Múltiples Dientes Supernumerarios en Paciente Pediátrico No Sindrómico. Una Revisión de la Literatura y Presentación de Caso Clínico / Multiple Supernumerary Teeth In A Non-Syndromic Pediatric Patient. A Review Of The Literature and Presentation of a Clinical Case

Aquellos casos en que se excede la fórmula dentaria normal primaria de 20 dientes o definitiva de 32 dientes se conocen como dientes supernumerarios o hiperodoncia. Los supernumerarios se pueden presentar de manera única o múltiple y de forma heteromórfica o eumórfica. El supernumerario más prevalente es el mesiodens, se da más en hombres, en dentición permanente y en el maxilar. Su etiología no está confirmada, pero puede deberse a una hiperactividad de la lámina dental. El tratamiento varía de acuerdo a cada paciente según si está afectando a la dentición normal o no y el desarrollo que tengan las estructuras dentarias. El siguiente reporte de caso habla de un paciente de 6 años, no sindrómico, en donde se presentó con un mesiodens erupcionado y se encontraron más supernumerarios gracias a la radiografía complementaria.

Those cases in which the primary normal dental formula of 20 teeth or the final one of 32 teeth is exceeded are known as supernumerary teeth or hyperdontia. The supernumeraries can be presented in a single or multiple way and in a heteromorphic or eumorphic way. The most prevalent supernumerary is the mesiodens, it occurs more in men, in the permanent dentition and in the maxilla. Its etiology is not confirmed, but it may be due to hyperactivity of the dental lamina. The treatment varies according to each patient depending on whether it is affecting the normal dentition or not and the development of the dental structures. The following case report talks about a 6-year-old, non- syndromic patient, who presented with an erupted mesiodens and more supernumeraries were found thanks to the complementary radiography.

Microdont Developing Outside the Alveolar Process and Within Oral Diffuse and Plexiform Neurofibroma in Neurofibromatosis Type 1.

BACKGROUND/AIM: Numerical aberrations of permanent dentition and dystopic tooth eruption are part of the phenotype of the tumor predisposition syndrome neurofibromatosis type 1 (NF1). In these cases, surplus tooth germs usually develop in the alveolar processes of the jaw. This report attests to the dystopic development of a dysplastic supernumerary tooth in NF1 arising outside the jaw. CASE REPORT: The 8-year-old male patient developed a microdont outside the bone and above the occlusal plane of the retained maxillary right second molar. The supernumerary tooth was completely embedded in oral soft tissue. Hyperplastic oral soft tissue in the molar region and microdont were excised. Specimen of the mucosa surrounding the teeth was interspersed with diffuse and plexiform neurofibroma. The retained upper right first molar emerged spontaneously within a few months after surgery. The upper right second molar did not change position. CONCLUSION: Odontogenesis can take place within tumorous oral mucosa in NF1. Surgical removal of the tumorous mucous membrane facilitates tooth eruption in some cases.

Three-dimensional evaluation of morphology and position of impacted supernumerary teeth in cases of cleidocranial dysplasia.

Cleidocranial dysplasia (CCD) is a congenital anomaly characterized by the presence of impacted supernumerary teeth and delayed eruption of permanent teeth. However, there has been no detailed investigation on supernumerary teeth in patients with CCD using three-dimensional (3D) imaging techniques. The purpose of this study was to elucidate the morphology and position of supernumerary teeth using 3D images reconstructed from cone-beam computed tomography (CBCT) data in a group of five Japanese subjects (male, 3; female, 2; age, 15.0-25.4 years) with CCD. All five subjects exhibited supernumerary teeth (39 in total; average, 7.8; range, 1-15). All supernumerary teeth were impacted and existed as pairs with adjacent permanent teeth. Comparison of the size (the crown and dental-root lengths, the crown mesiodistal and buccolingual diameters), the number of cusps and dental roots, the position, and direction of supernumerary teeth in relation to the adjacent permanent teeth was analyzed. The results of relationship analyses revealed that, at sites other than the molar region, supernumerary teeth were positioned on the lingual and distal sides and supernumerary teeth resembled the morphology of their adjacent permanent teeth in terms of the number of cusps but were smaller than the adjacent permanent teeth. In the molar region, supernumerary teeth were microdontia, which were apparently small and obscure morphologically. In addition, while all adjacent permanent teeth exhibited normal direction, five supernumerary teeth exhibited inverse direction. The findings of this study will improve our understanding of the characteristics of CCD and provide important information for the pathophysiology and clinical treatment.

Laser-assisted management of ectopic eruption of permanent incisors.

Ectopic eruption originates from the malpositioning of a tooth bud ending in the eruption of the tooth in an improper direction. This anomaly is a consequence of ectopic development of the tooth germ. This condition gives rise to significant aesthetic and occlusal issues in the early mixed dentition stage. The most frequently influenced teeth are the maxillary first molars, accompanied by the maxillary cuspids. Ectopic eruption is seldom seen and might derive from traumatic injury. In some cases, hyperplastic and fibrotic gingival tissue may lead to ectopic eruption of a permanent incisor. Managing ectopically erupting teeth generally rests on several reasons including extraction of supernumerary tooth, removal of cyst and excision of hyperplastic tissue and subsequent to orthodontic movement of tooth if necessary. In this case, the use of Er, Cr: YSGG lasers for the correction of hyperplastic soft tissues involving ectopically erupting permanent incisors are depicted considering two cases.

Unilateral supplemental maxillary lateral incisor: report of three rare cases and literature review.

Additional teeth to the normal dentition are called supernumerary teeth; they can be found in higher rates in permanent than in deciduous dentition, in both sexes, associated or not with other diseases or syndromes. The aim of this article is to report three rare cases of unilateral supplemental lateral incisors, in Romanian child and adult patients, and to evaluate the treatment options in each case, considering particularities such as age, physiognomy, associated issues and occlusion. The differential diagnosis between a supernumerary lateral incisor in formation and a rudimentary is sometimes difficult to make using only panoramic X-ray, so a cone-beam computed tomography analysis can be indicated. Usually, due to the pathological issues that they can cause, the supplemental maxillary lateral incisors are removed; although, in some cases, it may be necessary to remove the normal tooth, for example in cases of major crowding, in which the normal tooth is more displaced from the line of the arch than the supplemental one, or when there is a lack of periodontal support surrounding the normal tooth. This article highlights that even if, in younger patients, the majority of these teeth is extracted because later in life they can cause difficulties in orthodontic and prosthetic treatment, there are still rare cases which do not necessitate treatment, because they are asymptomatic, rather well aligned and go unnoticed. Also, the article includes a detailed literature review of reported cases of supplemental maxillary lateral incisor.

Modified maxillary vestibular approach with subperiostal intranasal dissection for surgical extractions of mesiodentes impacted in the floor of the nasal cavity.

INTRODUCTION: Impacted mesiodentes in the inverted position may interfere with the base of the nasal cavity or the nasal septum. They can rarely erupt into the nose as well. Traditionally they are extracted via intraoral approaches (transpalatal or vestibular). Also, an endoscopically assisted transnasal approach can be used. In this paper, the authors are the first to present a group of patients suffering from impacted mesiodentes who have been surgically treated using a modified maxillary vestibular approach with subperiostal intranasal dissection. MATERIAL AND METHOD: The prospective study was completed in the time period 12/2013-6/2017. The inclusion criteria were: 1. Mesiodens impacted in the inverted position extending to the base of the nasal cavity or into the nasal septum without concomitant pathological lesion and without eruption into the nasal cavity. 2. Localization of the mesiodens at the level of or dorsally to the roots of the upper middle incisors in the sagittal plane or ventrally to the roots of these teeth, but with the crown extending significantly posteriorly to the base of the nasal cavity.3. Indication for extraction because of clinical or orthodontic reasons. RESULTS: In total, 9 patients were enrolled into the group. In these patients, surgical extractions of 9 mesiodentes were performed using the alternative approach described above. All extractions were done according to a uniform surgical protocol. The mean age of the patients was 11.7 ± 3.1 years (age range 7-17 years). The crown's most cranial point exceeded the bone of the nasal cavity on average by2.0 ± 1.4 mm (in the range 0-5 mm). 8 mesiodentes were conical, 1 was tuberculate. Surgical procedure and postoperative healing were always without any complications. CONCLUSION: For the removal of midline supernumerary teeth, the modified maxillary vestibular approach with subperiostal intranasal dissection in comparison to the intraoral palatal approach provides less postoperative morbidity and a lower risk of complications (smaller surgical wound, minimal exposure of maxilla, minimal bone loss, reduced risk of damage to the roots of the upper incisors, lower risk of damage to the nasopalatine neurovascular bundle, good visibility in the surgical field, easier surgery, and finally no need of postoperative palatal splint). For oral and maxillofacial surgeons the presented technique represents a more traditional way of surgical tooth extraction than the endoscopically assisted transnasal approach.

Radiographic characteristics of mesiodens in a non-syndromic pediatric population in the Black Sea region.

AIM: A mesiodens is the most frequent type of supernumerary tooth. They can be related to several complications, such as ectopic eruption and midline diastema. The aim of the present study was to assess the radiographic properties of mesiodens by analyzing the associated age, sex distribution, number of mesiodens per patient, shape, direction of eruption, and their association with complications. METHODS: The present study was performed using panoramic radiographs of 14 400 pediatric patients (4-14 years old) who visited the Department of Pediatric Dentistry at Gaziosmanpasa University for a variety of dental complaints from 2015 to 2018. RESULTS: There were 82 mesiodens diagnosed in a total of 71 patients. Among the 82 mesiodens, 51 (62.1%) were conical in shape, which was the most commonly seen shape, followed by 14 supplemental (17.07%), and 12 (14.6%) tuberculate. Of the 82 mesiodens, 65 (79.2%) were aligned vertically, nine (10.9%) were inverted, and eight (9.7%) were horizontally placed. Clinical complications were observed in 76.8% of patients. CONCLUSION: The management of mesiodens can be performed using three methods: (a) spontaneous eruption; (b) early intervention; and (c) delayed intervention. However, the management of mesiodens should be evaluated on an individual basis to determine the best treatment method. Mesiodens-associated complications should be addressed prior to the lateral incisors erupting.

Multiple supernumerary teeth in a likely syndromic individual from prehistoric Illinois.

OBJECTIVE: This paper reports the first published case of a prehistoric human with five or more supernumerary teeth. Such cases are often neglected in paleopathology, in part due to a gap between the medicodental and anthropological literature leading to the view in anthropology that supernumerary teeth are curious anomalies rather than pathologies. DESIGN: Reconstruction and pathological description of the skeletal remains were performed according to standard osteological protocols. Each supernumerary tooth was categorized based on its morphology, location, and orientation. The dental characteristics of the individual were compared to published norms for incidences of syndromic and non-syndromic supernumerary teeth and a differential diagnosis was subsequently performed. RESULTS: Six supernumerary teeth and one deciduous tooth were identified. Additionally, the individual suffered from impacted teeth, dilacerated roots, and extensive sutural anomalies (including retention of the metopic suture into adulthood and an unusually high number of sutural bones). The morphology and location of the supernumerary teeth, in conjunction with the suite of other symptoms, are highly unusual among non-syndromic patients and therefore are indicative of a complex genetic disorder. CONCLUSIONS: The individual reported here almost certainly suffered from a genetic disorder or syndrome resulting in extensive dental and sutural abnormalities. Despite a lack of post-cranial involvement, a tentative diagnosis of Cleidocranial Dysplasia was made on the basis that mutations in the RUNX2 gene may cause the dental symptoms without any pathology of the clavicle.

Characterization of dental phenotype in patients with cleidocranial dysplasia using longitudinal data.

OBJECTIVE: To investigate the characteristics of the dental phenotype in patients with cleidocranial dysplasia (CCD) using longitudinal data. MATERIALS AND METHODS: Twelve unrelated Korean CCD patients were observed using a longitudinal series of radiographs and clinical photographs. Statistical analysis was performed on the dental phenotypic data. RESULTS: Although dysplasia of the clavicles, open fontanelle, and wormian bone were observed in all 12 patients, delayed fusion of the mandibular symphysis was found in four patients. One patient did not have a supernumerary tooth (ST). However, 62 STs were found in 11 patients (mean, 5.6 per patient; range of ST emergence, 5 years 6 months-14 years 8 months; developing position, occlusal to the permanent incisors, canines, and premolars and distal and apical to the permanent molars). The mandibular premolar region was the most frequent area of ST development (50.0%, P < .001). All 12 patients showed impacted permanent teeth (IPT), including one patient without ST (mean, 17.8 per patient). Impaction occurred most frequently in the mandibular premolar region and least frequently in the maxillary molar region (93.8% vs 39.6%, P < .01). The ratio of spontaneous eruption of IPT after removal of retained deciduous teeth and/or ST was highest for the maxillary and mandibular incisors (all 54.6%) and lowest for the mandibular canines and premolars (26.7% and 28.9%, respectively); however, the difference was not significant. CONCLUSIONS: The emergence time and development position of ST and the root development of IPT should be considered to determine the timing for the removal of ST and forced eruption of IPT.

Rare molariform supernumerary teeth: Why are they bilateral?

Anterior supernumerary teeth in the permanent dentition may be supplemental or rudimentary. Rudimentary types are further classified as conical, tuberculate, and molariform. The molariform type has been only rarely reported. We report a rare variety of anterior supernumerary teeth - the molariform type, occurring bilaterally and in association with a midline supernumerary tooth. We also suggest a hypothesis for the bilateral occurrence of supernumerary teeth.

Characterization of Coronal Pulp Cells and Radicular Pulp Cells in Human Teeth.

Dental pulp has garnered much attention as an easily accessible postnatal tissue source of high-quality mesenchymal stem cells (MSCs). Since the discovery of dental pulp stem cells (DPSCs) in permanent third molars, stem cells from human exfoliated deciduous teeth and from supernumerary teeth (mesiodentes) have been identified as a population distinct from DPSCs. Dental pulp is divided into 2 parts based on the developing stage: the coronal pulp and the radicular pulp. Root formation begins after the crown part is completed. We performed a sequential study to examine the differences between the characteristics of coronal pulp cells (CPCs) and radicular pulp cells (RPCs) from permanent teeth, mesiodentes, and deciduous teeth. Interestingly, although we have not obtained any data on the difference between CPCs and RPCs in permanent teeth, there are some differences between the characteristics of CPCs and RPCs from mesiodentes and deciduous teeth. The MSC characteristics differed between the RPCs and CPCs, and the reprogramming efficiency for the generation of induced pluripotent stem cells was greater in RPCs than in CPCs from deciduous teeth. The proportion of CD105+ cells in CPCs versus that in RPCs varied in mesiodentes but not in permanent teeth. The results indicate that the proportion of CD105+ cells is an effective means of characterizing dental pulp cells in mesiodentes. Taken together, the stem cells in deciduous and supernumerary teeth share many characteristics, such as a high proliferation rate and an immunophenotype similar to that of DPSCs. Thus, mesiodentes accidentally encountered on radiographs by the general dental practitioner might be useful for stem cell therapy.

Genetic analysis of non-syndromic familial multiple supernumerary premolars.

OBJECTIVE: Supernumerary teeth, a term describing a condition where patients have an abnormally large number of teeth, can be associated with non-syndromic or syndromic phenotypes. PDGFRs are cell surface tyrosine kinase receptors, and are involved in several aspects of tooth development. The purpose of this study was to identify causative genes of familial supernumerary teeth and the molecular pathogenesis of tooth number abnormalities through genetic analysis of a family that showed supernumerary premolars in two successive generations. MATERIAL AND METHODS: We recruited a Korean family with supernumerary premolars and performed mutational analyses to identify the underlying molecular genetic aetiology. RESULTS: Targeted exome sequencing identified a missense mutation in PDGFRB (c.C2053T, p.R685C). Sanger sequencing confirmed that three affected individuals in the patient's family were heterozygous for the mutation. CONCLUSIONS: This is the first report of a Korean family that carries a PDGFRB mutation potentially responsible for supernumerary premolars. Our results demonstrate the power of next-generation sequencing in rapidly determining the genetic aetiology of numerical tooth abnormalities.

A rare case of mandibulary parapremolars in siblings: case report and literature review.

Supernumerary teeth in permanent dentition are influenced by hereditary and environmental, having clinical variations such as location, number and morphology. Parapremolars can be found as a single supernumerary tooth or as multiple, usually in the lower jaw, sometimes in association with other types of supernumerary teeth. Familial inheritance often involves more than one generation. This paper presents a case of two brothers, one with only one parapremolar and a good oral status and hygiene, the other with poor hygiene, multiple parapremolars and one mesiodens, causing various complications. The aim of this paper is to show the presence of parapremolars in brothers with no other medical relevant history, located in the same site, and to point the influence of genetic factors in the etiology of supernumerary teeth. Along with a review of the literature, this article shows the importance of an early diagnosis and follow-up using successive panoramic radiographs of such cases, in order to limit or prevent the inflammatory, carious, periodontal and occlusal complications that can seriously affect both the jaws and the normal dentition.

Characteristics and sequelae of erupted supernumerary teeth: A study of 218 cases among Sri Lankan children.

AIM: In the present study, we investigated the characteristics and sequelae of erupted supernumerary teeth (ST) in a sample of Sri Lankan children. METHODS: Data were recorded from patients' clinical records, radiographs, models, and extracted teeth. RESULTS: The sample consisted of 239 ST from 218 patients. The mean age of the sample was 9.08 ± 2.47 years. The male-to-female ratio was 2.8:1. The majority (42.66%) of patients with ST were in aged 8-10 years. Many (94.94%) of the ST were located in the premaxilla (incisor), followed by the canine (4.22%), premolar (0.42%), and molar (0.42%) regions. The most common shape of ST teeth was conical. Malocclusion (59.83%) was the major problem associated with ST, and the clinical impact was highest on the 8-10-year age group. A strong association was observed between patients' age and clinical impact to the dentition (χ2 =42.09, P=.000). CONCLUSION: Because the majority of ST can lead to malocclusion, especially in mixed dentition, awareness, early detection, and timely clinical intervention of ST are recommended.

Sonodynamic effect of hematoporphyrin monomethyl ether on ligature-induced periodontitis in rats.

OBJECTIVES: The aim of this study was to perform a histological evaluation of sonodynamic therapy (SDT) of hematoporphyrin monomethyl ether (HMME) on artificially induced periodontal disease in rats. METHODS: Submerging ligatures were placed at the subgingival region of the first maxillary molar in rats. Eighty rats were randomly assigned into four groups: group 1 received no treatment; group 2 was subjected to 50 µg/mL HMME alone; group 3 was treated with low-intensity ultrasound alone (1 W/cm(2)); and group 4 was treated with 50 µg/mL HMME plus ultrasound irradiation (1 MHz, 30 minutes). Ten rats in each group were euthanized at 7 and 15 days, and periodontal tissue samples were taken for histological examination. RESULTS: The animals treated by SDT showed less bone loss (P<0.05) at all experimental periods than the other three groups. No significant differences were found between the control and HMME groups (P>0.05). CONCLUSION: Our results suggest that HMME-mediated SDT can effectively alleviate the periodontal tissue destruction in artificially induced periodontitis in rats. Hence, SDT may have good clinic potential as a noninvasive treatment of periodontal diseases.

Supernumerary fourth molar and dental pathologies in a Chalcolithic individual from the El Mirador Cave site (Sierra de Atapuerca, Burgos, Spain).

We present a middle-aged Chalcolithic male with a supernumerary distomolar in the mandible. The prevalence of supernumerary teeth in present-day populations is low, ranging from 0.1% to 3.4%; most supernumerary teeth are documented in the anterior and molar regions of the maxilla in present populations. However, the prevalence of supernumerary molars in past populations is still unknown. Moreover, a complete pathological study has been done of this individual. Maxilla, mandible and teeth have been analyzed searching for dental pathologies. A cone-beam computed tomography (CBCT) analysis of mandibular and maxillary fragments was performed to check the evidence of hyperdontia. Dental wear and maxillary alveolar bone have been analyzed with environmental scanning electron microscope (ESEM) to improve the diagnosis of an abscess and evidence of tooth picking. This individual shows a left distomolar in the mandible without any evidence of other supernumerary teeth. The fourth molar is not associated with any congenital disease. However, this individual suffered severe dental wear and a variety of oral pathologies such as, dental decay, abscesses, pulpitis, periodontal disease, toothpicking marks in an upper molar, arthritis of the temporomandibular joint and malocclusion associated with high masticatory loads. To our knowledge, this individual from El Mirador Cave (Sierra de Atapuerca, Spain) shows the most ancient case of a fourth molar documented. The poor oral health of this individual corresponds to the general dental health of Chalcolithic populations.

Characterization of mesenchymal progenitor cells in crown and root pulp from human mesiodentes.

OBJECTIVE: Mesiodentes are usually found in the central position of the upper or lower jaw as supernumerary teeth. Here, we obtained 10 mesiodentes and three permanent teeth (PT) and separated the dental pulp (DP) from these into crown and root portions. We then characterized and compared the isolated crown portion-derived cells (crown cells) with root portion-derived cells (root cells) using a range of in vitro assays. MATERIALS AND METHODS: Crown cells and root cells were examined for cell surface marker expression, colony-forming unit-fibroblast (CFU-F), cell proliferation, cell cycle characteristics and markers, and osteogenic and adipogenic differentiation. RESULTS: The proportion of CD105-positive cells (CD105(+) cells) in the crown cells vs the root cells varied among the mesiodentes, but not among the PT. When there were more CD105(+) cells in the root cells than in the crown cells, the root cells showed higher CFU-F, proliferation capacity, and osteogenic differentiation capacity. In contrast, when the crown cells contained more CD105(+) cells than the root cells, the crown cells showed the higher CFU-F, proliferation capacity, and osteogenic differentiation capacity. In addition, the sorted CD105(+) cells showed higher CFU-F and proliferation capacity than the sorted CD105(-) cells. CONCLUSION: These results indicated that proportion of CD105(+) cells is an effective means of characterizing DP-derived cells in mesiodentes.

Odontomas and supernumerary teeth: is there a common origin?

The aim of the present work is to analyze all scientific evidence to verify whether similarities supporting a unified explanation for odontomas and supernumerary teeth exist. A literature search was first conducted for epidemiologic studies indexed by PubMed, to verify their worldwide incidence. The analysis of the literature data shows some interesting similarities between odontomas and supernumerary teeth concerning their topographic distribution and pathologic manifestations. There is also some indication of common genetic and immuno-histochemical factors. Although from a nosological point of view, odontomas and supernumeraries are classified as distinct entities, they seem to be the expression of the same pathologic process, either malformative or hamartomatous.