Supernumeraries by almuzian
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  • 1. Dr.Mohammed Almuzian, 2014 Page 0 UNIVERSITY OF GLASGOW Supernumerary teeth Personal notes Dr.Mohammed Almuzian 1/1/2013
  • 2. Mohammed Almuzian, University of Glasgow, 2013 Page 1 Table of Contents Definition ...................................................................................................................2 Incidence ....................................................................................................................2 Aetiology....................................................................................................................2 Classifications ............................................................................................................2 Another classification according to position into ......................................................3 Complications ............................................................................................................3 Management...............................................................................................................4 Summary and recommendations of RCSEng. (Yaqoob et al 2010)..........................6
  • 3. Mohammed Almuzian, University of Glasgow, 2013 Page 2 Supernumeraries Definition A 'tooth' or 'tooth-like' structure which develops in addition to the normal series of 32 teeth. Incidence 1. Rarely occurs in primary dentition (0.8%) Brook 1974 2. 2% in permanent dentition. Brook 1974 3. Syndromic cases around 22% 4. M:F = 2:1 5. 80% occur in anterior Max Aetiology Developmentally due to disturbance during initiation and proliferation stages (Dichotomy of the tooth bud or hyperactivity of dental lamina). 1. Non Syndromic (familial or isolated) 2. Syndromic • Down's syndrome • Cleidocranial dysplasia • CLP anomalies: Supernumerary teeth associated with cleft lip and palate result from fragmentation of the dental lamina during cleft formation Classifications 1. Conical supernumeraries are small peg-shaped teeth with normal root formation. When located in the midline of the anterior maxilla these teeth are known as
  • 4. Mohammed Almuzian, University of Glasgow, 2013 Page 3 mesiodens ( whilst in the maxillary molar region they are known as paramolars (buccal, lingual or interproximal to the second and third molars) or distomolars (distal to the third molar) 2. Tuberculate supernumeraries are characterized by a multicusped coronal morphology and a lack of root development . These teeth are usually found palatal to the maxillary permanent incisors, often occur in pairs and frequently prevent eruption of the permanent incisors. 3. Supplemental supernumeraries represent the duplication of a tooth within a series and can be difficult to differentiate from the normal tooth. These teeth are usually found at the end of a series and can be seen in the incisor, premolar and molar fields. They represent the most common type of supernumerary found in the primary dentition 4. Odontomes are developmental malformations that contain both enamel and dentine. It can be compound (containing many small separate tooth-like structures usually situated in the anterior jaw) or complex (a large mass of disorganized enamel and dentine usually situated in the posterior jaw). Another classification according to position into 1. Mesiodense 2. Paramolar 3. distomolar Complications Garvey, 1999 1. Asymptomatic 2. Eruption and aesthetic problems
  • 5. Mohammed Almuzian, University of Glasgow, 2013 Page 4 3. Failure of tooth eruption:  Most common cause of failure of eruption of the permanent incisors 28% and 38%.  Tuberculate supernumerary teeth are more likely to cause an obstruction than conical supernumerary teeth (1 in 1 compared to 1in 5).  In addition, 1/3 of compound odontomes and 1/2 of complex odontomes prevent eruption of teeth (compound odontomes are four times more common than complex odontomes).  In 80% of cases in which supernumerary teeth overlie the incisor, removal of the supernumerary will result in the permanent incisor erupting spontaneously within an average time of 16 months provided there is enough space 4. Ectopic eruption of other teeth 5. Dilacerations 6. Spacing. 10% of midline diastemas due to erupted or unerupted supernumeraries 7. Crowding displacements or rotations of adjacent erupted teeth . 8. Cystic formation 9. Root resorption of adjacent teeth 10.Rotation of adjacent teeth, 11.Alveolar Bone Grafting, Supernumerary teeth may compromise secondary alveolar bone grafting in patients with cleft lip and palate. 12.Implant Site Preparation Correlation of the supernumerary features with central incisor eruption DiBiase (1969) has found a correlation between the supernumerary features and central incisor eruption:  Morphology: Conical and incisiform types were associated with eruption, tuberculate and odontomes types with delayed eruption.
  • 6. Mohammed Almuzian, University of Glasgow, 2013 Page 5  Relative size: Smaller types associated with eruption, larger types with delayed eruption.  Root formation: Complete root formation was associated with eruption, absence and incomplete root formations with delayed eruption.  Direction: Variations and inversions were associated with eruption, vertical types with delayed eruption.  Mesiodistal position: mesially placed types were associated with eruption, central and distally placed types with delayed eruption. Management a. Visual examination. The sign of supernumerary tooth include: 1. Erupted supernumerary 2. Delayed tooth eruption and asymmetric eruption 3. Diastema 4. Rotation or abnormal inclination of the adjacent 5. Colour change or mobility of the adjacent b. Clinical examination 1. Mobility 2. Vitality 3. Palpation c. Radiograph (parallax technique) d. Treatment Treatment depends on 1. Age of the patient 2. Position of the supernumerary tooth
  • 7. Mohammed Almuzian, University of Glasgow, 2013 Page 6 3. On its effect or potential effect on adjacent teeth. 4. Type Options : 1. leave it and monitor  satisfactory eruption of related teeth has occurred;  no active orthodontic treatment is envisaged;  there is no associated pathology;  removal would prejudice the vitality of the related teeth. 2. Extract +ortho  Spontaneous eruption of the supernumerary caused aesthetic problem.  Prevent eruption;  Diastema or displacement;  Pathology;  Active orthodontic alignment of an incisor in close proximity to the supernumerary is envisaged;  Its presence would compromise secondary alveolar bone grafting in cleft lip and palate patients;  The tooth is present in bone designated for implant placement; Summary and recommendations of RCSEng. (Yaqoob et al 2010) Three factors influence the time it takes for an impacted tooth to erupt following removal of the supernumerary: 1. Age and root development of the impacted incisors 2. The space available within the arch for the unerupted tooth.
  • 8. Mohammed Almuzian, University of Glasgow, 2013 Page 7 3. The type of supernumerary tooth; 4. The distance the unerupted permanent tooth was displaced; a. Children up to nine years with incomplete root development of permanent incisor: 1. Create space if required. 2. Maintain the space 3. Remove obstruction but do not uncover bone from unerupted incisor maintain integrity of follicle. 4. Monitor eruption for 18 months – 80% erupt spontaneously 5. If exposure required then expose minimally to eliminate soft tissue obstruction and wait for 6 months. 6. If tooth is still high, expose and bond bracket. b. Children above nine years with complete or nearly complete apex: 1. Create space if required. 2. Maintain the space 3. Remove obstruction 4. If permanent incisor high then monitor eruption for 12 months. 5. If tooth still unerupted at 12 months, expose and bond bracket as required. c. Children referred late (over 10 years): 1. Create space if required. 2. Maintain the space 3. Remove obstruction 4. Expose and bond bracket at first operation. tooth is ectopic if malpositioned due to genetical factors or displaced by the presence of pathology