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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 47-49

Nonsyndromic multiple unerupted permanent and supernumerary teeth


1 Department of Pedodontics and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
2 Department of Orthodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
3 Department of Oral and Maxillofacial Pathology, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India

Date of Web Publication15-Feb-2017

Correspondence Address:
Santanu Mukhopadhyay
Department of Pedodontics and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata - 700 014, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_102_16

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  Abstract 

Failure of eruption of multiple permanent teeth is uncommon. This may be attributed to some local and systemic factors. In general, systemic factors are responsible for eruption failure of multiple teeth whereas the local causes tend to affect one or few teeth. In this article, we describe a rare case of multiple impacted permanent teeth of normal series and supernumeraries in a 14-year-old girl not associated with any syndrome.

Keywords: Impacted teeth, nonsyndromic, permanent dentition, supernumerary teeth


How to cite this article:
Mukhopadhyay S, Roy P, Halder M. Nonsyndromic multiple unerupted permanent and supernumerary teeth. Int J Health Allied Sci 2017;6:47-9

How to cite this URL:
Mukhopadhyay S, Roy P, Halder M. Nonsyndromic multiple unerupted permanent and supernumerary teeth. Int J Health Allied Sci [serial online] 2017 [cited 2020 May 26];6:47-9. Available from: http://www.ijhas.in/text.asp?2017/6/1/47/200194

Eruption is the axial or occlusal movement of the tooth from its developmental position within the jaw to its functional position in the occlusal plane.[1] A variation of 6 months from the usual date of emergence of a tooth into the oral cavity is considered normal. Failure of eruption of multiple permanent teeth is uncommon. This may be attributed to some local and systemic factors. The common systemic factors associated with delayed or the noneruption of permanent teeth are cleidocranial dysplasia, hypothyroidism, Gardner syndrome, Noonan's syndrome, Down syndrome, Aarskog syndrome, hypothyroidism, hypopituitarism, Vitamin D-resistant rickets, and Zimmermann–Laband syndrome.[2],[3],[4] The local causes associated with eruption failures are arch length deficiency, the presence of supernumerary teeth, dentoalveolar trauma, cyst or neoplasms of the jaw and thick overlying fibrous or osseous tissue.[2],[3],[4] In general, systemic factors are responsible for eruption failure of multiple teeth whereas the local causes tend to affect one or few teeth.[3] Idiopathic or nonsyndromic impaction of multiple permanent teeth is rare. In this article, we report an interesting case of multiple impacted permanent teeth and supernumerary teeth not associated with any systemic disease or syndrome.


  Case Report Top


A 14-year-old girl reported to our department with the chief complaint of retained primary teeth and noneruption of permanent teeth. Her medical and birth history were not significant. She was the second child of healthy nonconsanguineous parents. The patient was moderately built, had normal intelligence and did not show any skeletal abnormality. On intraoral examination, only four teeth were visible: Left primary canine, right primary first molar, and right permanent first molar in the maxillary arch and right primary first molar in the mandibular arch [Figure 1] and [Figure 2]. A panoramic radiograph was taken to evaluate the status of underlying permanent dentition. On radiographic examination, various impacted permanent teeth of normal series and multiple supernumerary teeth were observed in both maxillary and mandibular arch [Figure 3]. The supernumeraries were localized in the upper and lower premolar region. In addition, the two mandibular permanent teeth, the right second molar, and the left first molars could not be visible radiographically. The jaw bones showed the normal trabecular pattern.
Figure 1: Photograph showing two retained primary teeth and a restored right permanent first molar in the maxillary arch

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Figure 2: The mandibular arch showing only the presence of right primary first molarFigure 2: The mandibular arch showing only the presence of right primary first molar

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Figure 3: Multiple unerupted permanent and supernumerary teeth can be observed on the radiograph

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The patient was referred to a pediatrician for a general examination. Her biochemical and hematological reports including T3, T4, thyroid stimulating hormone, and alkaline phosphatase values were found to be within the normal limit. Radiographic examination of the skull, spine, and chest did not reveal any abnormality. Therefore, the presence of any systemic disease or syndrome was ruled out. The parents were informed about the presence of multiple impacted teeth belonging to permanent dentition and supernumerary series. The patient was referred to the oral and maxillofacial surgery department for surgical removal of supernumeraries.


  Discussion Top


Supernumerary teeth are relatively common dental anomalies with an incidence of 0.1% and 3.8%.[5],[6] A review of literature shows that a single supernumerary occurs in 76%–86% of cases, 2 supernumerary teeth are present in 12%–23% of cases and 3 or more supernumeraries are found in only 1% of cases.[6] Studies have revealed that a single supernumerary tooth occurs most frequently in the maxillary midline, where it is termed as mesiodens, followed by the supernumeraries of maxillary molar region and mandibular premolar region. Supernumerary premolars account for 10% of all supernumeraries, and nearly 75% of them occur in the mandible.[7] However, multiple supernumeraries in nonsyndromic patients are commonly localized in the premolar region. In addition, 62.1% of supernumerary premolars are observed in the mandibular premolar region.[8] According to Yusof multiple supernumeraries are more common in males with a male to female ratio of 9:2.[5] Supernumerary teeth in the present case were also observed in the premolar regions of a female involving both the jaws.

The majority of supernumeraries, as high as in 75% of cases, remain impacted. Radiographic examination remains the most reliable diagnostic tool for detecting these anomalies. More recently, cone beam computed tomography is used for exact localization of the impacted supernumeraries as it permits 3D reconstruction.[9]

Supernumeraries are capable of causing a variety of complications which may include hindrance of tooth eruption, diastema formation, rotation, displacement, ectopic eruption, root resorption, and malformation of adjacent teeth.[10],[11] Dentigerous cyst formation was also reported in some cases.[10] In the present case, supernumerary teeth were associated with failure of eruption of multiple permanent teeth.

The management of nonsyndromic multiple supernumerary teeth is to a great extent individualized which may include surgical removal of supernumeraries. In the present case, multidisciplinary management involving surgical extraction of supernumerary teeth and orthodontic treatment of impacted permanent teeth to align them in their proper position was contemplated.

The exact etiology of the supernumerary tooth is not clearly known. A number of theories such as hyperactivity of dental lamina theory, genetic theory, atavism theory, phylogenetic theory, dichotomy of tooth bud, progress zone, and combination of genetic and environmental factors have been proposed.[10],[11] In this patient, the family history for the presence of supernumerary teeth was negative.

A review of the literature reveals that nonsyndromic cases of multiple impacted permanent teeth occur alone or present in combination with supernumeraries. Dalampiras et al., Vani et al., Bayar et al. reported cases involving multiple impacted permanent teeth not associated with any syndrome.[2],[3],[4] On the other hand, Ansari et al., Lei et al. reported nonsyndromic cases multiple supernumerary teeth.[12],[13] The present case is similar with the one reported by Nagaveni et al., who also observed multiple impacted permanent and supernumerary teeth in a nonsyndromic patient.[14]

In the present case, the exact number of supernumeraries could not be determined due to the superimposition of permanent teeth. However, it was evident that these supernumeraries were localized in the premolar region. Yusof, Ansari et al. also observed multiple supernumeraries in the premolar region.[5],[12]

The etiology or mechanism of tooth eruption is not fully understood. Several theories such as bone remodeling, root growth, vascular pressure, and periodontal ligament traction have been put forward to explain this complex process. The causes of the early or delayed eruption of tooth are not known, and the literature has mostly described case reports.[15] Arrested eruption in the present case might be due to the lack of eruptive force in combination with the presence of multiple supernumeraries, retained primary teeth, and diminished resorption of alveolar bone.

Congenitally missing teeth or hypodontia is one of the most common dental anomalies with the prevalence varies from 4.2% to 11.3% in different populations studied.[16],[17] Mutations in genes such as MSX, PAX9, or TGFA might be the cause of hypodontia in different population groups. Patients with missing teeth may suffer from unsightly dental appearance, malocclusion, insufficient alveolar bone growth, reduced chewing ability, and improper pronunciation. Treatment is usually multidisciplinary and may be expensive.[16]

Simultaneous occurrence of multiple impacted permanent and supernumerary teeth in all four quadrants is rare. Another important feature of the present case is the concomitant occurrence of multiple supernumerary teeth and agenesis of two mandibular permanent molars. In addition, our patient showed retention of primary teeth, a feature commonly seen in hypothyroidism, hypopituitarism, cherubism, cleidocranial dysplasia, and gingival fibromatosis.[14] The results of the clinical, radiographic, and biochemical investigations ruled out the presence of any systemic disease was ruled out in our patient.


  Conclusion Top


The present case was unique in many ways. The failure of eruption of multiple permanent and supernumerary teeth are generally associated with syndromes. However, our patient is a nonsyndromic case of multiple impacted permanent and supernumerary teeth involving all four quadrants. Furthermore, along with supernumerary teeth, agenesis of two mandibular permanent molars was also observed.

The parents had given informed consent regarding case study and publication of photograph.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kumar GS. Orban's Oral Histology and Embryology. 12th ed. India: Mosby; 2009. p. 41.  Back to cited text no. 1
    
2.
Dalampiras S, Christina B, Stanko P. Full retarded eruption of permanent dentition: Report of a rare case (8-year follow up). Eur J Dent Med 2012;4:34-7.  Back to cited text no. 2
    
3.
Vani S, Nooney A, Raju KS, Hemadri M. Idiopathic multiple unerupted permanent teeth: A rare case report. J NTR Univ Health Sci 2014;3:283-6.  Back to cited text no. 3
  Medknow Journal  
4.
Bayar GR, Ortakoglu K, Sencimen M. Multiple impacted teeth: Report of 3 cases. Eur J Dent 2008;2:73-8.  Back to cited text no. 4
    
5.
Yusof WZ. Non-syndrome multiple supernumerary teeth: Literature review. J Can Dent Assoc 1990;56:147-9.  Back to cited text no. 5
    
6.
Rajab LD, Hamdan MA. Supernumerary teeth: Review of the literature and a survey of 152 cases. Int J Paediatr Dent 2002;12:244-54.  Back to cited text no. 6
    
7.
Kawashita Y, Saito T. Nonsyndromic multiple mandibular supernumerary premolars: A case report. J Dent Child (Chic) 2010;77:99-101.  Back to cited text no. 7
    
8.
Thumati P, David CM, Tiwari R. Non-syndromic multiple supernumerary teeth: A case report and review of literature. IJSS Case Rep Rev 2014;1:1-5.  Back to cited text no. 8
    
9.
Brauer HU. Case report: Non-syndromic multiple supernumerary teeth localized by cone beam computed tomography. Eur Arch Paediatr Dent 2010;11:41-3.  Back to cited text no. 9
    
10.
Garvey MT, Barry HJ, Blake M. Supernumerary teeth – An overview of classification, diagnosis and management. J Can Dent Assoc 1999;65:612-6.  Back to cited text no. 10
    
11.
Mukhopadhyay S. Mesiodens: A clinical and radiographic study in children. J Indian Soc Pedod Prev Dent 2011;29:34-8.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
12.
Ansari AA, Malhotra S, Pandey RK, Bharti K. Non-syndromic multiple supernumerary teeth: Report of a case with 13 supplemental teeth. BMJ Case Rep 2013;2013. pii: Bcr2012008316.  Back to cited text no. 12
    
13.
Yan L, Yu LW, Bhandari K, Shan CL. Report of a case with 19 supernumerary teeth in a non-syndromic patient. Indian J Dent 2014;5:92-5.  Back to cited text no. 13
  Medknow Journal  
14.
Nagaveni NB, Umashankara KV, Manjunath S. Multiple impactions in non-syndromic patient: A case report. Arch Orofac Sci 2011;6:73-8.  Back to cited text no. 14
    
15.
Kjær I. Mechanism of human tooth eruption: Review article including a new theory for future studies on the eruption process. Scientifica (Cairo) 2014;2014:341905.  Back to cited text no. 15
    
16.
Rakhshan V. Meta-analysis and systematic review of factors biasing the observed prevalence of congenitally missing teeth in permanent dentition excluding third molars. Prog Orthod 2013;14:33.  Back to cited text no. 16
    
17.
Mukhopadhyay S, Mukhopadhyay P, Sarkar S, Ghosh C, Kar S. Prevalence and distribution of hypodontia in a group of Bengali pediatric population. J Cranio Maxillary Dis 2015;4:28-32.  Back to cited text no. 17
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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