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.

Pindborg tumor associated with a supernumerary tooth: a case report

The calcifying epithelial odontogenic tumor is a rare benign neoplasm that accounts for approximately 1% of all odontogenic tumors. Most of the cases occur in the posterior mandible, and a few involve the maxilla. Despite their relatively indolent biological behavior, tumors in the maxilla tend to grow fast. We report the case of a 33-year-old female patient exhibiting swelling in the right maxilla. An isodense area associated with an impacted supernumerary tooth was found on imaging examination. The histopathologic diagnosis was a calcifying epithelial odontogenic tumor. The treatment of choice was surgical removal of the lesion and associated dental elements. The patient has been followed up for 11 months and shows no signs of recurrence. Besides describing this case, we reviewed the literature on the association of calcifying epithelial odontogenic tumors with supernumerary teeth and found two case reports addressing this subject.

Tratamento cirúrgico de mesiodentes sob sedação consciente com óxido nitroso: relato de caso clínico / Surgical treatment of mesiodens under conscious sedation with nitrous oxide: clinical case report

Dentes supranumerários são caracterizados como um excesso no número de dentes da série normal. Os mesiodentes, definidos pela sua localização mediana aos incisivos centrais superiores, referem-se ao tipo de dente supranumerário mais comumente encontrado na cavidade oral, normalmente intraósseo e assintomático. A presença desses dentes pode ocasionar alterações na dentição permanente, mas a abordagem cirúrgica na fase da dentição mista mostra resultados satisfatórios no alinhamento dental espontâneo. Em pacientes pediátricos, a sedação consciente com óxido nitroso tem demonstrado ser uma alternativa segura e eficaz no controle do medo e da ansiedade. Objetivo: relatar um procedimento cirúrgico de remoção de dois mesiodentes em paciente pediátrico sob anestesia local associada à sedação com óxido nitroso. Relato de caso: paciente do sexo feminino, 11 anos de idade, necessitava de remoção cirúrgica de dois dentes supranumerários localizados em região anterior de maxila. Com a avaliação da tomografia computadorizada, pôde-se observar a posição em que ambos se encontravam. Realizou-se também a exodontia do elemento dentário 14, como solicitado pela ortodontista, para posterior continuidade do tratamento ortodôntico. Devido à complexidade cirúrgica e ao tempo operatório, considerando a idade da paciente e o possível aumento nos níveis de ansiedade, optou-se pela realização de sedação consciente com óxido nitroso. Conclusão: clinicamente, dentes supranumerários podem causar danos locais. O tratamento cirúrgico associado à sedação consciente mostrou-se bastante seguro e efetivo no controle comportamental, além de poder ser implementado na rotina ambulatorial.(AU)

Supernumerary teeth are defined as those in addition to the normal series. The mesiodens, is the most common supernumerary tooth and it is present in the midline between the two central incisors. It is usually intraosseous and asymptomatic. The presence of these teeth may cause changes in permanent dentition and the surgical approach in the mixed dentition phase shows satisfactory results in spontaneous dental alignment. In pediatric patients, conscious sedation with nitrous oxide has been shown to be a safe and effective alternative in controlling fear and anxiety. Objective. To report a surgical procedure for the removal of two mesiodens in a pediatric patient under local anesthesia associated with nitrous oxide sedation. Case report. 11-year-old female patient required surgical removal of two upper mesiodens. The computed tomography images assisted to indicate their exact position. The extraction of the upper right premolar (tooth #14) was also performed as requested by the orthodontist. Considering the patient's age and the possible increase in anxiety levels, along with surgical complexity and operative time, the conscious sedation with nitrous oxide was selected. Conclusion. Clinically, supernumerary teeth cause local damage and surgical treatment associated with conscious sedation has proved to be quite safe and effective in the behavioral control besides being able to be implemented in the outpatient routine.(AU)

Queratoquiste Odontogénico en un Paciente con Displasia Cleidocraneal: reporte de un Caso / Odontogenic Keratocyst in a Patient with Cleidocranial Dysplasia: case Report

RESUMEN: La displasia cleidocraneal (DCC), es un trastorno autosómico dominante poco común, que involucra principalmente a los huesos que se osifican por vía membranosa; afectando el cierre de fontanelas craneales y el desarrollo de las clavículas, además de anomalías dentales y vertebrales. El objetivo de este manuscrito fue reportar el caso de una paciente con DCC que presentó un queratoquiste odontogénico (QQO) intrasinusal. Presentamos el caso de una paciente de 81 años, diagnosticada en su niñez con DDC, que consultó por un desajuste protésico y molestias en relación a la zona del seno maxilar derecho. Clínicamente se observó desajuste de la prótesis y aumento de volumen de márgenes poco definidos en la zona maxilar derecha, color rosa coral; que se extendía por todo el margen hemimaxilar derecho hasta el fondo de vestíbulo; doloroso a la palpación, con un mes de evolución. Se solicitó CBCT, con el que se pudo verificar la presencia de un desarrollo tumoral de contenido similar a dentículos, ubicado en la totalidad del seno maxilar derecho; extendiéndose hasta el piso de la cavidad nasal y orbitaria. Se estableció la hipótesis diagnóstica de "odontoma compuesto". Se le intervino quirúrgicamente, bajo anestesia general, realizándose una excisión de la lesión; la que era de márgenes definidos, con cambios de coloración en tonos oscuros, con la inclusión de tres piezas dentarias; de aspecto maligno. Se logró enucleación completa, dejando remanente óseo limpio. La pieza fue enviada a estudio histopatológico. En informe histopatológico, describió la presencia de una lesion quistica con pared compatible con queratoquiste.

ABSTRACT: Cleidocranial dysplasia (CCD) is an uncommon autosomal dominant disorder that mainly involves bones that ossify via the membrane, affecting the closure of cranial fontanels and the development of the clavicles, as well as presenting dental and vertebral anomalies. The aim of this manuscritpt was to report a case of a patient with CCD who presented an intrasinusal odontogenic keratocyst.We present an 81-year-old female patient, diagnosed with this syndrome in childhood, who comes to our service for a prosthetic misalignment and discomfort of the right maxillary sinus area. Clinically, there was a mismatch of the prosthesis and an increase in the volume of undefined margins under it, coral pink color, which extended all over the right hemimaxillary margin to the bottom of the vestibule, painful on palpation, with a one month evolution. A CBCT was requested, which revealed the presence of a tumor development with content similar to denticles, located in the entire right maxillary sinus, extending to the floor of the nasal and orbital cavity. The diagnostic hypothesis of "compound odontoma" was established. The patient was operated on in the central ward, under general anesthesia performing the excisional biopsy of the lesion, which showed changes in coloration in dark tones, with defined edges, with the inclusion of three teeth showing malignancy aspects. Complete enucleation was achieved, leaving tumor-free clean bone remnant. In a histopathological report, the presence of a keratocyst wall was described, which is not very compatible given the appearance of the lesion, the presence of the dental pieces included in it, and the behavior of the lesion.

Dientes supernumerarios suplementarios en un paciente adulto parcialmente dentado: reporte de caso / Supplementary supernumerary teeth in a partially edentulous adult patient: case report

Aquellos casos en que se excede la cantidad normal de dientes para la fórmula primaria o definitiva se conocen como dientes supernumerarios o hiperodoncia. Esta puede presentarse de manera aislada o múltiple, unilateral o bilateral y afectar tanto a la maxila como a la mandíbula. Es más prevalente en hombres, en dentición permanente y en el maxilar, siendo el mesiodens el supernumerario encontrado con mayor frecuencia. Su etiología aún no está del todo clara, sin embargo, una hiperactividad de la lámina dental junto a una asociación de factores genéticos y ambientales sería la teoría más aceptada. Pueden ser asintomáticos y detectados solo en radiografías o pueden presentar manifestaciones clínicas como apiñamiento, retardo en la erupción, reabsorción radicular, diastemas entre otros. El tratamiento depende del tipo de diente y de su relación con las estructuras adyacentes. En el siguiente reporte presentamos el caso de un paciente de sexo masculino, de 54 años de edad, no sindrómico, desdentado parcial superior e inferior que acude a una consulta dental privada (Temuco) para solicitar tratamiento rehabilitador. En la radiografía panorámica de rutina se observan dos dientes supernumerarios, uno a cada lado de la mandíbula y en la región premolar. Al examinar este hallazgo con tomografía computarizada cone beam se determina que el supernumerario del lado derecho corresponde a un premolar suplementario y el de la izquierda a un supernumerario de morfología molariforme. En este caso se decide extraer los dientes debido a la localización de estos y a las implicancias con el tratamiento rehabilitador posterior.

Cases in which the normal amount of teeth is exceeded for the primary or permanent dentition formula, are known as supernumerary teeth or hyperdontia. This can occur in single, or multiple form, unilaterally or bilaterally, and affect both maxilla and mandible. It is more prevalent in men, in permanent dentition and in the maxilla; the mesiodens type being the most common supernumerary. Its etiology is still not entirely clear, however, hyperactivity of the dental lamina associated to genetic and environmental factors is the most accepted theory. Supernumerary teeth can be asymptomatic and can only be detected in radiographs. They can also present various clinical manifestations such as dental malposition, delay in dental eruption, root resorption and diastemas. Treatment depends on the type of tooth and its relation with adjacent structures. In the following report we present the case of an asymptomatic, upper and lower partially edentulous 54-year-old male patient, who requested rehabilitation treatment at a private dental clinic in Temuco, Chile. In routine panoramic radiography, two supernumerary teeth were observed, one on each side of the mandible and in the premolar region. Upon reviewing these findings with cone beam computed tomography, it was determined that the supernumerary on the right side corresponded to a supplementary premolar and the supernumerary on the left side corresponded to a supernumerary of molariform morphology. In this case we determined to extract the teeth, due to their location and impact on subsequent rehabilitation treatment.

Supernumerario distomolar en rama mandibular asociado a quiste dentígero. Presentación de un caso / Distomolar Supernumerary in the mandibular ramus associated with a dentigerous cyst. A case presentation

Introducción: Los dientes supernumerarios son anomalías donde hay un aumento de la fórmula dental normal. Ocasionalmente provocan complicaciones, como la formación de un quiste dentígero. Por lo infrecuente del hallazgo, y más aún del reporte de esta asociación, se realizó la presentación del caso. Objetivo: Describir el manejo de un supernumerario distomolar en rama mandibular asociado a un quiste dentígero, enfatizando en la importancia de los estudios imaginológicos preoperatorios y el abordaje quirúrgico endobucal. Presentación del caso: Paciente femenina de 34 años, que se extrajo los terceros molares en la adolescencia, y que 3 meses atrás presentó una celulitis facial por la que se le realizó una ortopantomografía, y se detectó un molar en la rama mandibular. Al examen bucal se encontró ligera expansión de la tabla vestibular de rama mandibular izquierda. Se constató en la ortopantomografía la presencia de una estructura dentaria del grupo molar asociada a área radiolúcida, lo que se corroboró en una tomografía. Se planificó la exéresis de ambos mediante abordaje endobucal bajo anestesia general. No se presentaron complicaciones. La paciente fue egresada a las 24 horas y fue seguida evolutivamente por consulta externa durante 6 meses. El diagnóstico histopatológico indicó la presencia de un quiste. Conclusiones: La detección de un diente supernumerio distomolar en rama mandibular asociado a quiste dentígero es una situación clínica infrecuente que permite explotar los beneficios de estudios imaginológicos digitales y crear un plan de tratamiento que culmine en la exéresis exitosa por vía endobucal, sin complicaciones(AU)

Introduction: Supernumerary teeth are anomalies in which there is an increase of the normal dental formula. They occasionally cause complications, such as the formation of a dentigerous cyst. Because of the unusual finding, and even more because of the report of this association, a case presentation is carried out. Objective: To describe the management of a supernumerary distomolar in the mandibular ramus associated with a dentigerous cyst, making emphasis on the importance of the preoperative imaging studies and the endo-buccal surgery approach. Case presentation: 34 years old female patient from whom the third molars were removed during adolescence, who presented facial cellulitis 3 months before the molars removal, which was a reason to perform an orthopantomography. Then, a molar in the mandibular ramus was detected. During oral examination, a light vestibular table expansion in the left mandibular ramus was found. The presence of a dental structure from the molar group which was associated with a radiolucent area was confirmed by orthopantomography, and was also confirmed by CT-scan. Exeresis of both molars under general anesthesia was planned, with an endo-buccal approach. There were no complications. The patient was discharged 24 hours later, and was treated in the outpatient consulting room for 6 months. Histopathological diagnosis revealed the presence of a cyst(AU) Conclusions: The finding of a supernumerary distomolar tooth in the mandibular ramus associated with a dentigerous cyst is an infrequent clinical situation that allows to make good use of the benefits of digital imaging studies, and implement a treatment plan that ends in a successful exeresis via an endo-buccal route, without any complications(AU)

Cone beam computed tomography for evaluation of impacted supernumerary teeth: a case report / Tomografía computarizada con haz de cono para evaluación de dientes supernumerarios impactados: reporte de caso

Supernumerary paramolars are the rare anomalies of the maxillofacial complex. These are more common in the maxilla than in the mandible. Supernumerary teeth are an infrequent developmental alteration that can appear in any area of the dental arches and which are often associated with several syndromes such as cleidocranial dysplasia or Gardner syndrome. Multiple supernumerary teeth in individuals with no other associated diseases or syndromes are very uncommon. Objective: To evaluate the value of cone-beam CT (CBCT) in the diagnosis and orientation of supernumerary teeth in the dental arches. Treatment: After taking a cone beam computed tomograph (CBCT), surgical extraction was performed under local anaesthesia. Conclusion: The position of the supernumerary teeth is varied in the maxilla, and often causes permanent dentition complications. CBCT imaging yields accurate 3-dimensional pictures of supernumerary teeth, local dental and bony structures, which is helpful for diagnosis and orientation of supernumerary teeth. Cone beam computed tomography is crucial for exact localization, for treatment planning, and for the surgical approach in cases of multiple supernumerary teeth.

Hallazgos imagenológicos de dens in dente tipo II con formato de odontoma dilatado en un mesiodiente / Imaging findings of a dilated odontoma shaped type II dens in dente in a mesiodens

Introduction: there are three types of dens in dente: Type I, minimal invagination confined to the crown of the tooth which does not extend beyond the amelocemental junction; Type II, invagination extends to the pulp chamber, but remains within the root canal with no communication with the periodontal ligament; and Type III, invagination extends to the root of the affected tooth, beyond the cementoenamel junction. The term dilated odontoma is used to describe the most severe variant of invagination (Type III), which is characterized by crown and/or root dilation of the affected tooth. Objective: describe a rare case of a dilated odontoma shaped dens in dente in a mesiodens and its imaging findings, diagnosed by cone beam computed tomography. Case presentation: a 14-year-old male patient was referred for radiographic examination of the mandible and maxilla to determine the cause of abnormal tooth eruption chronology. Two mesiodens were found on the maxilla. Due to the peculiar morphology of the mesiodens on the right side, cone beam computed tomography was performed. Multiplanar reconstructions revealed an oval structure on the eruption path of the upper right central incisor, in contact with its palatal surface. Coronal and sagittal reconstructions showed that invagination extended beyond the cementoenamel junction, without any additional apical/lateral formation. Conclusions: the final diagnosis was dilated odontoma shaped type II dens invaginatus in a mesiodens(AU)

Introducción: existen tres categorías de dens in dente: Tipo I, invaginación mínima confinada a la corona del diente y que no se extiende más allá de la unión amelo-cementaria; Tipo II, la invaginación se extiende a la cámara de la pulpa, pero permanece dentro del canal de la raíz, sin comunicación con el ligamento periodontal; y Tipo III, la invaginación se extiende a la raíz del diente afectado, más allá de la unión cemento-esmalte. El término odontoma dilatado se utiliza para describir la variante más grave de la invaginación (tipo III), que se caracteriza por la dilatación de la corona y/o laraíz del diente afectado. Objetivo: describir un caso raro de un dens in dente con formato de odontoma dilatado en un mesiodiente y sus hallazgos imagenológicos, diagnosticados mediante tomografía computarizada de haz cónico. Presentación del caso: paciente varón, 14 años de edad, fue enviado a un servicio de Radiología Odontológica con el fin de determinar la causa de anómala cronología de la erupción dental en maxilar superior y mandíbula. Dos mesiodientes fueron identificados en el maxilar superior. El mesiodiente del lado derecho llamó la atención debido a su peculiar morfología, por lo que se realizó la tomografía computarizada de haz cónico. Las reconstrucciones multiplanares revelaron una estructura ovalada ubicada en el trayecto de erupción del incisivo central superior derecho, en contacto con su superficie palatina. Reconstrucciones coronales y sagitales demostraron que era posible identificar la extensión de la invaginación más allá de la unión cemento-esmalte, sin constitución de forma apical/lateral accesoria. Conclusiones: el diagnóstico final fue dens invaginatus tipo II en forma de odontoma dilatado en un mesiodiente(AU)

An Unusual Single Quadrant Dental Anomaly: A Case Report.

Anomalies of the dentition present real challenges to the dental practitioner. The occurrence of multiple supernumerary teeth in the absence of an associated systemic condition or syndrome is considered as a rare phenomenon. Here, we discuss a case of four supernumerary teeth in one maxillary quadrant with a fusion of supernumerary tooth to maxillary permanent central incisor, which was evident on radiological and clinical examination. Various radiographic views including intraoral periapical radiograph, maxillary occlusal radiograph, orthopantomograph, and cone-beam computed tomographic (CBCT) imaging were done to identify and locate the presence of supernumerary and supplemental teeth. The present case emphasizes the importance of different radiographic views and modalities in correct identification of the dental anomalies and thereby providing a prompt diagnosis and treatment as the exact identification of supernumerary teeth and differentiating it from permanent tooth is of prime importance in treatment planning and management.

Non-syndromic Multiple Supernumerary Teeth:A Case Report and Review of Literature.

Supernumerary teeth are regarded as an anomalous increase in the number of naturally occurring teeth. Multiple supernumerary teeth can be seen in association with syndromes such as Cleidocranial dysplasia, Gardner’s syndrome, Fabry-Anderson syndrome and Ehlers-Danlos syndrome. Non-syndromic occurrence however is a rarity and very few reported cases exist. Th e exact etiopathogenesis of the condition remains unknown, but several theories have been proposed, the most popular one being “hyperactivity of dental lamina.” When present, supernumeraries often pose a problem to the normal development and eruption of the neighboring dentition. Most of them are accidental fi ndings on radiographs, which also happens to be the most reliable tool in early diagnosis of this abnormality. We describe a case of 28-year-old male having 10 supernumerary teeth with non-syndromic association, which were diagnosed during routine radiographic evaluation.

Multiple Supernumerary Teeth in a Non Syndromic Patient: Case Report.

Supernumerary teeth, also known as hyperdontia, is a term used to describe extra teeth that develop in addition to the 20 primary and 32 permanent teeth that we are predisposed to have. Hyperdontia is seen more commonly in the permanent dentition than primary teeth. Th e incidence in the permanent dentition is reported to vary between 0.1% and 3.8%, and its frequency in the primary dentition is found to be 0.3-0.8%. A 32-year-old male patient reported to the department of oral medicine and radiology with the chief complaint of stains and deposits, his clinical examination revealed 9 supernumerary teeth and panoramic radiographic revealed 3 more extra making a total of 12 supernumerary teeth.

Pre-orthodontic assessment of a non-syndromic multiple supernumerary teeth with cone beam imaging

Multiple supernumerary teeth or hyperdontia can be associated with several syndromes, or it can be present in patients without systemic diseases. The presence of supernumerary teeth, which is relatively a frequent disorder of odontogenesis, is characterized by an excess number of teeth that appears in any area of the dental arches. It can affect any dental organ and usually is associated with different alterations such as: over retained teeth or delayed eruption, dental malposition or occlusal problems. The use of non-conventional radiographic imaging techniques [cone beam] during any pre-orthodontic assessment is a valuable tool that helps make the early diagnosis of these types of abnormalities in order to formulate an ideal orthodontic treatment plan. A routine panoramic radiograph for a 24-year-old male showed the presence of multiple supernumerary teeth which were located in the four quadrants of his mouth. The family's medical history was non-contributory, and an extra-oral examination did not reveal any abnormality. A cone beam computed tomography examination was performed for more details

Clinical and intraoral findings of a patient with tricho-rhino-phalangeal syndrome type I.

Tricho-rhino-phalangeal syndrome (TRPS) is a rare and an autosomal dominant disorder having the following characteristics: slowly growing sparse hair, medially thick and laterally thin eyebrows, bulbous tip of the nose, long flat philtrum and thin upper lip with vermilion border, protruding ears, cone-shaped epiphyses and swelling. Our report intends to introduce TRPS to the dental literature and to present oral, clinical and radiological data of a patient with TRPS. A rare association of supernumerary teeth was also diagnosed and one of them was extracted as it impeded on the eruption path of left premolar tooth.

Supplemental premolars in a 13 year old child--a case report.

A case of 13 old year is presented with supernumerary maxillary premolars one on either side. Radiograph revealed presence of five more supernumerary teeth unerupted in both maxilla and mandible. The implications of early diagnosis and management to prevent further complications are discussed.

Panoramic radiography

Panoramic radiograph can provide an additional diagnostic information. However we realise that panoramic radiographs are adjuncts to and not substitutes for good radiogrph