Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Supernumerary Teeth - A Clinical Case Report

Bhaskaran Sathyapriya*, Purushothaman Lakshmanan, Ramachandran Tamilselvi, Duraisamy Revathi

Department of Anatomy, Sree Balaji Dental College & Hospital, Bharath Institute of Higher Education & Research, Chennai, Tamilnadu, India

Abstract: A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. Supernumerary teeth may be encountered by the general dental practitioner as a chance finding on a radiograph or as the cause of an impacted central incisor. They may also be found intraorally following spontaneous eruption. The most common supernumerary tooth appears in the anterior maxillary midline followed by lower bicuspid region. The aim of the present study is to report the case of an impacted supernumerary teeth and its effect on adjacent teeth.

Keywords: Supernumerary teeth, radiograph, impaction, dental arch

Citation: Bhaskaran Sathyapriya, Purushothaman Lakshmanan, Ramachandran Tamilselvi, Duraisamy Revathi, Supernumerary Teeth - A Clinical Case Report. International Journal of Dental Sciences and Research, 5 (4). 83-87. January 2017. doi:10.12691/ijdsr-5-4-1

1. Introduction

Supernumerary teeth are considered to be one of the most significant dental anomalies affecting children and adolescents [1]. Supernumerary teeth also known as hyperdontia, may be defined as an extra teeth that develop in addition to the 20 primary and 32 permanent teeth [2]. Sometimes the supernumerary teeth can also be accompanied by a absence of one or more teeth Supernumerary teeth may occur singly, multiply, unilaterally or bilaterally, and in one or both jaws [3,4,5]. Most frequent locations are upper jaw, midline, upper palatal region of upper incisors, lower bicuspid region, and distal region with respect to the third molar [6,7]. When multiple supernumerary teeth are present (>five), the most common site affected is the the lower bicuspid region, followed by molar region and anterior region [8]. Development of the tooth is a continuous process with a number of physiologic growth processes and various morphologic stages interplay to achieve the tooth’s final form and structure [9,10,11]. Interference with the stage of initiation or any momentary event may result in single or multiple missing teeth or supernumerary teeth [12].

The etiology of supernumerary teeth is not completely understood. Phylogenetic theory is one of the earlier theories that represents a return to the anthropoids which had a dental set up with greater number of teeth [9]. The most accepted theory is Dental lamina hyperactivity theory. According to Dental follicle dichotomy theory, the follicle is divided into two equal or different parts which leads to two similar teeth, or one similar tooth and one dysmorphic tooth [9,10,12]. Genetic heritage plays a very important role in the advent of supernumerary teeth. A dominant, autosomal, recessive gene associated to chromosome X is associated to supernumerary teeth. Its prevalence is stronger in males than in females [13]. Supernumeray teeth are also associated to different syndromes such as: Apert, craniofacial dysostosis or Crouzon syndrome, cleidocranial dysplasia or cleidocranial dysostosis, cleft lip and palate, Down’s syndrome, Gardner syndrome, Hallerman-Streiff syndrome, type I and type III oral-digital-facial syndrome, leopard or multiple lentigines syndrome, tricho-rhino-phalangeal syndrome, Kippel-Trenaunary-Weber syndrome, hypertrichosis syndrome, Zimmermann-Laband syndrome, type III Ehlers-Danlos syndrome, Sturge-Weber syndrome, Fabry-Anderson syndrome, Larsen syndrome [14,15,16,17,18,19,20,21,22].

Primosh classifies supernumerary teeth according to their shape in the following fashion: [23] Supplemental or eumorphic is a duplication of the normal dental series, the most common supplementary teeth are permanent upper lateral incisors, bicuspids and molars [23].

Rudimentary or dysmorphic are smaller-sized teeth. presenting abnormal shape or size. They can be Conical, Tubercular, Molar-shaped [23]. Supernumerary teeth can also be found impacted, inverted and impacted, associated to other dental anomalies, fused to a permanent tooth as well as associated to the germination of a lower central tooth. SN teeth can also be associated to taurodontism [24,25,26,27,28]. According to their location they can be classified as follows: Mesiodens are found between upper central incisors. They can appear as one single tooth, multiple teeth, unilateral or bilateral, erupted or impacted, vertical, horizontal, or inverted. They are frequently found in the lower jaw area. Complications associated to impacted mesiodens are: delay in eruption of permanent tooth, deviation of the tooth’s eruption, retention or resorption of the permanent tooth’s root and diastema. [24,29,30]. Paramolar is a small and rudimentary supernumerary molar, located in a labial (buccal) or lingual position with respect to an upper molar, or in the interproximal space found between second and third molars [31]. Distomolar is located on the distal surface of the third molar. It is a small, rudimentary tooth which rarely prevents normal eruption of other teeth. [10]. In the case of supernumerary teeth, early diagnosis is paramount to avoid complications. [27]. Diagnosis can be conducted through clinical or x-ray assessment. Treatment will depend upon supernumerary tooth position and class, as well as on the effect this tooth exerts on primary or permanent dentition. [32,33]. The present study reports the case of an impacted supernumerary teeth and its clinical implications.

2. Case Report

A 25yr old female patient came to with the chief compliant of pain in upper front teeth region since 6 months and pain on pressing in the nostril since 9 months. There was no history of systemic disease. The patient was neither allergic to any drugs nor under any medications. There was no extra oral swelling. Intra oral examination revealed dental caries in relation to 11, 12, no swelling, sinus opening, tender on percussion in relation to 11, 12 (Figure 1). Electric pulp testing showed delayed response in relation to 11, 12, 21. Preoperative radiograph showed coronal radioluscency approaching pulp in relation to 11, 12, a large periapical radioluscency in relation to 12, 11, 21 and a periapical radioopacity resembling tooth (Figure 2). 12, 11, 21 were treated endodontically and a post endo radiograph was taken (Figure 3). Oblique releasing and intrasulcular incisions were given (Figure 4 & Figure 5). On elevation of the flap the huge lesion was exposed (Figure 6 & Figure 7. The lesion was then enucleated followed by the exposure of the supernumerary tooth (Figure 8 & Figure 9). The supernumerary tooth was removed with bayonet forceps and corrugation of the epithelial remnants was done (Figure 10 – Figure 13). Enucleated specimen was immediately sent for histopathological examination. H & E stained soft tissue section showed 2-3 layered nonkeratinized stratified squamous epithelium with collagen fibers and the connective tissue showed chronic inflammatory cells all suggestive of a dentigerous cyst. The patient was followed up regularly for a period of about 3 weeks (Figure 14 & Figure 15).

Figure 1. Pre Operative Intra Oral Photograph

Figure 2. Pre Operative Intra Oral Periapical Radiograph

Figure 3. Post Endo Intra Oral Periapical Radiograph

Figure 4. Oblique Releasing Incision

Figure 5. Intrasulcular Incision

Figure 6. Elevation of flap

Figure 7. Exposure of huge Lesion

Figure 8. Enucleation of Lesion

Figure 9. Exposure of supernumerary teeth

Figure 10. Removal of supernumerary teeth with bayonet forceps

Figure 11. Supernumerary teeth removed

Figure 12. Extracted tooth and lesion

Figure 13. Immediate post Operative Intra Oral

Figure 14. post Operative Intra Oral Periapical Radiograph

Figure 15. 3 weeks Post Operative Intra Oral Photograph

3. Discussion

Supernumerary teeth are usually asymptomatic and unerupted supernumerary teeth may be detected as a chance finding during radiographic examination [31,34]. Supernumerary tooth in the maxillary anterior region is of major concern to the patient because of the unpleasant appearance. It may lead to crowding, delay or failure of eruption of permanent teeth, diastema, root resorption dilaceration, loss of vitality, subacute pericoronitis, gingival inflammation, periodontal abscesses, dental caries due to plaque retention in inaccessible areas, incomplete space closure during orthodontic treatment, and pathological problems such as dentigerous cyst formation, ameloblastomas, odontomas and fistulae. They may also interfere in alveolar bone grafting and implant placement [15,27,33,34,35,36].

Usually, the supernumerary teeth are detected using an anterior occlusal or periapical radiograph using paralleling technique, panaromic view (orthopantomograph) and computed tomography [32,34,35,37]. Radiographs are important in assessing the location and nature of these anomalies. The major shortcoming of the conventional radiography is overlapping of structures on the film. Computed tomography (CT) has proved to be superior to other radiographic methods in visualizing bone tissue [34,35]. CT images clearly show the intraosseous location, inclination, and morphology of impacted teeth, as well as the distance from adjacent structures [34,35]. However, radiographs alone are not adequate for the definitive diagnosis. The radiographic interpretation should always conjunct with clinical findings. Supernumerary teeth can be managed either by removal/endodontic therapy or by maintaining them in the arch and frequent observation. Removal of supernumerary teeth is recommended in cases where they are causing any pathological changes or crowding along with esthetical problem and difficulty in oral hygiene maintenance. In the present case, since the supernumerary tooth caused aesthetic problem periapical lesion in relation to 12, 11& 21 and pain, it was extracted and the lesion was enucleated. The patient was followed up regularly for a period of about 3 weeks.

4. Conclusion

Unerupted supernumerary tooth, direction of the crown, the location, the influence on adjacent teeth, resorption of adjacent roots and the formation of dentigerous cysts should be carefully evaluated. Early detection, clinical, radiographical examination combined with advanced diagnostic aids is necessary for accurate diagnosis to prevent associated complications. Treatment depends on the type and position of the supernumerary tooth and on its effect or potential effect on adjacent teeth.

References

[1]   | De Oliveira Gomes C, Drummond SN, Jham BC, Abdo EN, Mesquita R. A survey of 460 supernumerary teeth in Brazilian children and adolescents. Int J Paediatr Dent 2008; 18: 98-106.
[2]   | Schulze C. Developmental abnormalities of the teeth and jaws. In: Gorlin RJ, Goldman HM, eds. Thoma’s oral pathology. St Louis: CV Mosby, 1970:112-22.
[3]   | Mitchell L. Supernumerary teeth. Dent Update 1989; 16:65-9.
[4]   | Hattab FN, Yassin OM, Rawashdeh MA. Supernumerary teeth: report of three cases and review of the literature. ASDC J Dent Child 1994; 61: 382-393.
[5]   | Rajab LD, Hamdan MAM. Supernumerary teeth: review of the literature and a survey of 152 cases. Int J Paediatr Dent 2002; 12: 244-254.
[6]   | Luten JR, Jnr. The prevalence of supernumerary teeth in primary and mixed dentitions. J Dent Child 1967; 34:48-9. Fazliah SN. Supernumerary tooth: report of a case. Archives of Orofacial Sciences 2007; 2: 54-58.
[7]   | Brook AH. Dental anomalies of number, form and size: their prevalence in British schoolchildren.J Int Assoc Dent Child 1974; 5:37-53.
[8]   | Blanco Ballesteros G. Dientes múltiples supernumerarios. Reporte de un caso. Revista Estomatológica 2005; 13 (1): 13-18.
[9]   | Gómez Antón G, Melara Murguía AJ, Sáez Martínez S, Ballet Damau LG. Agenesias y supernumerarios: a propósito de un caso. Rev Oper Dent Endod 2008; 5: 88.
[10]   | Fernández Montenegro P, Balmaceda Castellón E, Berini Aytés L, Gay Escoda C. Estudio retrospectivo de 145 dientes supernumerarios. Med Oral Pato Oral Cir Bucal 2006; 11: 339-344.
[11]   | Sathyapriya B, Lakshmanan P, Tamilselvi R et al. Clinical Assesment of Age by Clinical Eruption of 2nd Molar in 12 - 14 years for Medicolegal Investigations. Indian Journal of Forensic Medicine and Toxicology ISSN 2017;11(2): 257-61.
[12]   | Chaappuzeau López E, Cortés Caballero D. Anomalías de dentición en desarrollo: agenesias y supernumerarios. Revista Dental de Chile 2008; 99 (2): 3-8.
[13]   | Babu V, Nagesh KS, Diwakar NR. A rare case of hereditary multiple impacted normal and supernumerary teeth. J Clin Pediatr Dent 1998; 23 (1): 59-62.
[14]   | Erdody G, López JC, Quesada D. Quiste dentígero asociado a diente supernumerario. Ciencia Odontógica 2011; 8 (1): 68-72.
[15]   | Radi Londoño JN, Álvarez Gómez GJ. Dientes Supernumerarios: Reporte de 170 casos y revisión de la literatura. Rev Fac Odont Univ Ant 2002; 3 (2): 57-67.
[16]   | Saap JP, Eversole LR, Wysocki GP. Patología oral y maxillofacial contemporánea. 2ª edición. Madrid: Elseiver Mosby; 2005.
[17]   | Moret Yuli. Enfermedades genéticas que afectan la cavidad bucal. Acta Odontol Venez 2004; 42 (1): 59-66.
[18]   | Regezi JA, Sciubba JJ. Patología Bucal. 3ª edición. Nueva York: Interamericana McGraw-Hill; 1991.
[19]   | Sendín Velasco MB, Rodríguez Achaerandio A, Cores Calvo O, Mateos García V. Cuatro molares supernumerarios a nivel de los cordales: caso clínico. Gaceta Dental Industria y Profesiones 2007; 184: 138-141.
[20]   | Shafer W.G. Tumores benignos e malignos da cavidade bucal. In: Shafer W.G., Levy B.H., editors. Tratado de patologia bucal. 2nd ed. Nueva Editorial Interamericana; México: 1986. pp. 141-143.
[21]   | King NM, Sanares AM. Oral-facial-digital syndrome, Type I: a case report. J Clin Pediatr Dent 2002; 26 (2): 211-215.
[22]   | Ruz de la Cuesta M, Planelles Gomis J, Amoros Rodríguez A, Juste Ruíz M. Síndrome trico-rino-falángico. Un caso familiar. Rev Esp de Cir Ost 1985; 20: 181-187.
[23]   | Primosch R. Anterior supernumerary teeth assessment and surgical intervention in children. Pediatr Dent 1981; 3: 204-15.
[24]   | Atasu M, Orguneser A. Inverted impaction of a mesiodens: a case report. J Clin Pediatr Dent 1999; 23 (2): 143-6.
[25]   | Atasu M, Cimilli H. Fusion of the permanent maxillary right incisor to a supernumerary tooth in association with a germination of permanent maxillary left central incisor: a dental, genetic and dermatoglyphic study. J Clin Pediatr Dent 2000; 24 (4): 321-33.
[26]   | Genc A, Namdar F, Goker K, Atasu M. Taurodontism in association with supernumerary teeth. J Clin Pediatr Dent 1999; 23 (2): 151-4.
[27]   | Chevitarese AB, Tavares CM, Primo L. Clinical complications associated with supernumerary teeth: report of two cases. J Clin Pediatr Dent 2003; 28 (1): 27-32.
[28]   | Gallas MM, García A. Case study: retention of permanent incisors by mesiodens: a family affair. Br Dent J 2000; 188: 63-4.
[29]   | Baca Pérez BR, López Carrichez C, Alobera Gracia MA, Leco Berrocal MI. Mesiodens Mandibular. Cient Dent 2007; 4 (3): 199-202.
[30]   | Stellzing S, Basdra EK, Komposch G. Mesiodens. J Orofac Orthop 1997; 58: 144-53.
[31]   | Contreras Somoza MF, Salinas Noyola A, Sáez Martínez S, Sellet LG. Signos de dientes supernumerarios. Rev Op Dent Endod 2007; 5 (60): 210.
[32]   | Shah A, Gill DS, Tredwin C, Naini FB. Diagnosis and management of supernumerary teeth. Dent Update 2008; 35: 510-20.
[33]   | Patchett CL, Crawford PJM, Cameron AC, Stephens CD. The management of supernumerary teeth in childhood- a retrospective study of practice in Bristol Dental Hospital, England and Westmead Dental Hospital, Sydney, Australia. Int J Paediatr Dent 2001; 11: 259-65.
[34]   | Bayrak S, Dalci K, Sari S. Case report: Evaluation of supernumerary teeth with computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100:e65-9.
[35]   | Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC. Three-dimensional evaluations of supernumerary teeth using cone-beam computed tomography for 487 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103:403-11.
[36]   | Seddon RP, Johnstone SC, Smith PB. Mesiodentes in twins: a case report and a review of the literature. Int J Paediatr Dent. 1997; 7: 177-84.
[37]   | Patil S, Pachori Y, Kaswan S, Khandelwal S, Likhyani L, Maheshwari S. Frequency of mesiodens in the pediatric population in North India: A radiographic study. J Clin Exp Dent. 2013; 5: e223-6.