A CASE REPORT ON IMPACTED TUBERCULATED SUPERNUMERARY TEETH

BY, DR.SRINIVAS.L.S POST GRADUATE STUDENT DR.SYAMALA REDDY DENTAL COLLEGE &HOSPITAL BENGALURU

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SUPERNUMERARY TOOTH (Hyperdontia)

Supernumerary teeth -a developmental disturbance during odontogenesis The first report of a supernumerary tooth appeared between AD 23 and 79. Supernumerary teeth may be Single or multiple, unilateral or bilateral,erupted or un erupted ,one or both jaws. It can be
(1)

Eumorphic

Heteromorphic/Dysmorphic

(2)

Classification

Classification position in the arch shape.(3) Position in the arch

in the midline-Mesiodens in the premolar region-Para-

premolars molars molars

in the molar region-Paradistal to the molars-Disto-

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According to shape

CONICAL

TUBERCULATE

MOLARIFORM MOLARIFORM

Epidemology

Prevalence -0.1-3.8% Male to female ratio- 2:1.

PREVELANCE

(4)

PERMANENT

0.10-3.6%(4) 0.02-1.9% 0.15-3.8%(5)

PRIMARY

PERMANENT

MESIODENS
PRIMARY

0-1.9%

Male to female of 2:1.

(5)

Etiopathogenesis

Represents Phylogenetic relic of extinct ancestors.

(6)

Dichotomy -suggests that the tooth bud is split to create two teeth.
(7)

Hyperactivity of the dental lamina (most widely supported).

(8)

Commonly associated with

Cleidocranial

dysplasia Gardners syndrome Also associated with cleft lip and palate

Clinical significance
Interfere with normal occlusion. Interfere with eruption of normal tooth. Aesthetic Delayed eruption Displacement Crowding Less commonly- odontogenic cysts & resorption

CASE REPORT

A 11year old male patient normal in his facial appearance, not exhibiting any physical or skeletal abnormality nor any symptoms suggestive of any syndromic background. His medical history was non contributory

Intra oral examination revealed all the teeth that are expected in a 11year old child,except maxillary left central incisor,which was missing.

Diagnostic aids

Patient was advised an OPG an IOPAR an Occlusal radiograph and Diagnostic cast was prepared

OPG

Diagnostic casts

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Treatment plan
Conclusions of radiographs, and clinical examination. Localization Clarks shift cone technique.

Surgical procedure

Conical mesiodens

Tuberculate mesiodens

7th day after surgery

After suture removal

Pre operative, post operative IOPAR. IOPAR of tuberculate mesiodens

Extracted specimens

The topmost specimen is barrel shaped with open apex. The specimen below is conical in shape

Tubercle

Incompletely formed root

After the extraction of the teeth,patient is recalled at regular interval for the followup regarding the impacted left central incisor . If needed surgical exposure followed by orthodontic intervention has to be carried out. The present case is unusual due to the presence of a two impacted mesiodens with an unusual morphology in a nonsyndromic patient.

References
1.Maya C, Ashok Kumar BR. Familial occurrence of mesiodens with unusual findings: Case report. Quintessence Int 1998;29:49-51. 2.Sharma A. Familial occurrence of mesiodens: A case report. J Indian Soc Pedo Prev Dent 2003;21:2. 3.RajabLD,Hamdan AM.Sypernumerary teeth .Review of the literature and a survey of 152 cases.Int J Paediatr Dent 2002 ;12:244-54 4. Arathi R, Ashwini R. Supernumerary teeth: A case report. J Indian Soc Pedo Prev Dent 2005;23:103-5. 5. Shashikiran ND, Reddy VV, Mandroli P. Molariform supernumerary tooth: A case report. J Indian Soc Pedo Prev Dent 2000;18:18-20. 6 . Rajendran R, Sivapathasundaram B. Shafer's textbook of oral pathology, 5 th ed. Elsevier: New Delhi, India; 2006. 7. Prabhu NT, Rebecca J, Munshi AK. Mesiodens in the primary dentition: A case report. J Indian Soc Pedo Prev Dent 1998;16:93-5. 8.von Arx T. Anterior maxillary supernumerary teeth: A clinical and radiographic study. Aus Dent J 1992;37:189-95. 9. Sedano HO, Gorlin RJ. Familial occurrence of mesiodens. Oral Surg Oral Med Oral Pathol 1969;27:3601. [PUBMED] 10. Primosch RE. Anterior supernumerary teeth and surgical intervention in children. Pediatr Dent 1981;3:20415. [PUBMED] 11. Ersin NK, Candan U, Alpoz AR, Akay C. Mesiodens in primary, mixed and permanent dentitions: A clinical and radiographic study. J Clin Pediatr Dent 2004;28:295-8. [PUBMED] 12. Peter Heasmen;Restorative Dentistry,Paediatrric and Orthodontics. 13. Eur J Paediatr Dent. 2004 Mar;5(1):35-40. [PUBMED]

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Thank you

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Diagnosis is not the end, but the beginning of practice.

Martin H. Fischer

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