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CASE REPORT
Year : 2012  |  Volume : 1  |  Issue : 3  |  Page : 204-206

Mandibular bilateral unerupted non-obstructing supernumerary premolars as a rare paradental anomaly


1 Department of Oral and Maxillofacial Pathology, DJ Dental College, Modinagar, Ghaziabad, India
2 Public Health Dentistry, Shree Bankey Bihari Dental College and Research Center, Ghaziabad, India
3 Department of Prosthodontics, Shree Bankey Bihari Dental College and Research Center, Ghaziabad, India
4 Private Practitioner, Tagore Garden, New Delhi, India

Date of Web Publication3-Jan-2013

Correspondence Address:
Vineet Gupta
C-40, East Krishna Nagar, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9626.105389

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  Abstract 

Non-syndromal multiple supernumerary teeth are most commonly seen in mandibular premolars region, followed by the molar and the anterior regions respectively. Dental literature rarely reports symmetrical supernumerary teeth in all four quadrants. However, supernumerary premolars may not become radiographically visible until the patient's normal premolars have erupted. This article presents a case of a 45-year-old male with bilateral unerupted fully formed, buccally angulated, supernumerary premolars in the mandibular region without any obstruction to the eruption of mandibular first and second premolars. There was no syndrome associated. The delayed development of the supernumerary teeth in the premolar region supports the hypothesis that these teeth were part of a post-permanent dentition.

Keywords: Bilateral, non-obstructing, premolars, supernumerary, unerupted


How to cite this article:
Gupta V, Kumar P, Kumar P, Lakhani N. Mandibular bilateral unerupted non-obstructing supernumerary premolars as a rare paradental anomaly. Eur J Gen Dent 2012;1:204-6

How to cite this URL:
Gupta V, Kumar P, Kumar P, Lakhani N. Mandibular bilateral unerupted non-obstructing supernumerary premolars as a rare paradental anomaly. Eur J Gen Dent [serial online] 2012 [cited 2019 Jul 19];1:204-6. Available from: http://www.ejgd.org/text.asp?2012/1/3/204/105389


  Introduction Top


Extra teeth in dentition are termed "Supernumerary teeth" and are a very well known dental phenomenon. These are described as the teeth formed in excess of the number found in a normal dentition and may or may not mimic the normal shape. If such teeth closely resemble the adjacent teeth, they are classified as supplemental. On the other hand, if they present abnormal shape and size, they are termed rudimentary. Supernumerary teeth can remain impacted for many years without clinical, pathologic, or orthodontic complications. Multiple supernumerary teeth are not a common occurrence and have been reported in the literature over the years as a well-recognized clinical phenomenon. Supernumerary teeth are estimated to occur in the maxilla 8.2 to 10 times more frequently than the mandible. Supernumerary premolars represent between 8% of all supernumerary teeth. [1],[2],[3] Their reported prevalence ranges between 0.3-0.8% in the primary dentition and 0.1-3.8% in the permanent dentition. [1],[2],[4] They are more likely to develop in the mandible than in the maxilla and usually resemble the normal premolars in shape and size. [2] Supernumerary premolars occur three times more in males than in females, indicating a sex-linked inheritance, with the highest frequency of occurrence in the mandibular premolar region (74%). [2],[4] They are also the most common supernumerary teeth in the mandibular arch (7%). [2] Supernumerary premolar locations are predominantly lingual. The buccally located ones are partially or completely erupted. [3],[4],[5] Seventy-five percent of these teeth are impacted, unerupted, and generally asymptomatic, and the majority are of a supplemental type. [2],[4] Bodin, Julin, and Thomsson reported that only 2% of the supernumerary premolars exhibited any pathological changes and indicated that these teeth should be left untreated rather than risk surgical damage. [6]

Removal of unerupted supernumeraries involves the risk of damage to the adjacent structures and a decision should be made whether to remove or monitor them. Early surgical intervention is recommended when the supernumerary is causing problems, such as, hindering the eruption or malposition of permanent teeth.

This article reports a case of mandibular, bilateral, fully formed, unerupted, buccally directed supernumerary premolars which lay dormant without the need for any surgical removal.


  Case Report Top


A 45-year-old Indian male presented with chief complaint of mild pain in upper and lower arch since 2 to 3 days. The grossly carious, painful, first premolar on mandibular left side was extracted by us two months ago on patients will. Clinically, gum infection was found and accordingly, treatment was given. However, an orthopantomogram was taken to aid in the diagnosis. It revealed mandibular bilateral unerupted extra premolars [Figure 1] without impeding the eruption of other normal premolars. Diagnosis was further authenticated by occlusal radiograph, which confirmed buccal eruption of the supernumerary premolars. No pathology was detected bilaterally. Thus, it was decided that there was no need for surgical removal of unerupted extra premolars on both the sides. The patient's medical history was insignificant. Radiographic investigations of the parents and the sibling were undertaken to rule out the hereditary component.
Figure 1: Orthopantomogram depicting bilateral supernumerary premolars

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  Discussion Top


Cases of bilateral supplemental premolar teeth developing later than their counterparts have been reported in literature. Reports have demonstrated that supernumerary premolar teeth develop approximately 7 to 11 years after normal development and it appears that this case may be a similar example. [3],[5] Supernumerary premolars are reported to have a wide range of expressions. A majority of these have been found to lie dormant between the roots of permanent premolars and molars as reported by Solares et al. [7] However, cases have been reported where these teeth have hindered the eruption of some permanent teeth. Scanlan and Hodges reported a case in which supernumerary teeth had blocked the eruption of second permanent mandibular molars. [8] Hyun et al. have also reported a case in which the supernumerary premolar had led to root resorption of an adjacent tooth. [9]

In this case, the bilaterally impacted supernumerary premolars presented with no obstruction to the eruption of the first and second premolars on both the sides. Usually, the buccally located Supernumerary premolars are partially or completely erupted but in this case, buccally located bilateral premolars were found to be completely unerupted with no pathology, which is a rare finding. [4],[10],[11],[12] When supernumerary teeth are discovered, a decision needs to be made whether to remove or monitor them. Surgical removal of impacted teeth involves the risk of damage to the adjacent structure, and therefore, a decision needs to be made with regard to the surgical risks and the benefits of removal.

In this case, it was decided not to remove supernumerary teeth, as there was no obstruction in the eruption of the first and second mandibular premolars and occlusion also had developed normally. In this case, the presence of the supernumerary teeth was an incidental finding on radiograph as both supernumerary teeth were unerupted. This is in keeping with other studies where case reports have been presented. Also, the sex predilection for occurrence of supernumerary premolars among males were emphasized once again by the present case. [4],[13] In present case, the age at identification of the supernumerary is quite high i.e., 45 years and this would be indicative of the late development of these supernumerary teeth. Previous case reports show a large age variation depending on when these teeth are identified on radiograph. [4],[14] The stage of development of the supernumerary teeth is in keeping with the late development of these teeth, so in general the earlier the tooth is identified, the less well developed the tooth presents. Also, in older patient it is more likely that there is full development of the crown and root of the supernumerary tooth. [2],[4],[14] Supernumerary teeth are often identified with certain syndromes such as Gardener's syndrome. However, the patient in this study did not present with any syndrome. The aetiology of supernumerary teeth is complex. However, it is generally agreed that, although a genetic component may exist, environmental factors cannot be discounted. [2],[4],[15]

 
  References Top

1.King NM. Multiple supernumerary premolars in three patients. Aust Dent J 1993;38:11-6.  Back to cited text no. 1
    
2.Shah A. Diagnosis and management of supernumerary teeth. Dent Update 2008;35:510-20.  Back to cited text no. 2
    
3.Arathi R, Ashwin R. Supernumerary teeth: A case report. J Indian Soc Pedod Prev Dent 2005;5:103-5.  Back to cited text no. 3
    
4.Masih S, Sethi HS, Singh N, Thomas AM. Differential expressions of bilaterally unerupted supernumerary. J Indian Soc Pedod Prev Dent 2011;29:320-2.  Back to cited text no. 4
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5.O'Dowling I. Supernumerary pre-molar teeth in the mandible. J Ir Dent Assoc 2009;55:293-5.  Back to cited text no. 5
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6.Bodin I, Julin P, Thomsson M. Frequency and distribution of supernumerary teeth among 609 patients. Dentomaxillofac Radiol 1978;7:15-7.  Back to cited text no. 6
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7.Solares R, Romero MI. Supernumerary premolars: A literature review. Pediatr Dent 2004;26:450-8.  Back to cited text no. 7
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8.Scanlan PJ, Hodges SJ. Supernumerary premolar teeth in siblings. Br J Orthod 1997;24:297-300.  Back to cited text no. 8
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9.Hyun HK, Lee SJ, Ahn BD, Lee ZH, Heo MS, Seo BM, et al. Nonsyndromic multiple mandibular premolars. J Oral Maxillofac Surg 2008;66:1366-9.  Back to cited text no. 9
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10.Piattelli M, Piattelli A. Multiple impacted and erupted supernumerary premolars. Acta Stomatol Belg 1995;92:75-6.  Back to cited text no. 10
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11.Saini T. Keene JJ Jr, Whetten J. Radiographic diagnosis of supernumerary premolars: Case reviews. ASDC J Dent Child 2002;69:184-90.  Back to cited text no. 11
    
12.Arigbede AO. Bilaterally impacted supplemental premolar: A case report and review of the literature. Niger J Med 2008;17:363-5.  Back to cited text no. 12
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13.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. 13
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14.Nazif MM, Ruffalo RC, Zullo T. Impacted supernumerary teeth: A survey of 50 cases. J Am Dent Assoc 1983;106:201-4.  Back to cited text no. 14
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15.Brook AH, Elcock C, al-Sharood MH, McKeown HF, Khalaf K, Smith RN. Further studies of a model for the etiology of anomalies of tooth number and size in humans. Connect Tissue Res 2002;43:289-95.  Back to cited text no. 15
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