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PubMed1979

Traction--a surgical/orthodontic procedure.

Maxillary crowding may cause failure of eruption of the canine. The teeth so displaced are directed buccally or palatally. In both cases, surgical intervention is indicated after space has been made in the arch. Palatally displaced canines are treated by surgical excision of palatal mucosa to promote eruption. Wide excision is indicated to prevent the healing process from covering the exposed tooth crown. Because of the anatomy of the buccal mucosa, however, surgical excision of the crowns of buccally displaced canine frequently results in periodontal problems. An alternative technique is therefore presented; this involves the surgical exposure of the crowns of buccally displaced teeth to allow the attachment of a wire traction hook. The crown is then recovered. The traction hook provides a point of attachment, so that orthodontic forces may be applied to the unerupted tooth to guide its eruption. The preservation of the mucosal flap ensures a normal epithelial attachment develops on the buccal surface of the tooth, and the normal gingival anatomy of the buccal mucosa is maintained. The procedure may also be used in cases where upper incisors have been prevented from erupting because of the presence of supernumerary teeth. Even after surgical removal of the supernumerary teeth, the permanent incisors often fail to erupt. In such cases, the placement of traction hooks will enable the orthodontist to bring the unerupted teeth into their correct positions in the arch.

Adolescent↗

PubMed2002

Further studies of a model for the etiology of anomalies of tooth number and size in humans.

A multifactorial model based on an underlying continuous distribution of tooth size, with thresholds determining hypodontia and supernumeraries, has been proposed [1]. Our aim is to investigate this model by comparing tooth morphology of affected patients and their first degree relatives with normal controls. An image analysis system [2] was used to measure teeth on study models of controls, patients with hypodontia of varying degrees and location, first-degree relatives of hypodontia index cases, and patients with supernumerary teeth in the maxillary incisor region. Mesio-distal crown size in hypodontia patients was smaller than controls, and this difference was significant for all tooth types. There was a general pattern: the more severe the hypodontia, the smaller the size of the tooth formed. Patients with supernumerary teeth had permanent maxillary central and lateral incisors and canines that were significantly larger in mesio-distal width than controls. The maxillary central incisors also differed in taper in supernumerary patients compared to controls. Hypodontia prevalence was higher in first-degree relatives (22%) of hypodontia index cases than in the general population (4.4%), and unaffected relatives had smaller teeth than controls. Thus, there were generalized and localized effects within the dentition, and these findings are compatible with the statistical expectations of the proposed multifactorial model.

Adult↗

PubMed2001

Histological and analytical studies of a tooth in a patient with cleidocranial dysostosis.

A histopathological and analytical study of a permanent tooth from a patient with cleidocranial dysostosis (CCD) was performed. The patient was a 47-year-old woman, who had 10 erupted permanent teeth and 2 partially erupted and 19 completely impacted teeth, including supernumerary teeth. The erupted right upper premolar was extracted and observed using a light microscope and an electron probe X-ray microanalyzer (EPMA). Findings showed enamel hypoplasia, predominantly irregular globular dentin and Tomes' granular layer, and a complete lack of cellular cementum in the ground section. The incremental von Ebner and counter Owen lines were obscure. Comparative quantitative analysis using the EPMA showed that the quantities of calcium and phosphate were lower in the enamel and dentin than those of the control sample.

Bicuspid↗

PubMed2003

Endodontic and orthodontic treatment of a cross-bite fused maxillary lateral incisor.

AIM: To describe combined endodontic and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY: A rare case is presented in which combined endodontic and orthodontic treatment was performed on a cross-bite fused tooth. Clinical and radiographic examination showed the maxillary lateral incisor fused with a supernumerary and an impacted canine. The fused tooth required nonsurgical and surgical endodontic treatment for functional and aesthetic reasons. The root canals were dressed with calcium hydroxide for 2 months before they were obturated with thermoplasticized injectable gutta-percha. Then, the distal part of the fused tooth was removed and the mesial part of the tooth was replanted and fixed. Three months after the completion of orthodontic therapy, the impacted canine erupted between the remaining tooth and the first premolar. Recall examination, 3 years after completion of root canal treatment, showed clinical and radiographic evidence of healing. KEY LEARNING POINTS: Fusion has been described as a development anomaly characterized by the union of two adjacent teeth. Proper combined endodontic and orthodontic treatment resulted in maintaining one tooth half and solving the aesthetic and functional problem of a fused tooth.

Child↗

PubMed2004

Esthetic enhancement of ceramic crowns with zirconia dowels and cores: a clinical report.

There has been an increase in the use of esthetic metal-free ceramic crowns in restoring endodontically treated teeth or teeth with severe coronal destruction. Tooth-colored dowels and cores are used to enhance the esthetic result. This report describes the treatment of a patient with bilateral maxillary supernumerary lateral incisors, a severe malocclusion, and maxillary anterior tooth discoloration. Treatment included heat-pressed, metal-free ceramic crowns supported by zirconia ceramic dowel-and-core foundations.

Adult↗

PubMed1997

Late developing supernumerary teeth in the mandible.

This paper presents two cases in which supplemental premolars were an incidental finding. Although anomalies of tooth number and form are quite common, both cases demonstrate late forming supernumeraries with one case illustrating their development in a more unusual site. It is not routine practice to screen for late development of teeth during orthodontic treatment. Therefore the possibility of their interference with occlusal development or orthodontic mechanics such as space closure, should always be kept in mind.

Bicuspid↗

PubMed2006

Two cases with supernumerary teeth in lower incisor region.

Abnormalities in number of teeth are occasionally noted in clinical cases. Many theories have been proposed as regards the causes of the occurrence of supernumerary teeth, including atavism theory, mechanical tooth germ separation theory, tissue induction theory, and dental laminar morphological disturbance theory. However, none of these theories alone offers a sufficient explanation for this phenomenon. The incidence of supernumerary permanent teeth is approximately 1-3%. These are the maxillary anterior teeth, the maxillary molars, and the maxillo-mandibular premolars in terms of descending order of site of occurrence. On the other hand, incidence in the mandibular anterior tooth area, of which there have been few detailed reports, is about 0.01%, a markedly low value. In this paper, we report two rare cases of supernumerary teeth in the mandibular incisor area. We discuss their etiology and orthodontic treatment, and detail a differential diagnosis between the normal and supernumerary teeth. We found that it was difficult to establish a clear etiology and differentiation between the normal and supernumerary teeth.

Adolescent↗

PubMed1996

Fourth molars: a clinical study.

Supernumerary teeth may be found in both the primary and permanent dentition, although they are more common in the permanent dentition. Presence of a fourth molar is rare, and such a tooth is almost invariably impacted. Dental practitioners should be aware of the possibility of encountering this rare supernumerary, its diagnosis and treatment. The authors of this article conducted a survey of patients in Montreal, looking specifically at the prevalence, aetiology, diagnosis, pathology and treatment of fourth molars. Their findings are reported here, and compared with data from the literature over the past 15 years.

Adolescent↗

PubMedDate not supplied

Hyperdontia in children below four years of age: a radiographic study.

Sixty-six children (forty-one boys and twenty-five girls) were evaluated for differences in characteristics of premaxillary hyperdontia between the primary and permanent dentitions. The study population had forty-five supernumerary teeth in their primary dentitions and fifty supernumerary teeth in their permanent dentitions. Eighty percent of the primary supernumerary teeth were located in the lateral incisor regions, in proper alignment within the dental arch. Sixty-two percent of the supernumerary teeth in the permanent dentitions were situated in the central incisor regions; 90 percent were outside the dental arch, mostly palatal; and 42 percent were inverted. Seventy-three percent of the supernumerary teeth in the primary dentitions had erupted. Twin tooth formation occurred in twenty-eight patients, the majority in the primary dentition; but in eleven children, both dentitions were involved. Interference with the normal dentition occurred most often in the permanent dentition. Children with primary supernumeraries exhibit a greater chance of hyperdontia in the permanent dentition than do others.

Child, Preschool↗

PubMed1996

Polarizing activity, Sonic hedgehog, and tooth development in embryonic and postnatal mouse.

Tooth development involves reciprocal epithelial-mesenchymal interactions, polarized growth, mesenchyme condensation, and complex morphogenetic events. Because these processes bear similarities to those occurring in the developing limb, we asked whether morphogenetic signals found in the limb also occur in the developing tooth. We grafted mouse embryo tooth germs to the anterior margin of host chick embryo wing buds and determined whether the dental tissues had polarizing activity. Indeed, the grafts induced supernumerary digits. Activity of both molar and incisor tooth germs increased from bud to cap stages and was maximal at late bell stage in newborn. With further development the polarizing activity began to decrease, became undetectable in adult molar mesenchyme but persisted in incisor mesenchyme, correlating with the fact that incisors grow throughout postnatal life while molars do not. When different portions of neonatal incisors were assayed, a clear proximo-distal gradient of activity was apparent, with maximal activity restricted to the most proximal portion where undifferentiated mesenchyme and enamel organ reside. In situ hybridizations demonstrated that prior to induction of supernumerary digits, the tooth germ grafts induced expression in host tissue of Hoxd-12 and Hoxd-13. In addition, whole-mount in situ hybridizations and immunohistochemistry showed that developing tooth germs express Sonic hedgehog (Shh). Shh expression was first detected in bud stage tooth germs; at later stages Shh transcripts were prominent in enamel knot and differentiating ameloblasts at the cuspal region. We concluded that tooth germs possess polarizing activity and produce polarizing factors such as Shh. As in the limb, these factor(s) and activity probably play key roles in establishing polarity and regulating morphogenesis during early tooth development. Given its subsequent association with differentiating ameloblasts, Shh probably participates also in cytogenetic events during odontogenesis.

Aging↗

PubMedDate not supplied

Anomalies of craniofacial skeleton and teeth in cleidocranial dysplasia.

Mutations involving the transcription factor CBFA1 cause cleidocranial dysplasia (CCD) in man. Recently, a mouse model of CCD has been generated (Cbfal +/-) [Komori et al., 1997], and disturbances of osteoclast differentiation have been documented. It has been shown that these animals exhibit hypoplastic clavicles and nasal bones, and retarded ossification of parietal, interparietal, and supraoccipital bones. Humans with CCD show all these features, including severely retarded ossification of the cranial base, strongly suggesting that both intramembranous ossification and endochondral ossification are affected. In addition, CCD patients have multiple supernumerary teeth and delayed tooth eruption. The present report presents 3D reconstructions of computerised tomography (CT) scans of the craniofacial region of a CCD boy examined at both 1 and 7 years of age. The anomalies in craniofacial skeleton and teeth are analysed and compared to the findings of our previous clinical studies and to the findings in the animal model. Based on the available information, we suggest that osteoblast, osteoclast, and dentinoclast differentiation may be disturbed in CCD.

Child↗

PubMed2002

The pattern of malocclusion among orthodontic patients seen in Dental Centre, University College Hospital, Ibadan, Nigeria.

The aim of this study was to analyse the malocclusion pattern among patients who presented for treatment in the Orthodontic Unit of the Dental Centre, University College Hospital, Ibadan, as baseline data for proper treatment planning, teaching and further research. A total of 289 subjects aged 5-34 years with mean age of 10.6 +/- 1.5 (S.D.) years were seen. Angle's classification of molar relationships among those seen is as follows: class I - 76.5%, Class II - 15.5% and Class III - 8.0%. There was increased overjet in 16.2% of the patients, reduced overjet in 0.7% while 2.1% had reversed overjet. Other occlusal abnormalities included: increased overbite (3.8%), reduced overbite (1.4%); anterior open bite (5.2%; crossbite (8.4%) and scissorsbite (0.6%). Crowding, spacing and retained primary incisors constituted 29.7%, 1.4% and 40.1%, respectively. Delayed eruption of canine (1.0%), Bimaxillary protrusion (0.7%), incompetent lips (0.7%), supernumerary teeth (0.7%) malformed tooth (0.3%), mandibular deviation on closure (1.0%) and oral habits (4.5%) were other forms of malocclusion diagnosed. Males were found to have significantly more of classes II and III molar relationships than females (P < 0.05). Occurrence of retained primary teeth as well as overjet deviations from normal were significantly higher in females (P < 0.05). No significant sex differences were found in the other occlusal disorders (P > 0.05): The findings were comparable with previous epidemiological surveys in other parts of the country.

Adolescent↗

PubMed1988

Application to forensic odontology of aspartic acid racemization in unerupted and supernumerary teeth.

Racemization of aspartic acid in dentin protein during the human lifetime progresses with age. The extent of racemization of aspartic acid in coronal dentin of normal permanent teeth can be used in forensic odontology to estimate the age of an individual at the time of death (Ogino et al., 1985). A series of experiments was conducted with dentin separated from unerupted and supernumerary teeth of various ages in an attempt to evaluate the advantages and limitations of this age-estimation method. The current study on nine tooth specimens showed that some unerupted permanent teeth with normal-sized and -shaped crowns (impacted third molar, canine, and incisor) could be used to estimate the age of individuals at the time of death within +/- 4 years. However, supernumerary teeth (mesiodens, paramolar) with extremely tiny (length of crown: 4 approximately 5 mn) and abnormally shaped crowns could not be used for analysis. In such cases, the estimated age of individuals analyzed by the racemization method deviated considerably from their actual age.

Adolescent↗

PubMed1984

A unifying aetiological explanation for anomalies of human tooth number and size.

Genetic and environmental factors are implicated in the aetiology of supernumerary teeth, hypodontia, megadontia and microdontia ; these anomalies tend to be associated. 1115 school children aged 11-14 years examined clinically and radiographically provided prevalence data. A further 703 children with dental anomalies were studied. 153 of these became probands for a family study and 327 of their first-degree relatives were examined. There were much higher frequencies (p less than 0.001) of all anomalies among the relatives of probands than in the general population. Males more often had supernumerary teeth and megadontia and females more frequently had hypodontia (p less than 0.05) and microdontia . For hypodontia, the proportion of relatives affected varied with the severity of the condition in the proband (p less than 0.05). In the prevalence study, there was an association between hypodontia and microdontia (p less than 0.001). These findings may be explained by a multifactorial model having a continuous scale, related to tooth number and size, with thresholds. Position on the scale usually depends upon the combination of numerous genetic and environmental factors, each with a small effect, but occasionally a chromosomal anomaly, a major single gene or a major environmental insult may have a large effect. The finding that the estimated difference between the means of the sexes was the same for each anomaly, within the limits of experimental error, supports the validity of the model.

Adolescent↗

PubMed2006

Phylogenetic memory of developing mammalian dentition.

Structures suppressed during evolution can be retraced due to atavisms and vestiges. Atavism is an exceptional emergence of an ancestral form in a living individual. In contrast, ancestral vestige regularly occurs in all members of an actual species. We surveyed data about the vestigial and atavistic teeth in mammals, updated them by recent findings in mouse and human embryos, and discussed their ontogenetic and evolutionary implications. In the mouse incisor and diastema regions, dental placodes are transiently distinct being morphologically similar to the early tooth primordia in reptiles. Two large vestigial buds emerge in front of the prospective first molar and presumably correspond to the premolars eliminated during mouse evolution. The incorporation of the posterior premolar vestige into the lower first molar illustrates the putative mechanism of evolutionary disappearance of the last premolar in the mice. In mutant mice, devious development of the ancestral tooth primordia might lead to their revivification and origin of atavistic supernumerary teeth. Similarity in the developmental schedule between three molars in mice and the respective third and fourth deciduous premolar and the first molar in humans raises a question about putative homology of these teeth. The complex patterning of the vestibular and dental epithelium in human embryos is reminiscent of the pattern of "Zahnreihen" in lower vertebrates. A hypothesis was presented about the developmental relationship between the structures at the external aspect of the dentition in mammals (oral vestibule, pre-lacteal teeth, paramolar cusps/teeth), the tooth glands in reptiles, and the earliest teeth in lower vertebrates.

Animals↗

PubMed2006

Characteristics and prevalence of non-syndrome multiple supernumerary teeth: a retrospective study.

OBJECTIVE: The goal of this study was to evaluate the radiological and clinical findings of non-syndromic multiple (five or more) supernumerary teeth in patients radiographically examined between 1999 and 2004. METHODS: Among 9550 patients, 251 cases of supernumerary teeth were found, including six cases of multiple supernumerary teeth. Patients with multiple supernumerary teeth were evaluated for age, sex, unilateral or bilateral distribution of the teeth, localization, morphology and complications or associated pathologies such as dentigerous cysts, eruption anomalies, resorption of adjacent teeth, displacement of tooth germ, malformation, migration, neurological symptoms, and secondary and periapical infections. RESULTS: All patients were male and most of the multiple supernumerary teeth were seen in the premolar region. The prevalence of multiple supernumerary teeth was 0.06%. Out of 37 multiple supernumerary teeth examined, 30 were impacted. Various associated anomalies were seen in 21.6% of cases. Although the mean age was high (23.1 years), no pathologies such as root resorption on adjacent teeth or cystic formation were observed, in contradiction of previous studies. CONCLUSION: In agreement with previous studies, the majority of supernumerary teeth were seen in the lower premolar region. That all patients with multiple supernumerary teeth were male and that most of these teeth were impacted was also in agreement with previous studies. The order of location frequency in previous studies has been premolar-molar-anterior; we found the order to be premolar-anterior with no supernumerary molar teeth observed. It was also interesting that no serious pathological findings were recorded.

Adolescent↗

PubMed2001

Endoscopic extraction of an intranasal tooth: a review of 13 Cases.

OBJECTIVE: To present the clinical experience of a series of 13 consecutive cases of an intranasal tooth treated by endoscopic extraction during a 15-year period. STUDY DESIGN: Retrospective review. METHODS: The records of 13 patients who underwent endoscopic extraction of an intranasal tooth at Taipei Medical University Hospital and Chang Gung Memorial Hospital between 1986 and 2000 were reviewed. RESULTS: All the patients had an uneventful recovery and the presenting symptoms were completely relieved after surgery. The follow-up period was 6 months to 14 years 5 months (average, 9 yr 2 mo). Examination of these extracted teeth showed that 11 were supernumerary teeth and two were ectopic permanent canine teeth. CONCLUSIONS: Endoscopic extraction of the intranasal tooth has the advantages of good illumination, clear visualization, and precise dissection, and in our experience the result of endoscopic extraction of an intranasal tooth is satisfactory. We recommend the routine use of a rigid endoscope in the treatment of an intranasal tooth.

Adolescent↗

PubMed1998

A controlled study of associated dental anomalies.

The purpose of this study was to reveal patterns of association among seven types of dental anomalies (aplasia of second premolars, small size of maxillary lateral incisors, infraocclusion of primary molars, enamel hypoplasia, ectopic eruption of first molars, supernumerary teeth, and palatal displacement of maxillary canines) in an untreated orthodontic population, ages 7 to 14. The prevalence of associated tooth anomalies in seven groups of 100 subjects selected according to one primarily diagnosed dental anomaly was compared with the prevalence of the examined dental anomalies in a control group of 1,000 subjects. Significant reciprocal associations (p < 0.005) were found among five of the anomalies (aplasia of second premolars, small size of maxillary lateral incisors, infraocclusion of primary molars, enamel hypoplasia, and palatal displacement of maxillary canines), suggesting a common genetic origin for these conditions. Supernumerary teeth appeared to be a separate etiological entity with respect to all other examined tooth anomalies. The existence of associations between different tooth anomalies is clinically relevant, as the early diagnosis of one anomaly may indicate an increased risk for others.

Adolescent↗