Multiple Erupted Maxillary Anterior Supernumerary Teeth:

Report Of Two Cases Showing Typical And Atypical

Features of Supernumerary Teeth

Olaiya Ogidan, BDS, MS,* A.T. Mahdi, BDS, FDSRCS, MSc, DOrthRCS**
*  Department of Preventive Dental Sciences,  King Abdulaziz University, P.O. Box 1540, Jeddah 21441, Saudi Arabia
** Assir Dental Center,   P.O.   Box 1393, Abha, Saudi Arabia 

 
Two cases of multiple erupted maxillary anterior supernumerary teeth showing typical and atypical characteristics of supernumerary teeth in this region with implications for early diagnosis are presented.

 
Supernumerary teeth result from disturbances during the initiation and proliferation stages in dental development.1-3 The maxillary incisor region is the site most frequently involved with supernumerary teeth.1-4 The supernumerary tooth present in the midline or just lateral to the midline is referred to as mesiodens.5-7 Supernumerary teeth in the maxillary incisor region cause local disorders, such as impaction, delayed eruption, displacement of the permanent incisors, development of dentigerous cyst, resorption of adjacent roots, or the supernumerary teeth may fail to erupt or erupt into the nasal cavity.5-14 Other disorders associated with supernumerary teeth in the maxillary incisor region include root dilaceration and delayed root formation.8,10 Two cases are presented in which there are four supernumerary teeth in the maxillary anterior, all fully erupted in Case 1 and three fully erupted in Case 2 together with normal permanent teeth.

Case 1

An 18-year-old Nigerian male presented with a complaint of "too many teeth" in the anterior region of the maxilla. Clinical examination showed a Class 1 malocclusion with all teeth erupted. There were three supernumerary teeth palatal to  and the fourth one was between the  and . The  was rotated mesio-palatally and  was placed palatal to . All four supernumerary teeth were of tuberculate shape [Fig. 1]. An upper anterior occlusal radiograph showed no impacted teeth. The roots of the supernumerary teeth were well developed although the apices of those palatal to  were still open [Fig. 2].

Case 2

The patient was a 17-year old Saudi male presenting with a similar complaint of "too many teeth" in the upper anterior region as in Case 1. Clinical examination revealed a Class 1 malocclusion with all teeth present and erupted apart from the third molars. Three peg-shaped erupted supernumerary teeth were present, each one palatal to the  and the third located in the midline between the . Upper central incisors were spaced, slightly rotated mesiopalatally, distally inclined and proclined, with the lateral incisors palatal relative to  [Fig. 3]. The lower arch was unremarkable with only very mild crowding anteriorly. In occlusion, the overjet was increased to 6 mm and a complete overbite (100%) with the paiatally displaced supernumeraries in crossbite with the lower incisors. The upper right premolars were in scissors-bite relationship with the lower. An upper anterior occlusal radiograph [Fig. 4) showed the three erupted supernumeraries with fully formed roots. A fourth inverted but similarly peg-shaped (conical-shaped) supernumerary tooth was discovered impacted in the palate but in the midline.

 
Supernumerary teeth in the premaxillary region have been divided into two main classes: one containing teeth of normal morphology known as supplemental teeth and the other of abnormal shape. The latter class has been further categorized into the conical type (peg-shaped) and the tuberculate type.15 The tuberculate supernumerary tooth seems to occur most frequently palatal to the upper central incisor and to be later in its development than the conical tooth, it also tends to delay or prevent the eruption of the corresponding permanent central incisor, and is rarely seen erupted in childhood.15 In contrast, the conical-shaped supernumerary tooth does not usually affect the eruption of the adjacent permanent incisors but may cause their displacement.15 This displace-ment may involve the crown, the root or the whole tooth.16 The conical supernumerary may be non-inverted or inverted. When non-inverted, it may remain unerupted palatal to the permanent incisors. When inverted, it may point posteriorly towards the nose or may even erupt into the nose.8,16,17
Matching the above characteristics with the cases presented, the supernumerary teeth in Case 1 showed the features of the tuberculate type while those in Class 2 exhibited the features of conical supernumerary teeth. In Case 1, the root apices of the supernumeraries palatal to  and  were still open suggesting that they were typically late in development than the normal permanent incisors. All supernumerary teeth were atypically erupted contrary to the usual behavior of this type of supernumerary.
However, Di Biase18 had stated that provided space was available in the arch, there could be spontaneous eruption of these supernumerary teeth. It is therefore plausible that the combination of age (with the patient presenting at an older age) and the availability of space would account for the eruption of both the supernumerary and the permanent incisor teeth in Case 1.

It has been shown that the maxillary arches of Nigerians are broad,19,20 thereby providing more space in the arch to accommodate the erupting teeth. Case 2 exemplified all typical features of the conical type of supernumerary teeth in their shape, location, eruption, displacement and spacing of the adjacent permanent incisors and the impaction of the inverted supernumerary tooth. The impacted supernumerary tooth was left in place and the patient was instructed to come for periodic examination.
Supernumeraries and the associated norma! permanent teeth could be seen erupted where there is adequate space in the arch especially in patients presenting at an older age. Supernumerary teeth may result in the non-eruption, displacement and spacing of adjacent permanent incisors. Therefore, early diagnosis of the presence and determination of the correct location of these teeth in the maxillary anterior region are essential to identify disturbances in eruption of individual teeth and treat them accordingly.