ABSTRACT
Supernumerary teeth can have normal or abnormal morphologic structure and characteristics, and their impacted form is diagnosed usually during X-ray examinations. In this case report, the presented patient is a 16-year-old female with anterior and right posterior open bite and bilateral posterior crossbite, upper right supernumerary paramolar, and impacted second and third molars. The paramolar development was the reason for the asymmetric growth of the alveolar bone in the upper jaw. The development of the bone is connected with the development of the teeth, and one additional tooth leads to extensive development in the maxilla. There is a risk of gingival recession occurrence when leveling the lower incisors due to the thin gingival biotype. A combined surgical-orthodontic treatment was done according to the following plan: extraction of supernumerary paramolar, germectomy of the upper right third molar (18) and at the same time periodontal graft in the lower anterior segment. A digitally three-dimensional (3D) printed appliance for rapid maxillary expansion was used for the transverse insufficiency of the upper jaw. The upper dental arch expander was designed with distal extension in the area of the upper right second molar (17). The extension was used as an anchorage during the orthodontic traction of the second molar. The treatment continued with a fixed orthodontic appliance-braces in the upper and lower jaw. With the extraction of the impacted and supernumerary teeth in the right maxillary segment, the eruption of 17 was stimulated and a change in the height of the alveolar bone was achieved. This favored the vertical changes and normalization of the occlusion. The maxillary expansion was also a significant factor in normalizing the occlusion. Observations on paramolar behavior showed that more often they develop in the bone and do not erupt. Each clinical case is highly individual, and patients seek orthodontic treatment at different stages of dentition development and corresponding development of the supernumerary teeth.
ABSTRACT
In the process of odontogenesis, a disturbance in the formation of the epithelium and mesenchyme can be observed and this can be manifested by atypical forms of dental development. Such biological phenomena with altered morphology are as follows: dens invaginatus (DI), dens evaginatus (DE), talon cusps, and double teeth (DT) or connate teeth (fusion and gemination). Patients with orthodontic anomalies who also exhibit teeth with morphogenetic disorders are presented in this article. Dens evaginatus and talon cusps pose orthodontic challenges in the treatment finishing phase. These reduce the possibility of achieving maximum intercuspidation between the lower and upper front teeth as well as poor incisor guidance. Other orthodontic challenges are as follows: the risk of occlusal trauma and periodontal loading of the antagonists and the possibility of accessory cusps to play the role of the inclined plane and lead to deviations in the closure of the lower jaw. The fused teeth can cause aesthetic and occlusal disturbances in the anterior segment. Furthermore, double teeth can lead to ectopic eruption or noneruption of adjacent teeth due to their increased crown size as is the case with one of the presented patients. This is because a double tooth occupies more space in the dental arch. If not diagnosed early, impaction of the adjacent tooth, violation of the occlusal ratios (Bolton/anterior), and exacerbation of the orthodontic deformity can be observed. The modern CBCT imaging is the best diagnostic method for identifying problems related to tooth positions or tooth germs.
