Supplemental teeth

There are some conditions which have a genetic basis where impacted teeth are seen more frequently and this includes cleidocranial dysplasia, cleft lip and palate, gingival fibromatosis and Down's Syndrome.

It is worth remembering that most central incisors should have erupted by the age of 7 and lateral incisors by the age of 8. Surprisingly, most referrals for impacted maxillary incisors are when the patient is 9 years of age. This delay in diagnosis could potentially influence the outcome and it is important that when the contralateral incisor has erupted 6 months previously there is likely to be a problem. Similarly, if the lateral incisors erupt well before the central incisor then consideration should be given to investigating further (Fig. 20).

It is perfectly possible that a supernumerary tooth may be present and not affect the eruption of the incisors (Fig. 21). Indeed one of the clinical signs that a supernumerary may be present is the evidence of spacing where a supernumerary is in the midline and causing a diastema between the upper incisors. The different types of supernumerary teeth seem to have different implications for treatment.

Conical supernumerary teeth are small and peg-shaped, they usually have a root and they do not often affect incisor eruption (Fig. 21), but if they are in the midline they can cause a median diastema. They should only be removed if they are adjacent to incisors which need to undergo root movement. Potentially the movement of the root against the supernumerary tooth could cause resorption of an incisor root.

Where the supernumerary teeth are tubercu-late these usually have no roots and develop palatally. They often prevent the eruption of central incisors and if they do, they need to be removed (Fig. 22). Complex and compound odontomes are rare, but can similarly prevent eruption of the permanent incisors and also need to be removed. Obviously, radiographs are needed to confirm any clinical observations about impacted teeth and parallax used in the same way as for canines in order to locate the position of the supernumerary teeth. Eighty per

Supplemental Teeth
Fig. 20 This patient has both her lateral incisors fairly well erupted but retained deciduous teeth. This could easily have been diagnosed sooner and may influence the outcome of final tooth position
Fig. 21 Conical supernumerary which has not inhibited the eruption of the permanent incisors. The supernumerary is in the midline
Tuberculate Type Supernumerary Tooth

Fig. 22 Anterior occlusal radiograph which shows both upper lateral incisors to have erupted, both upper deciduous central incisors are retained and the upper permanent central incisors are unerupted. There are two tuberculate supernumeraries present which are associated with the non-eruption of these upper permanent central incisors

Fig. 22 Anterior occlusal radiograph which shows both upper lateral incisors to have erupted, both upper deciduous central incisors are retained and the upper permanent central incisors are unerupted. There are two tuberculate supernumeraries present which are associated with the non-eruption of these upper permanent central incisors

Adult Central Eruption Palate

Fig. 23 Typical fibrous tissue impaction of the permanent incisor. In this patient a supernumerary had been removed 9 months earlier. The tooth will only require a small exposure on the palatal aspect to enable it to erupt. The bulge in the labial mucosa is clearly evident and this is where the crown will sit

Fig. 23 Typical fibrous tissue impaction of the permanent incisor. In this patient a supernumerary had been removed 9 months earlier. The tooth will only require a small exposure on the palatal aspect to enable it to erupt. The bulge in the labial mucosa is clearly evident and this is where the crown will sit

Fig. 24 Dental pantomogram of a patient who appears to have severe impaction of her lower left second premolar

Fig. 25 The same patient as in Figure 24, 9 months later where there has been good eruption of the lower left second premolar. Eventually this tooth made its way fully into the line of the arch and it was possible to upright the lower left first molar

cent of supernumerary teeth occur in the anterior part of the maxilla and there is a male to female ratio of 2:1. The incidence in the population as a whole varies, but is somewhere in the region of 1-2%.

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