatic and an incidental finding during dental visit; therefore, it could be left in place and kept under observation. However, surgical removal should be considered based on the pathological sequelae associated with it. Here, we present a case of bilateral nonsyndromic supernumerary parapremolars in the maxillary arch.
| Case Report | | |
A male patient aged 18 years reported to the Department of Periodontology outpatient department with the chief complaint of pain and food lodgment in the upper posterior region on both sides for few months. Intraoral examination revealed a regular set of permanent dentition along with two completely erupted supernumerary parapremolars on both the sides of the maxillary arch [Figure 1]a and [Figure 1]b. Both of these teeth were present palatal to the permanent first and second premolar and were conical in morphology, hence were considered as supernumerary teeth. Generalized plaque and calculus were present on the teeth along with generalized gingivitis. There was no extraoral deformity in the form of cleft lip or palate, and the clavicles were normal. His familial, medical, and dental histories were noncontributory. Radiovisuography was advised to evaluate the complete dentition which revealed two supernumerary teeth placed palatal to the regular set of maxillary premolars and did not reveal any other impacted or supernumerary teeth. The supernumerary teeth observed were of conical shape with completely formed roots [Figure 2], [Figure 3], [Figure 4]. Study models were prepared to evaluate the position of the erupted supernumerary teeth and malalignment of the dentition [Figure 1]a. | Figure 1: (a) Clinical photograph of the intraoral examination revealing presence of bilateral supernumerary paramolars in maxillary arch. (b) Study model showing the parapremolars
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The patient was informed about the presence of additional teeth and was educated about the difficulties associated in maintaining the oral hygiene and was advised for the extraction of the same. Mandibular arch had complete set of teeth and no supernumerary tooth. Left maxillary supernumerary tooth was carious and patient consented for the removal of the same. Oral hygiene measures were instituted and the follow-up was uneventful [Figure 5] and [Figure 6].
| Discussion | | |
Both genetic and environmental factors have been considered to play a role in the etiology of supernumerary teeth.[3] Various theories have been put forward as atavism theory,[4] dichotomy theory,[5] and dental lamina hyperactivity theory.[4] The most common developmental disorders that show an association with multiple supernumerary teeth are cleft lip and palate, cleidocranial dysostosis, and Gardner's syndrome.[5] Other associated syndromes include Fabry–Anderson's syndrome or chondroectodermal dysplasia,[6] Rothmund–Thomson syndrome, and Nance–Horan syndrome.[7]
However, this case was nonsyndromic. These paramolars were conical in shape and hence belong to category of conical teeth under morphological variation classification of supernumerary teeth.[8],[9] Conical tooth develops with root formation ahead of or at an equivalent stage to that of permanent incisors and usually presents as a mesioden. It may infrequently be found high and inverted into the palate or in a horizontal position. In most cases, however, the long axis of the tooth is normally inclined as mentioned in the literature. The conical supernumerary could result in rotation or displacement of the permanent incisor but rarely delays eruption.[10]
Treatment of supernumerary teeth is controversial as there are varied opinions among authors. According to Rotberg and Kopel,[11] removal of the supernumerary teeth is recommended as soon as it has been discovered. However, Koch et al.[12] stated that immediate removal of supernumeraries is not necessary if no pathology is present. Omer et al.[13] have suggested that if the supernumerary teeth are not causing any adverse effects on adjacent teeth and if there is no future orthodontic treatment foreseen, then it is reasonable not to go for immediate surgical intervention.
However, if complications such as prevention or delay of eruption of associated permanent teeth, crowding/malocclusion, incomplete space closure during orthodontic treatment, dilaceration, root resorption of adjacent teeth, and cyst formation occur, extraction of supernumerary teeth is indicated.[3] Supernumerary teeth may also compromise the esthetics, complicate alveolar bone grafting, compromise the sighting of implants, and impinge on nerves leading to paresthesia and/or pain.[6]
Therefore, in accordance with Garvey et al.[6] and Shah et al.,[3] if the unerupted supernumerary tooth is not associated with any complications, it could be kept under periodic review.
| Conclusion | | |
It is imperative to evaluate the patient clinically and radiologically when supernumerary teeth are detected so as to rule out its association with syndromes and also for its appropriate and timely management. It is important to educate the patient about the complications associated with the malposed supernumerary teeth for prompt treatment.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 9. | Andlaw RJ, Rock WP. A Manual of Paediatric Dentistry. 4 th ed. New York: Churchill Livingstone; 1996. p. 156. |
| 10. | Foster TD, Taylor GS. Characteristics of supernumerary teeth in the upper central incisor region. Dent Pract Dent Rec 1969;20:8-12. |
| 11. | Rotberg S, Kopel HM. Early vs. late removal of mesiodens: A clinical study of 375 children. Compend Contin Educ Dent 1984;5:115-9. |
| 12. | Koch H, Schwartz O, Klausen B. Indications for surgical removal of supernumerary teeth in the premaxilla. Int J Oral Maxillofac Surg 1986;15:273-81. |
| 13. | Omer RS, Anthonappa RP, King NM. Determination of the optimum time for surgical removal of unerupted anterior supernumerary teeth. Pediatr Dent 2010;32:14-20. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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