Accurate localization of impacted
supernumerary tooth
– A case report
associated with dentigerous cyst
Spiral CT evaluatio...
INDIAN DENTAL ACADEMY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
Leader in continuing dental education
ww...
www.indiandentalacademy.com
defined as

Supernumerary teeth may be defined
as any teeth or tooth substance in
excess of the usual configuration of
twe...
• Dichotomy of the tooth bud
• Local, independent, conditioned
hyperactivity of the dental lamina
• Hereditary

www.indian...
Prevalence
• Single supernumeraries - 76 to 86%
• Double supernumeraries -12 to 23%
• Multiple supernumeraries - < 1%
So L...
Effects of supernumerary teeth on the
developing dentition
Crowding
Failure of eruption
Diastema
Root resorption
Dilacerat...
www.indiandentalacademy.com
Case report

25yr old female pt
Pain in upper front
teeth region since 6
months and pain on
pressing in the nostril
since ...
PREOPERATIVE RADIOGRAPH
•Coronal
radioluscency
approaching pulp
irt 11,12
•A periapical
radioopacity
resembling tooth
•A l...
P endo
ost

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Spiral CT- Trans axial images

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Trans axial images

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Sagittal view

Inverted supernumerary tooth, not fused
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Coronal view
Pericoronal
radioluscency

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Management

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Oblique releasing incision

Intrasulcular
incision

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Elevation of the flap

Exposure of the lesion

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Exposure of the huge lesion

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Enucleation of
the lesion

Exposure of the
supernumerary tooth
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Removal of
supernumerary tooth with
bayonet forceps

Supernumarary tooth
removed

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Extracted tooth
& the lesion

Corrugation of the
epithelial remnants

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Immediate post op

Specimen for
histopathological examination
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Diagnostic

Post endo

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Immediate post
op after surgery
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H & E stained soft tissue section
2-3 layered
Nonkeratinized
SS epithelium
Collagen fibers

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Connective tissue

Chronic
inflammatory cells

Diagnosis – Dentigerous cyst
www.indiandentalacademy.com
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• Impacted teeth are often encountered in routine
radiographic examination
• In treatment planning, it is imperative to ac...
The major shortcoming of the conventional radiography
• Overlapping of structures on the film.
• Difficult to distinguish ...
www.indiandentalacademy.com
Spiral CT images of the tooth revealed
Trans axial view

• Palatal location of impacted tooth
• Lesion - 1.4x1.5cm
Coronal...
• Dentigerous cyst (24% of jaw cysts) is one of the
most common developmental odontogenic cysts
• Association with supernu...
Guidelines for the diagnosis of a dentigerous cyst
Daley and Winsock

1) A pericoronal radioluscency >4 mm in greatest
wid...
www.indiandentalacademy.com
conclusion
Unerupted supernumerary tooth
• direction of the crown, the location, the influence on
adjacent teeth, resorpti...
www.indiandentalacademy.com
References
•
•
•
•
•
•
•
•

INTERNATIONAL JOURNAL OF DENTAL CLINICS 2010:2(2): 39-42
Journal of Dental Research, Dental Cl...
•
•
•

Australian Dental Journal 1997;42:(3):160-5
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 130...
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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supernumerary tooth /certified fixed orthodontic courses by Indian dental academy

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  • of adjacent permanent teeth
    of adjacent teeth
    Malformation of adjacent teeth such as
    of adjacent teeth
  • When the supernumerary tooth is evident, the direction of the crown, the location, the influence on adjacent teeth, the resorption of adjacent roots and the formation of dentigerous cysts should be carefully evaluated [18]. Conventional radiographical examination involving panoramic, occlusal and periapical views have been used to locate their exact position for proper treatment plan and surgical removal. Computed tomography (CT) and Cone-beam CT have emerged as diagnostic techniques to assess supernumerary teeth.
  • To prevent Endanger vitality of adjacent teeth endo of 23 was done..Routine haematological and biochemical tests were normal. Maxillary left incisors [21],[22] were endodontically treated and were obturated with gutta-percha. Then, under general anaesthesia, surgical extraction of the impacted supernumerary teeth and enucleation of the cyst was done, followed by retrograde filling of 21 and 22 with mineral trioxide aggregate. The post operative course was uneventful. The histological examination of the specimen was suggestive of a dentigerous cyst.
  • Multiplanar reformation image of the tooth, the sagittal image showed palatal crown labial root and the root and the root pointed to the floor of the nasal cavity
  • Surgical removal of the cyst has been considered as the preferred choice of treatment. enucleation and tooth removal might result in damage to the nerve and blood vessels
    supplying the adjacent teeth
  • Management of a supernumerary tooth depends on the type and position of the tooth and its effect on the adjacent teeth. Removal of the supernumerary has been recommended where there is evidence of the associated pathology, eruption disturbances, displacement of the incisors or where the spontaneous eruption of the supernumerary tooth has occurred
  • Figure 1. Panoramic radiograph shows a large unilo-cular radiolucency in the anterior maxilla and the mesiodens in the left aspect of the lesion.
    The supernumerary tooth had a cone-shaped crown and a shortened root (Figure 1).
    The lesion was totally enucleated together with the supernumerary tooth under local anesthesia, and specimens were sent to the Department of Oral and Maxillofacial Pathology
  • Histological evaluation of the lesion has been recommended, owing to its potential to develop into an ameloblastoma or mucoepidermoid carcinoma
  • Histological evaluation of the lesion has been recommended, owing to its potential to develop into an ameloblastoma or mucoepidermoid carcinoma
  • Histological evaluation of the lesion has been recommended, owing to its potential to develop into an ameloblastoma or mucoepidermoid carcinoma
  • CASE REPORT
    CT in axial and coronal planes showed fluid filled unilocular lesion along with crown of mesiodens in the maxillary alveolar process (Fig 2). The Surgical resection of the lesion along with removal of mesiodens and histopathological examination confirmed the diagnosis of dentigerous cyst associated with mesiodens. The patient is under follow up since six months and no complications are observed
    Histological sections of both specimens revealed cyst walls composed of loosely arranged fibrovascu-lar connective tissue, lined by 2-4 layers of flattened non-keratinizing stratified squamous epithelium (Figure 2). The epithelium and the connective tissue interface was flat. Numerous cholesterol clefts and few chronic inflammatory cells infiltration were noted. No evidence of malignant changes was noted.
  • This problem makes it
    Compared with conventional plain films,
  • rarely have potential to develop odontogenic tumors like
    malignancy like
  • rarely have potential to develop odontogenic tumors like
    malignancy like
  • supernumerary tooth /certified fixed orthodontic courses by Indian dental academy

    1. 1. Accurate localization of impacted supernumerary tooth – A case report associated with dentigerous cyst Spiral CT evaluation - A case report www.indiandentalacademy.com
    2. 2. INDIAN DENTAL ACADEMY INDIAN DENTAL ACADEMY Leader in continuing dental education Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com www.indiandentalacademy.com
    3. 3. www.indiandentalacademy.com
    4. 4. defined as Supernumerary teeth may be defined as any teeth or tooth substance in excess of the usual configuration of twenty deciduous, and thirty-two permanent teeth. Schulze C.1970 www.indiandentalacademy.com
    5. 5. • Dichotomy of the tooth bud • Local, independent, conditioned hyperactivity of the dental lamina • Hereditary www.indiandentalacademy.com
    6. 6. Prevalence • Single supernumeraries - 76 to 86% • Double supernumeraries -12 to 23% • Multiple supernumeraries - < 1% So LLY. 1990 www.indiandentalacademy.com
    7. 7. Effects of supernumerary teeth on the developing dentition Crowding Failure of eruption Diastema Root resorption Dilaceration Loss of vitality Cyst formation www.indiandentalacademy.com
    8. 8. www.indiandentalacademy.com
    9. 9. Case report 25yr old female pt Pain in upper front teeth region since 6 months and pain on pressing in the nostril since 9 months O/E- Dental caries irt 11, 12, no swelling, sinus opening Tender on percussion irt 11, 12 EPT-delayed response irt 11, 12 ,21 www.indiandentalacademy.com
    10. 10. PREOPERATIVE RADIOGRAPH •Coronal radioluscency approaching pulp irt 11,12 •A periapical radioopacity resembling tooth •A large periapical radioluscency irt 12,11,21 www.indiandentalacademy.com
    11. 11. P endo ost www.indiandentalacademy.com
    12. 12. Spiral CT- Trans axial images www.indiandentalacademy.com
    13. 13. Trans axial images www.indiandentalacademy.com
    14. 14. Sagittal view Inverted supernumerary tooth, not fused www.indiandentalacademy.com
    15. 15. Coronal view Pericoronal radioluscency www.indiandentalacademy.com
    16. 16. Management www.indiandentalacademy.com
    17. 17. Oblique releasing incision Intrasulcular incision www.indiandentalacademy.com
    18. 18. Elevation of the flap Exposure of the lesion www.indiandentalacademy.com
    19. 19. Exposure of the huge lesion www.indiandentalacademy.com
    20. 20. Enucleation of the lesion Exposure of the supernumerary tooth www.indiandentalacademy.com
    21. 21. Removal of supernumerary tooth with bayonet forceps Supernumarary tooth removed www.indiandentalacademy.com
    22. 22. Extracted tooth & the lesion Corrugation of the epithelial remnants www.indiandentalacademy.com
    23. 23. Immediate post op Specimen for histopathological examination www.indiandentalacademy.com
    24. 24. Diagnostic Post endo www.indiandentalacademy.com Immediate post op after surgery
    25. 25. www.indiandentalacademy.com
    26. 26. www.indiandentalacademy.com
    27. 27. H & E stained soft tissue section 2-3 layered Nonkeratinized SS epithelium Collagen fibers www.indiandentalacademy.com
    28. 28. Connective tissue Chronic inflammatory cells Diagnosis – Dentigerous cyst www.indiandentalacademy.com
    29. 29. www.indiandentalacademy.com
    30. 30. • Impacted teeth are often encountered in routine radiographic examination • In treatment planning, it is imperative to accurately locate them and determine their relationships to adjacent teeth and anatomical structures in the area. • Usually, the required information can be obtained from periapical, occlusal, or panoramic radiographs. • Radiographs are important in assessing the location and nature of these anomalies. www.indiandentalacademy.com
    31. 31. The major shortcoming of the conventional radiography • Overlapping of structures on the film. • Difficult to distinguish a particular detail, especially when structures differ slightly in density. Computed tomography has proved to be superior to other radiographic methods in visualizing bone tissue. • 3D CT images clearly show the intraosseous location, inclination, and morphology of impacted teeth, as well as the distance from adjacent structures. www.indiandentalacademy.com
    32. 32. www.indiandentalacademy.com
    33. 33. Spiral CT images of the tooth revealed Trans axial view • Palatal location of impacted tooth • Lesion - 1.4x1.5cm Coronal view • Pericoronal radioluscency around the impacted tooth which was seen as periapical radioluscency involving 12,11 and 21 in the conventional radiographs Sagittal view • Inverted supernumerary tooth - 1.02cm and which was not fused with the surrounding tooth. www.indiandentalacademy.com
    34. 34. • Dentigerous cyst (24% of jaw cysts) is one of the most common developmental odontogenic cysts • Association with supernumerary teeth is RARE and estimated to constitute 5-6% of all dentigerous cysts Advanced diagnostic imaging methods • Cone beam computed tomography • Dental CT • Micro CT • Tuned aperture computed tomography • Magnetic resonance imaging www.indiandentalacademy.com
    35. 35. Guidelines for the diagnosis of a dentigerous cyst Daley and Winsock 1) A pericoronal radioluscency >4 mm in greatest width, 2) Histologically, fibrous tissue lined by nonkeratinized stratified squamous epithelium 3) A surgically demonstrable cystic space between the enamel and the overlying tissue. www.indiandentalacademy.com
    36. 36. www.indiandentalacademy.com
    37. 37. 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 Advanced diagnostic aids is necessary for accurate diagnosis to prevent associated complications. www.indiandentalacademy.com
    38. 38. www.indiandentalacademy.com
    39. 39. References • • • • • • • • INTERNATIONAL JOURNAL OF DENTAL CLINICS 2010:2(2): 39-42 Journal of Dental Research, Dental Clinics, Dental Prospects INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011:3(1):77-78 Journal of Clinical and Diagnostic Research , 2010 June ; 4:2601-2606. Journal of Clinical and Diagnostic Research , 2010 June , 4:2601-2606. Journal of Clinical and Diagnostic Research, 2010 June , 4:2601-2606. Journal of Clinical Rehabilitative Tissue Engineering Research January 22, 2011 Vol.15, No.4 Oral surgery, Oral medicine, Oral pathology, Oral surgery and Endodontology- vol 105,1, Jan 2008 www.indiandentalacademy.com
    40. 40. • • • Australian Dental Journal 1997;42:(3):160-5 American Journal of Orthodontics and Dentofacial Orthopedics Volume 130, Number 1 Journal of Clinical Rehabilitative Tissue Engineering Research January 22, 2011 Vol.15, No.4 www.indiandentalacademy.com
    41. 41. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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