Hindawi Publishing CorporationInternational Journal of
DentistryVolume 2012, Article ID 745265, 5
pagesdoi:10.1155/2012/745265Research ArticleSupernumerary Teeth in
Indian Children: A Survey of 300 CasesAmita Sharma1and Varun Pratap
Singh21Department of Pediatric Dentistry, College of Dental
Sciences, BPKIHS, Dharan, Nepal2Department of Orthodontics, College
of Dental Sciences, BPKIHS, Dharan, NepalCorrespondence should be
addressed to Varun Pratap Singh, [email protected] 11 July
2011; Revised 19 December 2011; Accepted 10 January 2012Academic
Editor: Preetha KanjirathCopyright 2012 A. Sharma and V. P. Singh.
This is an open access article distributed under the Creative
Commons AttributionLicense, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original
work is properlycited.The aim of this investigation was to study
children with supernumerary teeth who visited the Department of
Pedodontics andPreventive Dentistry, Government Dental College and
Hospital, Rohtak, Haryana, India. Only children with supernumerary
teethwere included in the study while patients having supernumerary
teeth with associated syndromes were excluded. Supernumerarieswere
detected by clinical and radiographic examination. The results
indicated that males were aected more than females witha sex ratio
of 2.9 : 1. Single supernumerary tooth was seen in 79% of the
patients, 20% had double, and 1% had three or moresupernumeraries.
Premaxillarysupernumerariesaccountedfor93.8%ofthecases. Conical
shapedsupernumeraryteethwerethe most common type (59.7%). Majority
of supernumeraries remained unerupted (65%). Fusion of
supernumerary tooth witharegulartoothwasobservedin4%ofthepatients.
Taloncusp, anassociateddental anomaly,
wasseenin5%ofthecases.Simultaneous hypodontia occurred in 2.3% of
patients with supernumeraries.1. IntroductionSupernumerary teeth
(hyperdontia) may be dened as extrateethmore than twenty in the
deciduous dentition or morethan thirty-two in the permanent
dentition [1]. The etiologyof supernumerary teeth is not well
understood. Several the-orieshavebeenput
forwardtoexplaintheanomaly. Onetheory suggests that supernumeraries
are formed as a resultof local, conditionedhyperactivityof dental
laminawhileanother theory proposes dichotomy of tooth bud.
Heredityplays an important role in the occurrence of
supernumeraryteethbut does not followasimpleMendelianpattern.
Afamilial tendencyandsex-linkedinheritance(malesbeingaectedtwiceas
frequentlyas females) has beendemon-strated [24].Supernumerary
teeth occur in 0.3 to 3.8 percent of dif-ferent populations
andappear tobe onthe rise. Out ofthese 90 to 98 percent occur in
the maxilla with a particularpredilection for the premaxilla.
Supernumerary teeth may besingle or multiple, unilateral or
bilateral, erupted or
impact-edandinoneorbothjaws.Multiplesupernumeraryteethare rare and
usually seen in association with cleft lip/palate,Cleidocranial
dysplasia, Gardnerssyndrome, andsoforth[5, 6].Supernumerary teeth
may be classied according to theirform/morphology (supplemental or
rudimentary includingconical, tuberculate, andmolariformtypes)
andlocation(mesiodens, paramolar, and distomolar). Detection of
super-numeraryteethis best achievedwithathoroughclinicaland
radiographic examination. Many complications
canbeassociatedwithsupernumerarieslikecrowding, delayederuption,
impaction, abnormal diastema, cystic lesions, ec-topic eruption,
root resorptionof adjacent teeth, andsoforth. An early diagnosis
allows an early intervention, a morefavourable prognosis, and
minimal complications [7].The purpose of this study was to
investigate the charac-teristics of supernumerary teeth among
children who
report-edtoourspecialtyclinicandcomparethedatawithothersimilar
studies.2. Material and MethodA survey was performed on 21,824
patients (11,218 femalesand 10,606 males) attending the Department
of Pedodontics2 International Journal of DentistryTable 1:
Distribution of supernumerary teeth by dentition and sex.Denotes
statistically signicant values (P < 0.01).Type of dentition Male
Female Total P ValueDeciduous 15 5 20 0.002Mixed 142 39 181
0.001Permanent 67 32 99 0.017Total 224 76 300 0.002Table 2:
Distributionof supernumerary teethby number perpatient.Number of
teethper patientNumber of patientsPercentage ofsupernumerary
teethOne 237 79.0Two 60 20.0Three or more 03 01.0Total 300
100.0Table 3: Type of supernumerary tooth.Type Number
PercentageSupplemental (Eumorphic) 70 18.2Rudimentary (Dysmorphic):
Conical 230 59.7Tuberculate 55 14.3Molariform 30 07.8Total 385
100.0andPreventiveDentistry, GovernmentDental CollegeandHospital,
Rohtak, Haryana, India over a period of six years.Out of the total
population, 300 children with ages rangingfrom 4 to 14 years were
diagnosed with supernumerary teethin dierent regions of the dental
arches. Reasons for visitingincluded caries, malocclusion, lack of
eruption of permanentteeth, androutinedental checkup.
Thecharacteristicsofsupernumerary teeth were noted and diagnosis
made duringclinical and radiographic examination with help of
occlusal,periapical, and panoramic radiographs. The horizontal
shifttechnique was used to determine the sagittal position of
theimpactedsupernumeraryteeth. Surgical removal of teethwhen and
where indicated further conrmed the character-istics of
supernumeraries. Patients with syndromes known tobe predisposed to
supernumerary teeth such as Cleidocranialdysplasia, Gardners
syndrome, clefts of lip, and palate werenot included in the study.
All the radiographs were reviewedin a negatoscope and interexaminer
discrepancies weresolved by mutual consensus. The Pearson
chi-square test wasused to determine potential dierences in the
distribution ofsupernumeraryteethwhenstratiedbygender. Pvalueofless
than 0.01 was considered statistically signicant.3. ResultsOut of
300 patients, 224 were male, and 76 were female, thesex ratio was
2.9 : 1 (Table 1).The total number of supernumerary teeth was
385among the 300 patients. Majority of the patients had
singleFigure1: Radiographicappearanceof
aneruptedsupplemental21alongwithanuneruptedtuberculatesupernumerarytoothinmaxillary
central incisor region.Figure 2: Two unerupted normally oriented
conical supernumer-ary teeth causing failure of eruption of 11 and
21.supernumerarytooth(Table 2)whichwasconical inform(Table
3).Supernumerary teeth located in the premaxilla were 361(93.8%),
andout of these, 293(81.2%) supernumerarieswere located in the
central incisor region (Figure 1), of which88 (30.0%) were in
midline (mesiodens). Sixty-eight super-numerary teeth were seen in
maxillary lateral incisor region(18.8%). The remaining teeth were
located inpremolar(3.6%), canine (1.0%), and mandibular incisor
(1.5%)regions. Alarge percentage of supernumerary teeth
remainedunerupted (65%), while 35% were partially or fully
erupted(Figures 2 and 3).Rotation/displacement of adjacent
permanent teeth wasthe most frequently found complication. Three
cases ofdentigerouscystassociatedwithsupernumeraryteethweredetected
(Figure 4).In 4%of the patients fusion of supernumerary tooth
withthe adjacent normal tooth occurred. Talon cusp, an associ-ated
dental anomaly was seen in 5% of the cases (Figure 5).Talon cusp on
supernumerary teeth was observed in 2%of the patients (Figure
6).Sevenpatients withsupernumerary teethwere
foundhavingsimultaneouslycongenitallyabsentteeth(excludingthirdmolars),
that is, concomitant hypohyperdontia wasobserved in 2.3% of the
cases (Figure 7).International Journal of Dentistry
3Figure3:Bilateralunerupted(inverted)conicalmesiodentesob-served
during radiographic examination of fractured anterior
teeth.Figure4: Maxillaryocclusal
radiographshowingtwoimpactedsupernumeraryteeth.
Oneontherightsideisassociatedwitharadiolucency having sclerotic
border suggestive of dentigerous cyst.Figure 5: Occlusalradiograph
showingtalon cusp on 12and 22;fusion of 22 and supplemental
supernumerary 22.4. DiscussionTable
4providesanoverviewofstudiesdoneonsupernu-merary teeth in dierent
populations. Supernumerary teethmost commonly involved the
premaxilla which has also beenestablishedas the predominant
locationby others [2, 5,1113]. Supernumeraries appearedina variety
of forms(sizeandshape). Most commonwasconical,
followedbysupplemental, then by tuberculate and
molariformtypeFigure6: Awell-developedmesiodenswithtaloncusp:
atypicalsuperimposed inverted V-shaped radiopaque structure.Figure
7: Panoramic radiograph showing bilaterally erupted sup-plemental
mesiodentes; fusion of 61 and 62 and missing 22.(Table 3). Koch et
al. reported 56% conical, 12% tubercular,and 11% supplemental and
12% other congurations amongtheir patients [14]. In this study, 35%
of the supernumeraryteeth were erupted which is higher than that
reportedin Mckibbens study but comparable to Lius study [2,12].
Fewauthors have reportedaround20%of eruptedsupernumeraries [13,
15].Theassociationof taloncuspwithotherodontogenicanomalies
reported in the literature includes peg-shaped lat-eral incisors,
supernumeraryteeth, anddens
invaginatus,megadont[16,17].Veryfewcasesoftaloncusponsuper-numeraryteethhavebeenreported[18,
19]. Concomitanthypohyperdontia is a rare condition of mixed
numericvariationinhumandentition. It is
usuallymentionedasindividual case reports in the literature [20].
Its
prevalenceinorthodonticpatients(includingthirdmolars)hasbeenreported
to be 0.4% [21, 22]. In the present survey on Indianchildren,
ahighincidenceof other dental anomalies liketalon cusp and
concomitant hypodontia were seen to be asso-ciated with
supernumerary teeth while Celikoglu et al. foundnosuch
associateddentalanomaliesinTurkishpopulation[23].
Dentistsshouldtakecognizanceof associateddentalanomalies during the
examination for supernumerary teethso that a comprehensive
treatment can be rendered.Furthermore as supernumerary teeth are
often associatedwithdelayederuptionor impactionof permanent
teeth,early removal is recommended to facilitate the
spontaneouseruption of impacted permanent teeth [24]. In one
interest-ingstudyAshkenazi etal. demonstratedthatspontaneous4
International Journal of DentistryTable 4: Summary of various
studies carried out on supernumerary teeth in dierent
populations.Authors Sample size Country Age MethodTypes
ofsupernumeraryincludedMale : FemalePresent study300
childrendiagnosed withsupernumeraryteethIndia 414
YerasClinicalExamination andradiographsAll 2.9 : 1Tyrologou et
al.(2005) [8]97 children withdiagnosedmesiodensSweden 315
yearsClinical examinationand radiographsMesiodens 2 : 1Huang et
al.(1992) [9]152 children withdiagnosedsupernumeraryteethJordan 515
yearsClinical examinationand radiographsAll 2.2 : 1Liu (1995)
[2]112 children withdiagnosedsupernumeraryteeth in
thepremaxillaryregionsTaiwan 414 yearsClinical examinationand
radiographsIn the Premaxillaryregion.2.8 : 1von Arx (1992)[10]90
patients withanterior maxillarysupernumerarySwitzerland 610
yearsClinical examinationand radiographsIn the AnteriorMaxillary
region2.6 :
1eruptionofpermanentteethdependsonvariousvariableslikeapexdistanceof
theimpactedtoothrelativetoits-nal position, extent of vertical
impaction, morphologyofsupernumerary teeth, angle of impaction
relative to midline,and time of surgery. However the authors
recommended im-mediate orthodontic traction at the time of removal
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