Cas e R e po r t DOI: 10.

17354/ijss/2015/284

Supernumerary Teeth in Maxillary Anterior Region:

Report of Three Cases and Their Management
Sonu Acharya
Reader, Department of Pedodontics and Preventive Dentistry, Institute of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar,
Odisha, India

Abstract
A supernumerary tooth is one that is additional to the normal series and can be found in any region of the dental arch. Most of
the supernumerary teeth are located in the anterior maxillary region. These supernumerary teeth again are classified according
to their presence where they are located and form. These teeth when present may give rise to a variety of clinical problems.
The detection of these teeth can be achieved by thorough clinical and radiographic examination. Their management should be
done by outlining a comprehensive treatment plan. Here we are discussing three different and unique cases, which brought
different presentations by the patients, and the different treatment protocols were followed in each case. The first case deals with
a 9-year-old female with non-eruption of maxillary incisors. The supernumerary teeth were surgically extracted and unerupted
teeth exposed. The second case reported is of a 13-year-old boy having a problem in closing of mouth because of the extra
tooth in the palatal side of the maxilla. Surgical extraction of the supernumerary tooth was done to treat the case. The third
case is a 13-year-old child with non-eruption of maxillary incisors since exfoliation of deciduous teeth. The supernumerary teeth
were surgically removed, and the incisors repositioned orthodontically.

Key words: Clinical, Maxilla, Mesiodens, Supernumerary

INTRODUCTION (7%), maxillary pre-molar region (4.2%) and mandibular

incisor region (4.2%) accounted for the rest cases.5 It was
Supernumerary teeth may be found by the dental practitioner also noted that the prevalence of supernumerary teeth in
as an occasional finding on a radiograph or may be the cause the general Caucasian population ranged between 1% and
of an impacted tooth. They can also be found intra-orally 3%, with prevalence of 2.7% and 3.4% among Japanese
and can be located anywhere in the mouth. These can be and Hong Kong populations, respectively.6-8 The low
present as a single tooth or multiple teeth, unilaterally or prevalence rate seen in cases of supernumerary teeth in
bilaterally, erupted or impacted and in mandible/maxilla primary dentition is because of being not taken seriously
or both the jaws (Tables 1 and 2).1 The prevalence of by the parents, mostly of normal shape (supplemental
supernumerary teeth varies between 0.1% and 3.8% and type), may erupt normally, and appear to be in proper
is usually seen more in the permanent dentition.2-4 A study alignment.9 There are certain complications reported due
has shown that these extra teeth are mostly located in to the presence of supernumerary teeth that may result
maxillary incisor region (64.3%) with mesiodens accounting in the failure in the eruption of adjacent permanent
for 32.4% of such cases. In other areas supernumeraries incisors.10 Problems associated with supernumerary teeth
in the maxillary third molar region (29.6%), mandibular are a failure of eruption,11 displacement of permanent
third molar region (7.0%), mandibular premolar region teeth,12 crowding,13 formation of the cyst,14 compromise
Access this article online on implant site or it may be asymptomatic.15,16 Early
diagnosis of the presence and removal of supernumerary
Month of Submission : 04-2015 teeth is essential. The treatment is dependent on the type
Month of Peer Review : 05-2015 and position of the supernumerary tooth as well as its
Month of Acceptance : 05-2015 effect on adjacent teeth (Table 3). There are chances of
Month of Publishing : 06-2015 delayed eruption of maxillary incisors due to the presence
www.ijss-sn.com
of supernumerary tooth or teeth.11 After the removal of
Corresponding Author: Dr. Sonu Acharya, Reader, Department of Pedodontics and Preventive Dentistry, Institute of Dental Sciences, Siksha
O Anusandhan University, Bhubaneswar - 751 003, Odisha, India. Phone: +91-9937793095. E-mail: sonu_ain@yahoo.com

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 Acharya: Supernumerary Teeth: Case Reports

advised to seek appropriate interdisciplinary opinion to

Table 1: Supernumerary teeth based on location
enable formulation of the best possible treatment plan for
Mesiodens Located between maxillary central incisors the patient. Here we discuss three cases of complications
(pre‑maxillary regions)
Paramolar Buccally/lingually or palatally in between caused due to supernumerary teeth and their management
2nd and 3rd maxillary molars, rarely in either surgically or combined surgical and orthodontic
between 1st and 2nd maxillary molars interventions. The basic purpose of the case reports is to
Distomolar Distal or distolingual to 3rd molars (maxillary
or mandibular, in mandibular often impacted) make the clinicians aware of the complications, which may
Parapremolar Additional tooth in premolar region arise from the supernumerary teeth and their management.
Paramolar root Additional root often in mandibular molar Most of the cases require us to extract these teeth as
Paramolar tubercle Additional cusp present on buccal surface of
a permanent molar
soon as they are detected. An immediate surgical removal
Parastyle, if additional cusp if present in
is indicated after diagnosis as inter- or post-operative
maxillary molar complications are less likely to be encountered. However,
Protostylid, if additional cusp is present in when unerupted teeth are without symptoms, do not appear
mandibular molar to affect dentition in any way, it is best to be left in place
and kept under observation. The following disadvantages
might be encountered following deferred surgical plan,
Table 2: Supernumerary teeth based on morphology which includes loss of eruptive force of adjacent teeth, loss
Morphology Appearance of space and crowding of the affected arch, and possible
Conical Small/peg shaped tooth with conical root midline shifts.
Tuberculate Barrel shaped crown with rudimentary root,
often paired
Supplemental Duplication of tooth in normal series (often in CASE REPORTS
deciduous dentition and in permanent maxillary
lateral incisors and mandibular premolars)
Odontome No regular shape, disorganized diffuse mass Case 1
of dental tissue A 9-year-old female child visited the Department of
Pedodontics and Preventive Dentistry with a complaint of
no eruption of the upper left front tooth (Figure 1a). The
Table 3: Supernumerary teeth based on eruption child was asymptomatic and medically fit. Oral examination
and orientation of this child revealed unerupted upper left central incisor
Supernumerary teeth according Supernumerary teeth along with non-eruption of lateral incisors on the same
to eruption according to orientation side. Central and lateral incisors of the right side were in
Erupted: Complete coronal aspect Vertical: Oriented as different stages of the eruption. The patient had mixed
is seen in oral cavity clinically normal series of dentition dentition with other permanent teeth in various stages of
Partially erupted: Only occlusal Inverted: Upside down
part is visible the eruption. The parents of the child were worried about
Impacted: Cannot be seen in Transverse: Horizontally the non-eruption of teeth as well as the esthetic appearance
oral cavity clinically, can only be placed of the child. The orthopantomograph (Figure 1b) revealed
diagnosed using radiographs
the presence supernumerary tooth. The occlusal view
(Figure 1c) and intra-oral periapical radiographs (Figure 1d)
the obstacle from the path of eruption of incisors they confirmed the presence of an inverted supernumerary
erupt normally or sometimes they have to be extruded tooth between both the central incisors. Here we would like
with the help of orthodontic forces.12 Management in to add that although patient had orthopantommograph we
each case is varied, multiple supernumerary teeth present advised maxillary occlusal view and peri-apical radiographs
a challenge to the surgeon, and their effects create for accurate localization of supernumerary teeth which will
unusual orthodontic problems. The clinician is therefore, benefit both the clinician, as it reduces the surgical time,
reminded always to take appropriate radiographs prior to as well as the patient, as it is less traumatic for patient.
orthodontic treatment to rule out, among other things, the The major limitation of a single radiograph is its relative
presence of supernumerary teeth. It has been shown that inability to demonstrate the relationship of two objects
premolars, both in the normal series and supernumeraries, that are either side by side or superimposed. It is difficult
may develop later than their usual anticipated times. This, to determine whether both are in the middle of the bone
therefore, means that radiographs should also be taken or buccal or lingual to each other. The supernumerary
at some appropriate time during and after orthodontic tooth was blocking the path of eruption of both central
treatment in children. Appropriate management of and lateral incisor of the left side. It was decided to
multiple supernumerary teeth requires careful planning remove surgically the supernumerary and thus facilitate
and practitioners encountering this phenomenon are the eruption of the incisor teeth. Informed consent was

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 Acharya: Supernumerary Teeth: Case Reports

a b c

d e f
Figure 1: (a) Unerupted left central incisor (b) Orthomantomograph showing the supernumerary teeth (c) Occlusal view, (d) Intra-oral
periapical radiograph (e) Surgical exposure of central incisor (f) Post-operative

taken from the parents. A palatal approach was planned view (Figure 2b) radiographs revealed the presence of
to expose surgically (Figure 1e) the incisors and remove another supernumerary apart from the one seen clinically.
the supernumerary tooth after clinical and radiographic Orthopantomograph also confirmed the presence of two
examination. Full thickness palatal flap was raised, and supernumerary teeth. After routine blood investigations
both incisors were exposed. Removal of bone with a round and taking informed consent from the parents of the child,
bur revealed the presence of supernumerary tooth which it was decided to remove the supernumerary teeth causing
was extracted. Sutures were placed so as to expose both complications. A palatal approach was taken to raise the
the incisors. The post-operative healing (Figure 1f) was flap and expose the supernumerary teeth (Figure 2c and d).
asymptomatic and patient was healthy and happy. In this Both the supernumerary teeth were surgically delivered
case, the complication elicited by supernumerary tooth was (Figure 2e) and flap was repositioned in place with sutures.
of non-eruption of permanent teeth and the change in the Post-operative healing was asymptomatic (Figure 2f) and
esthetic appearance of the child. The child also had a huge child remained healthy and in good spirits.
psychological impact as she was not able to talk and smile
properly as reported by the parents. The child patient at this Case 3
age is vulnerable to peer pressure and worried about their A 13-year-old male patient came to the department of
looks. Hence, the anterior teeth when not erupted till the pediatric dentistry with the complaint of unerupted upper
long period of time usually causes the children to become front teeth since the exfoliation of milk teeth. The patient
shy and has an impact on his/her psychological makeup. had all other permanent teeth present for his age. There
The clinicians have to remove therefore the supernumerary was no significant medical history. On visual examination
teeth to facilitate the early eruption of anterior permanent (Figure 3a) and palpation a bulge was felt in the central
teeth. incisors area confirming the presence of permanent teeth.
Intra-oral peri apical radiographs (Figure 3b) revealed the
Case 2 presence of two conical supernumerary teeth. Routine
A 13-year-old male child reported to the department of blood investigations were advised. The parents of the
pedodontics and preventive dentistry with complain of child were explained about the supernumerary teeth and
inability to close mouth and chew properly because of the informed consent taken from them to proceed for the
extra tooth in the upper front region. The child was healthy procedure. After proper local anesthesia, full thickness
and asymptomatic. Thorough oral and clinical examination labial (Figure 3c) and lingual flaps were raised from
revealed the presence of a supernumerary tooth at the maxillary right canine to the maxillary left canine regions.
palatal aspect behind the incisors (Figure 2a). The patient The crowns of maxillary right and left central incisors were
had a permanent set of teeth. On complete closure of both seen after raising the labial flap, but the supernumerary
the jaws it was seen that the lower central incisors were in were only visible after palatal flap (Figure 3d) with little
contact with the supernumerary tooth due to which the bone removal was done. After an adequate bone removal,
child was unable to close the mouth. The maxillary occlusal extraction of supernumerary teeth (Figure 3e) was done. At

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 Acharya: Supernumerary Teeth: Case Reports

a b c

d e f
Figure 2: (a) Pre-operative view (b) Occlusal view confirms two supernumeraries (c) Incision made, (d) Flap raised (e) Surgically
removed supernumerary teeth (f) Post-operative

a b c

d e f
Figure 3: (a) Pre-operative (b) Intra-oral radiograph showing two supernumerary teeth (c) Flap raised, (d) Supernumerary teeth
exposed (e) Teeth removed (f) Traction by orthodontic wires

the same appointment, it was decided to use orthodontic extra teeth can be localized using the intra-oral radiographs
force to extrude the incisor teeth. Begg’s brackets were of varied methods. A periapical radiograph utilizing the
placed and orthodontic traction (very light force at about paralleling technique gives the best localization compared
60-90 g) was given with the help of arch wire as elastics to other radiographic views. If teeth are causing no
(Figure 3f). The teeth came into alignment within 2 months. complications and are not likely to interfere with tooth
Here in this case, we applied light orthodontic forces as movement they can be monitored with only radiographic
the root completion had taken place, and we could have review. The supernumerary teeth can cause many
utilized the eruptive forces which s usually seen with young complications such as prevention and delay in eruption
permanent teeth with incomplete roots. of associated permanent teeth, displacement or rotation
of permanent teeth, crowding, incomplete space closure
DISCUSSION during orthodontic treatment, dilaceration, delayed root
development of adjacent teeth, formation of cysts etc.18 In
The etiology of these excess teeth is still not understood. our cases also the first and third case reported had come
Numerous factors can interfere with their formation. Few to clinic with complaint of non-eruption of anterior teeth
authors have reported that tooth anomalies can result from as reported in other cases too,18 similarly second case came
a complex interplay of genetic factors and developmental to us with complain of non-closure of mouth properly.
processes.1 One interesting theory, suggests that the local The patient should be warned of complications of varied
and independent hyperactivity of dental lamina results nature like cystic changes and migration of roots. If the
in an excessive proliferation of cells, which results in the patient does not want such complications, it is advisable
formation of extra tooth buds.17 The most important step to remove supernumerary teeth. If supernumerary teeth
in the management of supernumerary tooth is to identify are associated with complications, it is usual to extract
the complications associated with supernumeraries. These such teeth, which usually involves a minor oral surgical

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 Acharya: Supernumerary Teeth: Case Reports

procedure.11 Early extraction of supernumerary teeth, the problems associated with these supernumerary teeth
causing incisor impaction, may have the benefit of (Figure 4). The treatment depends on respective cases.
minimizing loss of eruptive potential, space loss and These extra teeth may remain clinically symptomless and
center line displacement. Even in those cases where the may be a chance finding or may cause complications.
un-erupted incisors are severely rotated, it is seen that Unless a supernumerary tooth causes complications, it
removal of the causative supernumerary tooth can result is best to follow a wait and watch procedure rather than
in self-correction and correct alignment.18 The greatest trying to extract these teeth.25 Two methods are followed
concern with early removal is the risk of affecting the for extraction of mesiodens; either early extraction before
formation of adjacent roots. In addition, a young child root formation of the permanent incisors or late extraction
may not be able to tolerate such a procedure and may after root formation of the permanent incisors.26 Some
develop a dental phobia. In the presented cases, there was authors recommend extraction of mesiodens in the early
a low risk of iatrogenic damage to adjacent permanent mixed dentition in order to facilitate spontaneous eruption
incisors root according to the clinical and radiographic and alignment of the incisors.27 In our cases also we saw
findings since root development of the central incisors that delay in the extraction of supernumerary teeth caused
was complete. Furthermore, the surgical procedure was complications of non-eruption of permanent teeth. If
simple; patients were cooperative and are more receptive indicated for extraction various anatomical structures in the
to surgical management under local anesthesia and thus vicinity of the supernumerary teeth have to be considered
easier to manage. However, delayed eruption of maxillary before extraction so that no complications arise later.
central incisors can result in mesial movement of the Some authors have mentioned a decision support system
lateral incisors, space loss and diminished development for the extraction of these teeth.28 In each of the cases
of dentoalveolar height. Furthermore, in situations where discussed here, the authors have utilized sufficient caution
a supernumerary tooth is preventing the eruption of while removing the supernumerary teeth so as to make the
an incisor, the eruptive potential of the incisor may be removal without post-operative complications.
lost if intervention is delayed. Following the removal of
Clinical significance: Treatment of hyperdontia depends
supernumerary teeth the un-erupted teeth usually erupts
on the respective case. In all the cases of our patients,
faster. The surgical removal of supernumerary teeth
supernumerary tooth extraction was performed. In
should be performed very carefully to avoid damage to the permanent dentition with regard to the possible
the underlying permanent teeth, which might lead to complications, it is advisable to remove supernumerary
ankylosis, displacement, rotation, and ectopic position. It teeth, including those not erupted. In cases of normal
also has been stated that the clinician should be cautious eruption and settings of supernumerary teeth, when
to prevent possible complications to blood vessels and they do not cause disturbances of the arch regularity it is
the damaging of nerves during the manipulation of the possible to ignore from this rule.
tooth, fracture of the maxillary tuberosity, perforation of
the maxillary sinus, the pterygomaxillary space, and the
orbit. Clinicians should also pay more attention to the
possibility of supernumerary teeth being fused with the
adjacent tooth structure at the crown or root level, which
may make the extraction difficult. Supernumerary teeth can
also be kept under observation without extraction when
satisfactory eruption of related teeth has occurred with
no associated pathology, but most of the researchers18-20
have opined that the extraction of erupted supernumerary
teeth in almost all cases except in those patients who had
missing teeth. Up to 91% of impacted permanent incisors
erupt within 18 months following removal.21 The patient’s
age and the availability of space in the dental arch are the
two critical factors in determining whether spontaneous
eruption occurs following the removal of a supernumerary
tooth. In our case too spontaneous eruption occurred
in one case as the patient was young but in other case
(case 3) we had to take help of orthodontic traction
which is also similar to cases reported in literature.22-24
In all our cases, we performed extractions to alleviate Figure 4: Treatment options for supernumerary teeth15

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 Acharya: Supernumerary Teeth: Case Reports

CONCLUSION 12. von Arx T. Anterior maxillary supernumerary teeth: A clinical and
radiographic study. Aust Dent J 1992;37:189-95.
13. Khalaf K, Robinson DL, Elcock C, Smith RN, Brook AH. Tooth size in
Supernumerary teeth are relatively less common but can patients with supernumerary teeth and a control group measured by image
lead to varied complications. The clinician should be able analysis system. Arch Oral Biol 2005;50:243-8.
to recognize the signs as early as possible suggesting the 14. Primosch RE. Anterior supernumerary teeth – assessment and surgical
intervention in children. Pediatr Dent 1981;3:204-15.
presence of supernumerary teeth, particularly those that 15. Parolia A, Kundabala M, Dahal M, Mohan M, Thomas MS. Management of
cause problems in eruption as seen with our presented cases, supernumerary teeth. J Conserv Dent 2011;14:221-4.
and perform the relevant investigations and treatment. On 16. Ashkenazi M, Greenberg BP, Chodik G, Rakocz M. Postoperative prognosis
of unerupted teeth after removal of supernumerary teeth or odontomas. Am
being able to diagnose such cases, each case has to be dealt J Orthod Dentofacial Orthop 2007;131:614-9.
in best possible way and to allay the apprehensions of 17. Liu JF. Characteristics of premaxillary supernumerary teeth: A survey of
parents about the complications they can create. 112 cases. ASDC J Dent Child 1995;62:262-5.
18. Shah A, Gill DS, Tredwin C, Naini FB. Diagnosis and management of
supernumerary teeth. Dent Update 2008;35:510-2.
REFERENCES 19. Ramesh K, Venkataraghavan K, Kunjappan S, Ramesh M. Mesiodens:
A clinical and radiographic study of 82 teeth in 55 children below 14 years.
J Pharm Bioallied Sci 2013;5:S60-2.
1. Tyrologou S, Koch G, Kurol J. Location, complications and treatment of
20. Mallineni SK, Nuvvula S. Management of supernumerary teeth in children:
mesiodentes – A retrospective study in children. Swed Dent J 2005;29:1-9.
A narrative overview of published literature. J Craniomaxillofac Dis
2. Yusof WZ. Non-syndrome multiple supernumerary teeth: Literature review.
2015;4:62-8.
J Can Dent Assoc 1990;56:147-9.
3. De Oliveira Gomes C, Drummond SN, Jham BC, Abdo EN, Mesquita RA. 21. Leyland L, Batra P, Wong F, Llewelyn R. A retrospective evaluation of the
A survey of 460 supernumerary teeth in Brazilian children and adolescents. eruption of impacted permanent incisors after extraction of supernumerary
Int J Paediatr Dent 2008;18:98-106. teeth. J Clin Pediatr Dent 2006;30:225-31.
4. Ng’ang’a PM, Ng’ang’a RN. Supernumerary teeth in a population 22. Kocadereli I, Turgut MD. Surgical and orthodontic treatment of an impacted
of 8-15 year-old orthodontic patients in Kenya. Afr J Oral Health Sci permanent incisor: Case report. Dent Traumatol 2005;21:234-9.
2000;1:16-8. 23. Das D, Misra J. Surgical management of impacted incisors in associate with
5. Scheiner MA, Sampson WJ. Supernumerary teeth: A review of the literature supernumerary teeth: A combine case report of spontaneous eruption and
and four case reports. Aust Dent J 1997;42:160-5. orthodontic extrusion. J Indian Soc Pedod Prev Dent 2012;30:329-32.
6. Cherrik HM. Radiology in the diagnosis of oral pathology in children. 24. Yeluri R, Hegde M, Baliga S, Munshi AK. Multiple supernumerary
Pediatr Dent 1982;3:424. teeth associated with an impacted maxillary central incisor: Surgical and
7. Niswander JD, Sujaku C. Congenital anomalies of teeth in Japanese orthodontic management. Contemp Clin Dent 2012;3:219-22.
children. Am J Phys Anthropol 1963;21:569-74. 25. Proff P, Fanghänel J, Allegrini S Jr, Bayerlein T, Gedrange T. Problems
8. Davis PJ. Hypodontia and hyperdontia of permanent teeth in Hong Kong of supernumerary teeth, hyperdontia or dentes supernumerarii. Ann Anat
schoolchildren. Community Dent Oral Epidemiol 1987;15:218-20. 2006;188:163-9.
9. Rajab LD, Hamdan, MA. Supernumerary teeth: Review of the literature and 26. Alaçam A, Bani M. Mesiodens as a risk factor in treatment of trauma cases.
a survey of 152 cases. Int J Paediatr Dent 2002;12:244-54. Dent Traumatol 2009;25:e25-31.
10. Garvey MT, Barry HJ, Blake M. Supernumerary teeth – An overview of 27. Meighani G, Pakdaman A. Diagnosis and management of supernumerary
classification, diagnosis and management. J Can Dent Assoc 1999;65:612‑6. (mesiodens): A review of the literature. J Dent (Tehran) 2010;7:41-9.
11. Welbury RR, Duggal MS, Hosey MT. Paediatric Dentistry. 3rd ed. Oxford: 28. Amarlal D, Muthu MS. Supernumerary teeth: Review of literature and
Oxford University Press; 2005. decision support system. Indian J Dent Res 2013;24:117-22.

How to cite this article: Acharya S. Supernumerary Teeth in Maxillary Anterior Region: Report of Three Cases and Their Management. Int
J Sci Stud 2015;3(3). Int J Sci Stud 2015;3(3):123-128.

Source of Support: Nil, Conflict of Interest: None declared.

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