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Ashish Shah
Supernumerary teeth are defined as those reported.4 Supernumeraries in the primary the premaxilla.1 Additionally, there
in excess when compared to the normal dentition may be under-reported. Spacing is a significant association between
series. Their reported prevalence ranges often present in the primary dentition may supernumerary teeth and invaginated teeth
between 0.3−0.8% in the primary dentition allow supernumerary teeth to erupt into (teeth with an exaggerated cingulum pit).6
and 0.1−3.8% in the permanent dentition.1-3 reasonable alignment and remain unnoticed These findings may be explained by the
Males are affected approximately twice as by parents. These children may have an initial fact that the embryological development
often as females. Methodology for detection dental examination following exfoliation of the premaxilla differs from that of the
and variation in the populations studied of deciduous supernumerary teeth.4 The remaining maxilla. Therefore, there can be
may account for the range of prevalence results of some major prevalence studies deviations in the premaxillary region that
on supernumerary teeth are summarized in do not occur in the remaining maxilla.7
Table 1. These deviations may lead to the formation
Ashish Shah, BDS, MFDS RCS(Eng), Supernumerary teeth can occur of supernumerary teeth and other
Specialist Registrar in Orthodontics, as singles, multiples, unilaterally or bilaterally anomalies, including invaginated teeth.
Royal Berkshire Hospital (Reading) and and in the maxilla, the mandible or both.1
Wexham Park Hospital (Slough), Daljit Cases involving one or two supernumerary
Aetiology
S Gill, BDS(Hons), MSc, BSc(Hons), teeth most commonly affect the anterior
The aetiology of supernumerary
FDS(Orth) RCS(Eng), MOrth, FDS RCS(Eng), maxilla, followed by the mandibular premolar
teeth is not completely understood. Both
Consultant Orthodontist/Honorary region. There are differences in the reported
genetic and environmental factors have
Senior Lecturer, Eastman Dental Hospital relative frequencies of supernumerary teeth
been considered.8 Several theories have
(UCLH NHS Foundation Trust) and UCL in other regions.1 Cases involving multiple
been suggested to explain their occurrence:
Eastman Dental Institute, Honorary supernumeraries (more than five) tend to
Consultant, Great Ormond Street Hospital, involve the mandibular premolar region.4
Christopher Tredwin, BDS(Hons), When investigating non-syndrome multiple Atavism
BSc(Hons), MSc, MFDS RCS(Eng), FDS(Rest supernumerary teeth, Yusof2 found 60.9% of It was originally suggested that
Dent) RCS, FHEA, Clinical Lecturer in Fixed the total sample to occur in the mandible supernumerary teeth were the result of
and Removable Prosthodontics, UCL and 44.8% in the mandibular premolar phylogenetic reversion to extinct primates
Eastman Dental Institute and Farhad B region. with three pairs of incisors. This theory has
Naini, BDS, FDS RCS, MSc, MOrth RCS, Supernumerary teeth are been largely discounted.9
FDSOrth RCS, Consultant Orthodontist, St estimated to occur in the maxilla 8.2
George’s Hospital and Kingston Hospital, to 10 times more frequently than the Dichotomy theory
London, UK. mandible,2,3,5 and most commonly affect This stated that the tooth bud
510 DentalUpdate October 2008
Authors Sample size Country of Age of Method of Reported prevalence Male: Female
study subjects detection of of supernumeraries ratio
supernumeraries
Bodin et al 21,609 patients Sweden Not specified Not specified 1.6% 1.7:1
(1978)13
Stafne
(1932)3 48,550 patients USA Average age Radiographs 0.91% –
approximately
40 years
splits into two equal or different-sized theory, a supplemental form would develop Genetic factors
parts, resulting in the formation of two from the lingual extension of an accessory These are considered
teeth of equal size, or one normal and one tooth bud, whereas a rudimentary form important in the occurrence of
dysmorphic tooth, respectively.1 However, would develop from the proliferation of supernumerary teeth. Many cases
this theory has been discounted.9 epithelial remnants of the dental lamina.9 have been reported of recurrence
Although all theories are within the same family.1 A sex-linked
Dental lamina hyperactivity theory hypothetical because of the inability to inheritance has been suggested
This involves localized, obtain sufficient embryological material, by the observation that males are
independent, conditioned hyperactivity most literature supports the dental lamina affected approximately twice as often
of the dental lamina.1 According to this hyperactivity theory.9 as females.1,9
Tuberculate
The tuberculate supernumerary
has a barrel-shaped appearance and a
crown consisting of multiple tubercles.9
It may be invaginated.1 Unlike conical
supernumerary teeth, which have complete
root formation, tuberculate types have
either incomplete or absent root formation.9
They are generally larger than conical
supernumerary teeth and are usually found
in a palatal position relative to the maxillary
incisors.1,9 Tuberculate supernumeraries are
often paired1 and bilateral supernumerary
cases have a predominance of tuberculate-
Figure 1. A dental panoramic tomograph showing the presence of a supplemental \B. shaped teeth.9 It has been suggested that
tuberculate supernumeraries may represent
a third dentition.9
Supplemental
Classification of supernumerary Supplemental supernumerary
teeth teeth resemble their respective normal
Supernumeraries are classified teeth. They form at the end of a tooth
according to morphology or location. series. The most common supplemental
tooth is the permanent maxillary lateral
Classification based on morphology incisor, although supplemental premolars
and molars also occur.1 The majority
Conical
of supernumerary teeth in the primary
Conical-shaped supernumerary
dentition are supplemental and rarely
teeth are the most common.1 They usually
remain unerupted.1,10
present with conical or triangular-shaped
Figures 1 and 2 show a
crowns and complete root formation. They
supplemental \B.
are found most often as isolated single
cases and are usually located between the
Figure 2. An upper anterior occlusal radiograph maxillary central incisors (mesiodens).9 Odontomes
also showing the presence of a supplemental \B However, they can also occur as bilateral These are hamartomas (benign,
for the same patient as in Figure 1. (mesiodentes) structures in the premaxilla.9 disordered overgrowths of mature tissue)
comprising all dental tissues and appearing
radiographically as well-demarcated, mostly
radio-opaque lesions in tooth-bearing areas.
There are two different types of odontome:
compound and complex. Compound
odontomes comprise many separate, small
tooth-like structures. A complex odontome
(Figure 3) is a single, irregular mass of
dental tissue that has no morphological
resemblance to a tooth.
The key features of
supernumerary teeth are summarized in
Table 2.
Type of supernumerary Relative occurrence Common locations Typical clinical Typical radiographic
appearance appearance
Odontome 6% Anterior maxilla and Numerous small tooth- Mixed radio-opaque area
posterior mandible like structures or a single, surrounded by radiolucent
irregular mass band
Table 2: Key features of supernumerary teeth.
is the localization and identification affecting the time taken include the distance References
of complications associated with the unerupted tooth was displaced, the space 1. Rajab LD, Hamdan MAM.
supernumeraries. Teeth can be localized available in the dental arch and the stage of Supernumerary teeth: review of the
using the vertical or horizontal parallax root development of the permanent tooth.1 literature and a survey of 152 cases. Int
technique. A periapical radiograph taken The patient’s age and the availability of J Paediatr Dent 2002; 12: 244−254.
using the paralleling technique gives the space in the dental arch are the two critical 2. Yusof WZ. Non-syndrome multiple
most detailed assessment compared to factors in determining whether spontaneous supernumerary teeth: literature review.
other radiographic views. eruption occurs following removal of J Can Dent Assoc 1990; 56: 147−149.
If teeth are causing no supernumerary teeth.27 3. Stafne, EC. Supernumerary teeth. Dent
complications and are not likely to interfere At the initial operation to remove Cosmos 1932; 74: 653−659.
with orthodontic tooth movement (ie if the supernumerary, attachment of a gold 4. Scheiner MA, Sampson WJ.
they lie beyond the dental apices) they chain to the unerupted tooth gives the Supernumerary teeth: a review of the
can be monitored with yearly radiographic option of applying orthodontic traction to literature and four case reports. Aust
review. The patient should be warned of the tooth if it does not erupt spontaneously. Dent J 1997; 42: 160−165.
complications, such as cystic change and However, in order to expose the unerupted 5. Acikoz A, Tunga U, Otan F.
migration with damage to nearby roots. tooth sufficiently for an attachment to be Characteristics and prevalence of non-
If the patient does not wish to risk such bonded, a greater amount of supporting syndrome multiple supernumerary
complications, it is acceptable to remove bone needs to be removed. Exposure of teeth: a retrospective study.
supernumerary teeth. If they are associated the unerupted tooth (with or without a Dentomaxillofac Radiol 2006; 35:
with the roots of permanent teeth, it may bonded attachment) may result in poor 185−190.
be sensible to await full root development gingival aesthetics, with less attached 6. Welbury RR, Duggal MS, Hosey M-T.
before surgical extraction to minimize the gingivae between the exposed tooth and Paediatric Dentistry 3rd edn. Oxford:
chances of root damage. Root development neighbouring teeth.14 Oxford University Press, 2005.
of the maxillary incisors should be complete If supernumerary teeth are 7. Hansen L, Kjaer I. A premaxilla with
by the age of ten years. likely to interfere with orthodontic tooth a supernumerary tooth indicating a
If supernumerary movement, they should be removed prior to developmental region with a variety of
teeth are associated with complications, the commencement of treatment. dental abnormalities: a report of nine
it is usual to extract such teeth, which If a supplemental tooth cases. Acta Odontol Scand 2004; 62:
usually involves a surgical procedure. Early is present and erupted, it may be difficult to 30−36.
extraction of supernumeraries, causing determine which is the supplemental and 8. Hall A, Onn A. The development
incisor impaction, may have the benefit which is the tooth of the normal dental series. of supernumerary teeth in the
of minimizing loss of eruptive potential, In these circumstances, assuming both teeth mandible in cases with a history of
space loss and centreline displacement. are healthy, it is logical to extract the tooth supernumeraries in the pre-maxillary
Even in cases where the unerupted incisors most displaced from the line of the arch for region. J Orthod 2006; 33: 250−255.
are severely rotated, early removal of the the relief of crowding. 9. Primosh RE. Anterior supernumerary
causative supernumerary tooth can result in Finally, the presence of teeth − assessment and surgical
self-correction and correct alignment.9 The a supernumerary tooth should alert the intervention in children. Pediatr Dent
greatest concern with early removal is the clinician to the possibility of the development 1981; 3: 204−215.
risk of affecting the formation of adjacent of late forming supernumerary teeth, 10. Liu JF. Characteristics of premaxillary
roots.9 Additionally, a young child may be especially in the lower premolar region. It supernumerary teeth: a survey of
unable to tolerate such a procedure and has been reported that up to 24% of patients 112 cases. ASDC J Dent Child 1995; 62:
may develop a dental phobia. However, with an anterior maxillary supernumerary 262−265.
delayed eruption of maxillary central may later develop supplemental premolars. 11. von Arx T. Anterior maxillary
incisors can result in mesial movement supernumerary teeth: a clinical and
of the lateral incisors, space loss and radiographic study. Aust Dent J 1992; 37:
diminished development of dento-alveolar Conclusion 189−195.
height.1 Furthermore, in situations where Supernumeraries are relatively 12. Nazif MM, Ruffalo RC, Zullo T. Impacted
a supernumerary tooth is preventing the common and can cause a variety of supernumerary teeth: a survey of
eruption of an incisor, the eruptive potential complications. The clinician should 50 cases. J Am Dent Assoc 1983; 106:
of the incisor may be lost if intervention is recognize signs suggesting the presence of 201−204.
delayed. supernumerary teeth, particularly aberrations 13. Bodin I, Julin P, Thomsson M.
Following removal of in the eruptive pattern, and perform the Hyperdontia. I. Frequency and
supernumerary teeth, the time taken for the relevant investigations. On diagnosis, each distribution of supernumerary teeth
unerupted tooth to erupt can vary between case should be managed appropriately among 21,609 patients. Dentomaxillofac
six months and three years.1 Up to 91% of in order to minimize complications to the Radiol 1978; 7: 15−17.
impacted permanent incisors erupt within developing dentition. This may include 14. Mitchell L, Bennett TG. Supernumerary
18 months following removal.27 Factors referral to an orthodontist.
October 2008 DentalUpdate 519