Study protocol for the management of impacted maxillary central incisors: a multicentre randomised clinical trial: the iMAC Trial.

BACKGROUND: Failure of eruption of the maxillary permanent incisor teeth usually presents in the mixed dentition between the ages of 7 and 9 years. Missing and unerupted maxillary incisors can be regarded as unattractive and have a potentially negative impact on facial and dental aesthetics. The presence of a supernumerary tooth (or odontoma) is commonly responsible for failed eruption or impaction of the permanent maxillary incisors. The primary objective of this trial is to investigate the success of eruption associated with maxillary incisor teeth that have failed to erupt because of a supernumerary tooth in the anterior maxilla. METHODS: This protocol describes an interventional multicentre two-arm randomised clinical trial. Participants meeting the eligibility criteria will be randomised (unrestricted equal participant allocation [1:1]) to either space creation with an orthodontic appliance, removal of the supernumerary tooth and application of direct orthodontic traction or space creation with an orthodontic appliance, removal of the supernumerary tooth and monitoring. The primary outcome of this trial is to determine the prevalence of successfully erupted maxillary central permanent incisors at 6 months following removal of the supernumerary tooth. Secondary outcome measures include (1) the effect of initial tooth position (assessed radiographically) on time taken for the tooth to erupt, (2) time taken to align the unerupted tooth to the correct occlusal position, (3) gingival aesthetics and (4) changes in the self-reported Oral Health Related-Quality of Life (OHRQoL) (pre-and post-treatment). DISCUSSION: There is a lack of high-quality robust prospective studies comparing the effectiveness of interventions to manage this condition. Furthermore, the UK national clinical guidelines have highlighted a lack of definitive treatment protocols for the management of children who present with an unerupted maxillary incisor due to the presence of a supernumerary tooth. The results of this trial will inform future treatment guidelines for the management of this condition in young children. TRIAL REGISTRATION: ISRCTN Registry ISRCTN12709966 . Registered on 16 June 2022.

Endodontic Management of a Fused Mandibular Third Molar with Supernumerary Tooth Using Cone-Beam Computed Tomography: A Case Report.

BACKGROUND Dental fusion is a developmental dental anomaly that clinicians must be aware of and able to identify. It results from the union of 2 adjacent tooth germs affecting the normal dentition and leads to a decrease in the number of permanent teeth. Clinically, the fused teeth show excessive width and irregular anatomy and can complicate any endodontic intervention. CASE REPORT A 26-year-old male patient presented to the clinic with severe pain related to the lower right mandibular area. The dental examination revealed a large tilted and irregular fused third molar with the fourth molar. The endodontic findings suggested a diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis. An intraoral periapical radiograph revealed fused molars with an irregular morphology and a wide mesiodistal width. Cone beam computed tomography (CBCT) was performed after obtaining consent from the patient. The morphology of the involved tooth was obtained in sagittal, coronal, and axial CBCT slices of 0.13 mm. The pulp chamber was continuous, and the number of canals was 5 in the 3-dimensional view before initiating endodontic treatment. After we discussed the options with the patient, he decided to proceed with nonsurgical root canal treatment for the fused molar. A successful management of a fused third molar with a supernumerary tooth was performed, and a 6-month follow-up radiograph showed normal apical tissue with absence of tenderness on percussion or palpation. No clinical swelling or sinus tract swelling was observed. CONCLUSIONS This case report indicates that a proper treatment plan ensures predictable outcomes by the use of all available diagnostic tools.

Management of prematurely erupted teeth in newborns.

The majority of natal and neonatal teeth are prematurely erupted primary teeth, whereas few are supernumerary in origin. They most commonly occur in mandibular central incisor region and often can lead to difficulty to the mother during breast feeding and tongue ulceration in newborn. Moreover, since majority of these have poorly developed roots and are mobile, there is always a fear of aspiration into respiratory passage. Extraction therefore is the most commonly rendered treatment for these teeth. This paper comprises cases of natal and neonatal teeth describing about their clinical characteristics and sequel. This paper has also highlighted the factor which needs to be considered during the management of natal/neonatal teeth and protocol followed at our centre.

Multidisciplinary management of an impacted maxillary central incisor associated with supernumerary teeth: a case report.

Permanent maxillary central incisor impaction is a rare condition of multifactorial etiology that should be treated on diagnosis. This article describes multidisciplinary treatment of an 11-year-old patient presenting with a permanent maxillary right central incisor that was impacted due to the presence of 2 supernumerary teeth. The diagnosis was reached through clinical evaluation, radiography, and cone beam computed tomography. Treatment involved the surgical removal of the supernumerary teeth followed by traction of the impacted tooth through a combination of removable and fixed orthodontic appliances. Orthodontic treatment was completed after 18 months, resulting in adequate positioning of the right central incisor in the arch. Periodic follow-up visits were scheduled for prophylaxis and oral hygiene reinforcement. After 2 years, the teeth were adequately aligned, the gingiva was healthy, and the patient was esthetically satisfied. The multidisciplinary approach allowed functional and esthetic oral rehabilitation, thus helping the patient to avoid the psychological impact of a missing anterior tooth.

Virtual orthodontic setup in orthodontic camouflage planning for skeletal Class III malocclusion.

The purpose of this paper was to emphasize the importance of the orthodontic setup in treatment planning for skeletal Class III malocclusion correction in an adult patient with moderate lower anterior crowding and anterior crossbite associated with two supernumerary lower incisors.

Pre-maxillary hypohyperdontia: a report of two cases.

BACKGROUND: Hypodontia and hyperdontia are considered to be at opposite ends of the dental development spectrum. Nevertheless, these anomalies may occur concomitantly (hypohyperdontia). CASE REPORT: This clinical report describes two case of hypohyperdontia occurring exclusively in the premaxillary region, and the difficulties associated with its diagnosis and management. Following 24 months of follow-up examinations, Case 1 developed a sequential supernumerary tooth in the tooth 35 region. CONCLUSION: Cases of hypohyperdontia can occur exclusively in the premaxillary region and may be difficult to diagnose. Multidisciplinary treatment planning is essential to facilitate appropriate management, and long-term follow-up is necessary as sequential supernumerary teeth may develop.

A patient with mandibular deviation and 3 mandibular incisors treated with asymmetrically bent improved superelastic nickel-titanium alloy wires.

Skeletal and dental discrepancies cause asymmetric malocclusions in orthodontic patients. It is difficult to achieve adequate functional occlusion and guidance in patients with congenital absence of a mandibular incisor due to the tooth-size discrepancy. Here, we describe the orthodontic treatment of a 22-year-old woman with an asymmetric Angle Class II malocclusion, mandibular deviation to the left, and 3 mandibular incisors. The anterior teeth and maxillary canines were crowded. We used an improved superelastic nickel-titanium alloy wire (Tomy International, Tokyo, Japan) to compensate for the asymmetric mandibular arch and an asymmetrically bent archwire to move the maxillary molars distally. A skeletal anchorage system provided traction for intermaxillary elastics, and extractions were not needed. We alleviated the crowding and created an ideal occlusion with proper overjet, overbite, and anterior guidance with Class I canine and molar relationships. This method of treatment with an asymmetrically bent nickel-titanium alloy wire provided proper Class I occlusion and anterior guidance despite the mandibular deviation to the left and 3 mandibular incisors, without the need for extractions.

Endodontic Management of Dilacerated Maxillary Central Incisor fused to a Supernumerary Tooth using Cone Beam Computed Tomography: An Unusual Clinical Presentation.

AIM: The purpose of this report is to present a case of endodontic management of a dilacerated maxillary central incisor fused to supernumerary tooth unusually appearing as a labial tubercle using cone beam computed tomography (CBCT) as a diagnostic aid. BACKGROUND: Anterior teeth are commonly encountered with aberrant anatomical variations in the crown, number of roots, and root canals. Fusion is an infrequent developmental abnormality in shape of the tooth caused by the union of two adjacent tooth germs. A complete knowledge of such complex anatomies is mandatory for a successful root canal treatment. It highlights the endodontic and restorative approach in the functional and esthetic rehabilitation of the involved tooth. CASE REPORT: Three-dimensional imaging using CBCT was used in this case to differentiate single labial canal and palatal C-shaped canal. The endodontic treatment was performed with the aid of dental operating microscope, and the root canals were obturated with a combination of single cone, carrier based, and cold flowable gutta-percha obturation system. The tooth remained asymptomatic without reinfection and symptoms of failure for 18 months. CONCLUSION: Cone beam computed tomography is indispensable in treatment planning for cases where the radiographs cannot reveal useful information regarding the root canal shape. Postobturation CBCT has helped in avoiding further retreatment of the tooth, which otherwise is a challenging task. CLINICAL SIGNIFICANCE: The use of sophisticated equipment, such as dental operating microscope and CBCT has helped in accurate diagnosis and treatment planning of fused central incisor respectively.

The epidemiology of supernumerary teeth and the associated molecular mechanism.

Supernumerary teeth are common clinical dental anomalies. Although various studies have provided abundant information regarding genes and signaling pathways involved in tooth morphogenesis, which include Wnt, FGF, BMP, and Shh, the molecular mechanism of tooth formation, especially for supernumerary teeth, is still unclear. In the population, some cases of supernumerary teeth are sporadic, while others are syndrome-related with familial hereditary. The prompt and accurate diagnosis of syndrome related supernumerary teeth is quite important for some distinctive disorders. Mice are the most commonly used model system for investigating supernumerary teeth. The upregulation of Wnt and Shh signaling in the dental epithelium results in the formation of multiple supernumerary teeth in mice. Understanding the molecular mechanism of supernumerary teeth is also a component of understanding tooth formation in general and provides clinical guidance for early diagnosis and treatment in the future.

[Supernumerary teeth in the maxilla and mandible-an interdisciplinary challenge. Part 2: diagnostic pathways and current therapeutic concepts]. / Überzählige Zähne im Ober- und Unterkiefer – eine interdisziplinäre Herausforderung Teil 2: Diagnostik und therapeutische Konzepte.

Proper localization of supernumerary teeth is very important for the diagnosis, treatment planning, and prior to any surgical intervention. Traditionally, supernumerary teeth were diagnosed and located using two-dimensional (2D) radiographic methods such as panoramic views, cephalometric imaging, and also intraoral (also often occlusal) radiographs. With the introduction of cone beam computed tomography (CBCT) in dental medicine, this three-dimensional (3D) imaging technique is now more and more used for the exact localisation of supernumerary teeth and the diagnosis of root resorption of adjacent teeth. Treatment planning depends on various factors such as the time of diagnosis, the age of the patient, the position of the supernumerary tooth and possible complications. In the present second part of this review article on supernumerary teeth in the maxilla and mandible, the diagnostic workflow and current treatment concepts will be presented and critically discussed.

[Supernumerary teeth in the maxilla and mandible-an interdisciplinary challenge. Part 1: epidemiology, etiology, classification and associated complications]. / Überzählige Zähne im Ober- und Unterkiefer – eine interdisziplinäre Herausforderung.

Supernumerary teeth develop in addition to the normal dentition and are a therapeutic challenge for pedodontists, orthodontists and oral surgeons alike. Therefore, interdisciplinary treatment concepts are needed for the benefit of the patient. In the present, two-parted literature review on supernumerary teeth, current classification, associated complications, diagnostic steps and different therapeutic approches are presented and discussed. Supernumerary teeth are diagnosed in the primary and permanent dentition. Supernumerary incisors, canines, premolars, and molars, as well as distomolars and mesiodentes can be seen according to the location of the supernumerary teeth. Furthermore, based on the morphology of the supernumeraries four different types can be differentiated: conical, tuberculate, supplemental, and odontoma. Supernumerary teeth often remain asymptomatic, and are only diagnosed incidentally during a routine dental visit on radiographs (often intraoral). Nevertheless, various complications have been reported in the literature for supernumerary teeth such as disturbed eruption, malpositioning/rotation, root resorption of neighbouring teeth, and development of dentigerous cysts in impacted supernumeraries. Root resorption of neighbouring teeth can be radiographically diagnosed in up to 22.8% of the cases.

Six upper incisors: what's next?

BACKGROUND: This case report describes our therapeutic approach taken in a girl with eruption disturbance of the upper anterior teeth. Two supernumerary teeth were involved, which required a combination of orthodontic and surgical treatment. DIAGNOSIS: The initial situation in the upper anterior segment was characterized by two supernumerary mesial incisors, ectopic eruption of the distally located lateral incisors, and crowded tooth buds in the canine areas. Key decisions had to be made as to whether any teeth needed to be extracted and, if so, regarding the timing and sites of extraction. Removing teeth too early would have preempted a complete assessment of tooth quality, whereas late extraction would have carried a risk of eruption disturbance. TREATMENT: Once the distal lateral incisors had erupted, the supernumerary mesial incisors were extracted and the central incisors (initially located in between) mesialized with a bracket appliance. Following space closure and mesialization of the lateral incisors, a functional appliance was used. Tooth 13 was erupting, while tooth 23 was displaced and subsequently aligned as part of the final bracket treatment. CONCLUSION: To successfully treat eruption disturbances, a careful diagnostic workup is essential, including informative radiographs, personalized treatment planning, and correct decision-making as to whether teeth need to be extracted and regarding the timing and sites of extraction. Finally, the eruption of the canines should be monitored.

Management of Unusual Rotation of Maxillary Central Incisor with Impacted Mesiodens: Case Report.

Supernumerary teeth are frequently found in the maxillary anterior region, largely in permanent dentition (rare in deciduous dentition). Shape of the supernumerary teeth may vary from conical, tueberculate, supplemental to odontome. Mesiodens is a conical type of supernumerary teeth located in the maxillary central incisor region and is generally unerupted. Presence of mesiodens may result in rotation, uneruption, or malalignment of adjacent maxillary incisors. In this article, we present a case report of unusual rotation of maxillary central incisor with impacted mesiodens.

Combined Surgical Removal of a Supernumerary Tooth and Orthodontic Traction of an Impacted Maxillary Central Incisor.

Impaction of permanent maxillary central incisors is a rare condition that can affect esthetics and oral function. The etiology of impaction is multifactorial and may be related to embryologic reasons, hereditary factors, mechanical obstacles, and pathologic elements, such as the presence of supernumerary teeth. The purpose of this report is to discuss the case of a 10-year-old patient who presented an impacted permanent maxillary right central incisor due to a supernumerary tooth. Surgical removal of the supernumerary tooth and orthodontic traction of the impacted central incisor by the closed eruption technique were performed. After 12 months, the permanent maxillary right central incisor was adequately positioned in the arch. The multidisciplinary treatment allowed the functional and esthetic rehabilitation to happen in a short period of time, thus reducing the patient's psychological impact caused by the lack of an anterior tooth.

Supernumerarios / Supernumerary teeth

En este artículo se describen los supernumerarios, las diversas teorías sobre su etiología, su frecuencia y lasalteraciones que pueden producir. Además, se dan pautas para su tratamiento. Los supernumerarios son anomalías del desarrollo que se encuentran con poca frecuencia, del 0,30 por ciento al 3,80 por ciento de la población, pero en pacientes con labio ypaladar fisurado pueden llegar al 28 por ciento. Se los puede definir como dientes adicionales a la serie dental normal. Se los encuentra raramente en ladentición primaria, en esta la distribución por sexo es similar; mientras que en la dentición permanente el sexo masculino prevalece en una proporción de 2 a 1. El mesiodens es el que se encuentra con mayor frecuencia. Constituye, según Shafer y Cols, más del50 por ciento de todos los supernumerarios...

Diagnosis and Endodontic Management of Fused Mandibular Second Molar and Paramolar with Concrescent Supernumerary Tooth Using Cone-beam CT and 3-D Printing Technology: A Case Report.

Supernumerary teeth in the molar area are classified as paramolars or distomolars based on location. They occur frequently in the maxilla, but only rarely in the mandible. These teeth are frequently fused with adjacent teeth. When this occurs, the pulp cavities may also be connected. This makes diagnosis and planning of endodontic treatment extremely difficult. Here we report a case of a mandibular second molar fused with a paramolar, necessitating dental pulp treatment. Intraoral and panoramic radiographs were obtained for an evaluation and diagnosis. Although the images revealed a supernumerary tooth-like structure between the posterior area of the mandibular second molar and mandibular third molar, it was difficult to confirm the morphology of the tooth root apical area. Subsequent cone-beam computed tomography (CBCT) revealed that the supernumerary tooth-like structure was concrescent with the root apical area of the mandibular second molar. Based on these findings, the diagnosis was a fused mandibular second molar and paramolar with a concrescent supernumerary tooth. A 3-dimensional (3-D) printer was used to produce models based on the CBCT data to aid in treatment planning and explanation of the proposed procedures to the patient. These models allowed the complicated morphology involved to be clearly viewed, which facilitated a more precise diagnosis and better treatment planning than would otherwise have been possible. These technologies were useful in obtaining informed consent from the patient, promoting 3-D morphological understanding, and facilitating simulation of endodontic treatment.

Unilateral fusion of a supernumerary tooth to a maxillary permanent lateral incisor: a report of a rare case.

A supernumerary tooth is an additional entity to the normal series of teeth that may occur in isolation or may be fused to a normal counterpart. Diagnosis and delineation of an accurate treatment plan in cases involving supernumerary teeth are often a challenge. This report describes a case of unilateral fusion of a supernumerary tooth to a maxillary permanent lateral incisor in which a conservative approach was used to reach a favorable outcome.

Fused and Geminated Permanent Maxillary Central Incisors: Prevalence, Treatment Options, and Outcome in Orthodontic Patients.

PURPOSE: Developmental disturbances during tooth formation may cause abnormalities in tooth size and shape, resulting in poor dental and facial esthetics. The purpose of this study was to evaluate the prevalence of fused/geminated teeth in the maxillary anterior region of orthodontically treated patients, and present treatment options and their outcome. METHODS: Pre- and post-treatment facial and intraoral photographs, study models, and panoramic and periapical radiographs of 574 consecutively treated patients (mean age: 13.3 years) from the orthodontic department were examined for the presence of fusion or gemination in the maxillary anterior region. RESULTS: There were eight patients (1.4 percent) with fused/geminated teeth in the maxillary anterior region. CONCLUSIONS: The prevalence found is relatively high compared to previous reports. Esthetic consideration is a determining factor for various treatment alternatives. A multidisciplinary approach is imperative for the successful treatment of these dental abnormalities.

The Diagnosis and Management of Multiple Supernumerary Teeth Involving Both Jaws.

Supernumerary teeth are frequently seen anomalies however its occurrence in both jaws is rare without being associated with complex syndromes. This case report describes the orthodontic and surgical treatment of a 13-year-old boy with nonsyndromal multiple and abnormal supernumerary teeth. The patient had several erupted and unerupted supernumerary teeth involving both jaws. Two abnormal tuberculate type erupted supernumerary teeth were present at the site of upper central incisors which leads to the impaction of the permanent incisors. In this report, clinical and radiographic evaluation as well as the treatment alternatives of this rare case was presented.