|Year : 2016 | Volume
| Issue : 1 | Page : 44-47
Presence of non syndromic incisiform supplemental maxillary lateral incisor in siblings: A case report
Shabina Shafi1, Asmaa Assaf Al-Assaf2, Suheel Manzoor3
1 Lecturer, Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha, KSA
2 Student, College of Dentistry, King Khalid University, Abha, KSA
3 Associate Professor, Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, KSA
|Date of Web Publication||7-Aug-2020|
MDS Shabina Shafi
Department of Pediatric Dentistry and Orthodontic Sciences, Division of pediatric Dentistry, College of Dentistry, King Khalid University, Abha
Source of Support: None, Conflict of Interest: None
Supernumerary teeth are defined as teeth in excess of the normal dental formula. Supernumerary teeth of orthodox shape and size that resemble normal dentition are called supplemental teeth. Supplemental teeth are less common than supernumerary teeth and are often overlooked because of their normal shape and size. We report a rare case that describes a non-syndromic incisiform supplemental maxillary lateral incisor, which caused crowding, poor aesthetics and it emphasizes the importance of early diagnosis and treatment in non-syndromic incisiform supplemental teeth.
Keywords: Incisiform supplemental lateral incisors, supernumerary teeth
|How to cite this article:|
Shafi S, Al-Assaf AA, Manzoor S. Presence of non syndromic incisiform supplemental maxillary lateral incisor in siblings: A case report. King Khalid Univ J Health Sci 2016;1:44-7
|How to cite this URL:|
Shafi S, Al-Assaf AA, Manzoor S. Presence of non syndromic incisiform supplemental maxillary lateral incisor in siblings: A case report. King Khalid Univ J Health Sci [serial online] 2016 [cited 2021 Jun 12];1:44-7. Available from: https://www.kkujhs.org/text.asp?2016/1/1/44/291599
| Introduction|| |
The existence of supernumerary teeth in the premaxillary region often creates unique diagnostic and great concerns for the practitioner. Supernumerary teeth are defined as teeth that surpass the normal dental formula. Supernumerary teeth also called hyperdontia, may occur unilaterally, bilaterally, single or multiple and in one or both jaws. The prevalence of hyperdontia in the general Caucasian population ranges between 0.35%-0.8% in primary dentition and 0.1%- 3.8% in the permanent dentition. Supernumerary teeth are more commonly found in the Mongoloid racial group with a reported frequency higher than 3%. Sexual dimorphism has been reported by most authors with males being more commonly affected. Although there appears to be no difference in the sex distribution for the primary dentition. Supernumeraries occur more frequently in the permanent dentition of boys than girls. Different sex ratios have been reported in the general Caucasian population; many authors have reported a sex ratio of 2 : 1. Various authors conducted studies on the sex-ratio differences .In a study the sex ratio was 2.5 : 1, again favoring males. Another reported a sex ratio as high as 5.5 : 1 favoring males for Japanese school children and 6.5:1 in Hong Kong children.
Supernumerary teeth can be classified into two types according to shape. Supernumerary teeth of normal shape and size (eumorphic) are termed supplemental, or incisiform whereas teeth of abnormal shape and smaller size (dysmorphic), are termed rudimentary and include three types, conical, tuberculate and molariform teeth.
Numerous theories have been proposed for the development of supernumerary teeth.
One theory states that the supernumerary teeth are a result of phylogenetic reversion to extinct primates with three pairs of incisors. However, these theories have been discounted now. The dichotomy of tooth bud, suggests that the tooth bud splits into two equal or different sized parts and holds some appeal. Another theory suggests that these teeth are formed because of localized and independent hyperactivity of the dental lamina. According to this theory, a supplemental teeth would develop from the lingual extension of an accessory tooth bud, whereas a rudimentary form would develop from the proliferation of epithelial remnants of the dental lamina. This is the most accepted theory.
The combinations of hereditary and environmental factors are also considered important etiological factors in the occurrence of supernumerary teeth. While an autosomal dominant trait has also been suggested, the increased incidence in males suggests of sex-linked heredity. As our case report, indicates some role of sex-linked heredity, as supplemental teeth were seen in sibling.,, Supplemental supernumerary teeth are found in a normal sequence of the dentition and are usually an extra lateral incisor, premolar or molar. It’s reported that the majority of primary extra teeth are supplemental, mostly lateral incisor. Supplemental teeth in a dental arch are a rare occurrence.
A case with non-syndromic unilateral supplemental primary and permanent maxillary right lateral incisor is presented.
| Case Report 1|| |
An 11 year old boy accompanied with his mother reported to the Department of Pedodontics with the chief complaint of irregularly placed upper front teeth. The patient medical history was non-contributory, nor were there clinical signs of any recognised syndrome. There was no previous trauma to the teeth or jaws, but detailed investigations into family history suggested being having an odd looking extra-tooth in the upper arch in his brother’s mouth. The mother was requested to report on the next visit along with his brother which is described in case report 2.An extra-oral examination did not reveal any abnormality. Intraoral examination in an 11 year old boy revealed presence of 12s (supplemental) having morphology similar to that 12. He had class 1 occlusion with mild upper arch crowding [Figure 1].
Orthopantomograph and Intraoral periapical radiograph were taken in relation to 12,12s.The crown appears normal with enamel, dentin, pulp and root configuration with sound periodontium in relation to maxillary right lateral incisor and their supplemental tooth. The crown and root morphology of both 12,12s were identical. Other investigation included clinical photographs [Figure 2] and [Figure 3].
|Figure 3: Intraoral periapical radiograph showing supplemental right permanent maxillary lateral incisor|
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The present case supplemental right maxillary permanent lateral incisor caused crowding, difficulty in oral hygiene and aesthetic problems. The teeth 12,12s were equally formed, and it was decided to extract the supplemental lateral incisor. The tooth which is more displaced and causing discomfort should be extracted under local anaesthesia as reported by Hattab et al. After this patient is advised for orthodontic treatment for the alignment of the anterior teeth and periodic monitoring was done.
| Case Report 2|| |
Is an 8 year old boy, younger brother of the first patient accompanied with his mother complaint of an odd looking extra-tooth in the upper arch. The patient medical history was non-contributory, nor were there clinical signs of any recognised syndrome. An extra-oral examination showed no abnormality, intraoral examination revealed mixed dentition with presence of two primary lateral incisors in right maxillary quadrant. This means that there was presence of supplemental primary lateral incisor (52s) with dental caries on mesial surface [Figure 4].
An Intraoral periapical and Orthopantomograph radiograph revealed complete root configuration with sound periodontium in relation to 52,52s.The crown and root morphology of both lateral incisors i.e. 52 and 52s were identical except the caries in 52s [Figure 5] and [Figure 6].
|Figure 6: Intraoral periapical radiograph showing supplemental right primary maxillary lateral incisor|
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The treatment methods and the timing of surgical removal of supplemental teeth is much debated among clinicians. In making decisions related to extraction of extra teeth, if two teeth are equally well formed, the tooth that is displaced the most should be extracted. Extraction is not always treatment of choice for primary supplemental teeth that are symptomless and are sometimes best to left in place and kept under observation.,
Based on the history, clinical examination and radiographic investigations, the final diagnosis of non-syndromic incisiform supplemental maxillary lateral incisor in sibling was made. The patients are under regular follow up and treatment plan was carried out as described in Case 1 and Case 2.
| Discussion|| |
Present case is unusual and rare as it demonstrates supplemental maxillary lateral incisor in sibling without any associated syndrome. Supernumerary teeth can be found in almost any region of the dental arch. Supernumerary teeth most commonly occur in maxilla, and are restricted to pre-maxilla which has also been established as the predominant location by others. These findings describe that the embryological development of the pre-maxilla varies from rest of the maxilla. Therefore, there can be deviations in the pre-maxillary region that do not occur in the remaining maxilla. The term supernumerary frequently encompasses the supplemental teeth which refer to teeth that are duplications of teeth in the normal series. If a supplemental tooth is present and erupted, it now and then becomes difficult to identify which tooth is supplemental and which is part of the normal tooth. Clinical and radiographic identification of all the teeth is very important for a good treatment planning. Thus, the treatment depends upon pedodontist, orthodontist and the type and position of these teeth and their effects on adjacent teeth.
Treatment of supernumerary teeth includes several controversies and varied opinions to deal with such conditions have been reported in the literature among authors, particularly with regard to the timing of removal. Koch stated that immediate removal of supernumeraries is not necessary, usually if the teeth are asymptomatic and no pathological sequelae is associated with it. The various approaches to the management of supernumerary teeth in children is recommended. The first option involves removal of the supernumerary as soon as possible. This could create dental fear in a child and can also cause devitalization or deformation of adjacent teeth. Secondly, the supernumerary could be left until roots of the adjacent teeth have completely formed. The potential disadvantages associated with this plan include loss of eruptive force of adjacent, loss of space , crowding of the affected arch, and possible midline shifts. It’s also said, if an offending supernumerary tooth is removed in prior, better will be the prognosis.
According to various schools of thoughts it is endorsed that immediate removal of the tooth prevents costly future orthodontic treatment. Others claim if a supernumerary teeth is asymptomatic and do not affect the dentition, extraction may not always be necessary, although should be periodically monitored. Moreover, whenever supernumerary primary teeth are diagnosed, parents or the guardian should be alarmed of the possible consequences to the permanent dentition as these teeth may be replicated in the permanent series in majority of the cases.
In the present case it was decided to extract the supplemental lateral incisor in 11year old boy to allow for proper alignment of the teeth and maintenance of oral hygiene with aesthetics followed by orthodontic treatment. For his brother periodic monitoring was done. There may be definite group of genes, which plays an important role in the formation of supernumerary teeth. A familial discrepancy in number of teeth is rare and the genetic or other causes need to be further investigated.
| Conclusions|| |
It’s a great challenge to the clinicians to decide timely management of supernumerary teeth, to prevent complications associated with it. Supplemental teeth should be observed to prevent its interference with the development and eruption of adjacent teeth. Dental practitioners should do thorough clinical and radiographic evaluation for supernumerary teeth and be clear with various treatment options.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]