Implant Placement When an Impacted Tooth and Supernumerary Teeth Are Present in the Maxilla.

The presence of impacted and/or supernumerary teeth in the maxillary anterior region can cause complications when attempting to perform restorations with implants. Extracting these structures can lead to adverse issues related to the adjacent dentition and require osseous grafting to provide a base to house the planned implant, but such an approach increases treatment time and cost. In this case report, a patient presented with an impacted permanent canine oriented on the horizontal plane with several supernumerary teeth coronal to the impacted canine. CBCT analysis revealed a very thin buccal plate over the impacted supernumerary teeth. The proposed treatment followed the principles of partial extraction therapy (PET) whereby the impacted structures were treated like bone, and implants were placed in contact with them or through them to achieve the desired osseointegration and provide long-term survival of the restored implants.

Minimally invasive surgical removal of bilateral impacted mandibular supernumerary teeth using 3D surgical guide template: a case report.

Impacted supernumerary teeth are defined as the presence of one or more teeth in a patient's upper and lower jaws in addition to the normal number of teeth in the dental arch. It has an incidence rate of approximately 1%-14% and more frequently occurs in males than females, may be single or multiple, unilateral or bilateral, erupted or impacted. In this article, we describe the case of a patient with two supernumerary teeth between the roots of the mandibular second premolar and the first molar, which influenced the effectiveness of the first orthodontic treatment. The special anatomical position of the complex supernumerary teeth made tooth extraction challenging. Given the higher risk status of surgery, we implemented a novel tooth extracting technique for this patient. Thus, in this study, we describe a case of minimally invasive extraction of bilateral mandibular impacted supernumerary teeth using a digital 3D positioning guide plate.

Clinical features of non-syndromic late developing supernumerary teeth: a sign of the third dentition?

OBJECTIVES: This study aimed to summarize the clinical features of non-syndromic late developing supernumerary teeth (LDST) and comparisons with common supernumerary teeth (ST) and explore the association between LDST and the third dentition. MATERIALS AND METHODS: This study retrospected cone-beam computed tomography (CBCT) and medical history of 41,903 consecutive patients from January to December 2021. Comparisons between ST and LDST were evaluated by Chi-square test or Fisher exact test. Correlation between chronological age and dental stage age was evaluated by Spearman's rank correlation coefficient. Binary logistic regression analysis was used to explore the features of LDST originating from the third dentition. RESULTS: Sixty patients with 126 non-syndromic LDST and 1602 patients with 1988 non-syndromic ST were identified. The prevalence of ST and LDST was 3.82% and 0.14%, respectively, with a male-female ratio of 1.78:1 and 1.31:1. LDST patients mainly had LDST in multiple (58.33%) and bilaterally (41.67%), with an average of 2.1/patient. Most LDST were normal-shaped (84.13%), vertically oriented (71.43%), located in the mandible (80.16%), and distributed in the premolar region (82.54%). The study also indicated that the development of LDST was correlated with permanent teeth, with LDST developing 6.48 to 10.45 years later. In this study, 72.22% of LDST met the clinical criteria for the third dentition. CONCLUSIONS: LDST manifested different clinical features from common ST. LDST might be closely related to the third dentition. CLINICAL RELEVANCE: This work would help to comprehend LDST from a clinical perspective, and may be complementary to the criteria of the third dentition.

Management options and long-term follow-ups for permanent double incisors: six to eleven-year case reports.

BACKGROUND: Double teeth are dental anomalies that can lead to aesthetic and orthodontic problems. CASE PRESENTATION: This report discusses two cases involving the multidisciplinary management of permanent maxillary left lateral incisors fused with a supernumerary tooth in two girls aged 9 and 10. Following intraoral and radiographic examinations, one was diagnosed with fusion, and the other was diagnosed with concrescence. The crown of the fused incisor was separated using a burs and extracted intraorally. The concrescent incisor was separated along its length using a laser and intentionally replanted extraorally. After a 6-year follow-up, no pathological signs were observed in the fused incisor. However, after an 11-year follow-up, external resorption was observed in the concrescent incisor. CONCLUSIONS: Both incisors remained asymptomatic throughout the observation period. This case report highlights two different and effective methods employed to preserve the natural function, form, and aesthetics of double incisors.

Clinical and radiological features of malformed mesiodens in the nasopalatine canal: an observational study.

OBJECTIVES: The purpose of this study is to investigate the morphological changes that occur when mesiodens is located within the nasopalatine canal, as well as clinical characteristics. METHODS: Clinical records and CT images of patients who had mesiodens in the nasopalatine canal were retrospectively analysed. In addition to demographic information, clinical symptoms and complications associated with extraction of mesiodens were recorded. Using CT images, number, location, size, and tooth morphology were evaluated. RESULTS: This study included 32 patients and 38 mesiodens within the nasopalatine canal. Supernumerary teeth exhibited a characteristic feature of thin and elongated shape in the canal (narrow width and elongation were observed in 96.6% and 53.3% of the patients, respectively). Fusion was found in 4 patients and dilaceration in 12. A complication occurred in 2 patients, which was tooth remnant, not a neurologic complication. Only 5 mesiodens could be detected in the nasopalatine canal on panoramic images. CONCLUSIONS: Morphological abnormalities in mesiodens within the nasopalatine canal were frequently detected, and these could be effectively diagnosed through 3D imaging analysis.

Natal and neonatal teeth: early diagnosis and management.

The eruption of teeth in newborns is a rare disorder of the oral cavity and are called 'natal teeth' when they are present at birth or 'neonatal teeth' when they erupt within the first month of life. In most of these cases, they are prematurely erupted deciduous teeth or supernumerary teeth. Supportive management should be given, to facilitate child's feeding and to prevent further complications, such as aspiration as the tooth could be mobile. This study describes a series of cases that were reported to our department, involving teeth located in the mandibular anterior region either at birth or within a few days after birth. The choice of treatment for each child was based on individual assessment of the case, considering options such as monitoring and extraction along with their associated complications.

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.

Prevalence, clinical characteristics, and 3-dimensional radiographic analysis of supernumerary teeth in Guangzhou, China: a retrospective study.

OBJECTIVE: The aim was to investigate the prevalence and clinical and 3-dimensional (3D) radiographic characteristics of supernumerary teeth (ST) in a paediatric dental population. The factors associated with ST eruption potential were analysed, and the optimal extraction time for nonerupted ST was discussed. METHODS: A retrospective study was performed in a 13,336-participant baseline population aged 3-12 years for whom panoramic radiographs had been obtained in the hospital from 2019 to 2021. The medical records and radiographic data were reviewed to identify patients with ST. Both the demographic variables and ST characteristics were recorded and analysed . RESULTS: In total, 890 patients with 1,180 ST were screened from the 13,336 baseline population. The ratio of males (679) to females (211) was approximately 3.2:1. Generally, ST occurred singularly and were frequently found in the maxilla (98.1%). A total of 40.8% of ST were erupted, and the 6-year-old age group presented the highest eruption rate (57.8%). The eruption rate of ST was highly negatively correlated with age. A total of 598 patients additionally underwent cone- beam computed tomography (CBCT). According to the CBCT images, the majority of ST were conical, normally oriented, palatally situated, nonerupted and symptomatic. The most common ST-associated complication was failed eruption of adjacent teeth. In addition, symptomatic ST were more common in the 7- to 8- and 9- to 10-year-old age groups. The eruption rate of ST was 25.3% among the patients who had undergone CBCT. A normal orientation and the labial position were significant protective factors for ST eruption, with odds ratios (ORs) of 0.004 (0.000-0.046) and 0.086 (0.007-1.002), respectively. Age and the palatal position were significant risk factors, with ORs of 1.193 (1.065-1.337) and 2.352 (1.377-4.02), respectively. CONCLUSIONS: This study provides a detailed analysis of ST characteristics in 3-12 year old children. Age as well as the position and orientation of ST were reliable predictors of the ST eruption. An age of 6 years old may be the optimal time for extraction of nonerupted ST to maximize the utilization of eruption potential and reduce the incidence of ST-associated complications.

Mesiodens: a propósito de dos casos / Mesiodens: two cases

El mesiodens es el diente supernumerario más común, localizado en la línea media maxilar entre los incisivos centrales. Su etiología es incierta y se han planteado múltiples teorías. El diagnóstico y tratamiento precoz permite la erupción espontánea de los incisivos permanentes, evitar las complicaciones asociadas, así como tratamientos posteriores más complejos. En este artículo se presentan dos casos de mesiodens de pacientes que acuden a la consulta de Pediatría de Atención Primaria (AU)

The mesiodens is the most common supernumerary tooth, located in the maxillary midline between the central incisors. Its etiology is uncertain and multiple theories have been put forward. Early diagnosis and treatment allows the spontaneous eruption of the permanent incisors, and avoids associated complications as well as more complex subsequent treatments. In this article, two cases of mesiodens in patients attending the primary care pediatric outpatient clinic are presented. (AU)

Suspected Endodontic Failure in a Patient with Cleidocranial Dysplasia: A Case Report.

A patient's medical history and related dental manifestations can significantly contribute to confounding signs and symptoms leading to a diagnostic challenge. An 18-year-old female patient presented with persistent radiographic radiolucency associated with the apex of a previously treated tooth (tooth 9); asymptomatic apical periodontitis and endodontic failure were suspected. This report presents how a patient's condition of cleidocranial dysplasia had a profound effect on her dental history, which included the presence of multiple supernumerary teeth. Extensive surgical intervention during the patient's childhood was required to remove the supernumerary teeth, which resulted in an endodontic misdiagnosis in her adult life. After clinical and radiographic examination, the patient was diagnosed with a periapical scar. Periapical fibrous scars have a prevalence of between 2.5% and 12% and are a rare healing process with fibrous tissue after surgical and nonsurgical interventions. This report describes the diagnosis and pathophysiology of fibrous scars, including their risk factors and long-term monitoring approaches.

Evaluation of radiographic characteristics and surgical removal of 147 mesiodens.

The aim of this study was to evaluate the radiographic characteristics and surgical removal of mesiodens among patients who had attended the Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery of the Faculty of Medicine, Yamagata University. This study included 121 patients in the final analysis. We retrospectively reviewed medical records including patient age, sex, mesiodens number, direction, position, opportunity for detection, surgical approach and operating time. The 121 patients comprised 82 males and 39 females. Mean age was 7.6 ± 3.1 years (range, 4-35 years). The total number of mesiodens among these 121 patients was 147. Ninety-six patients had one mesiodens, 24 patients had two mesiodens and 1 patient had 3 mesiodens. Seventy-nine mesiodens were detected while taking X-rays for routine dental examination and/or orthodontic treatment at their family dental/orthodontic clinic. Mean operating time for removal of the 147 mesiodens was 32.2 ± 18.1 min. Among the 96 patients with one mesiodens, mean operating time for removal of the mesiodens was 30.7 ± 16.5 min. Operating time for removal of a mesiodens tended to be prolonged with increased distance from the alveolar crest. Early detection of mesiodens on routine radiographic check-ups and surgical planning considering patient age, crown direction, position of the mesiodens will contribute to improved treatment of mesiodens.

Detection and characteristics of the gubernacular tract in supernumerary teeth on cone beam computed tomography.

OBJECTIVES: The aim of this study was to evaluate the prevalence and visualization of supernumerary teeth (ST) and imaging characteristics of their gubernacular tract (GT) using cone beam computed tomography (CBCT). METHODS: Presence and visualization of ST were retrospectively evaluated using 960 CBCT images. The imaging characteristics of GT were analyzed to determine various presentations of GT according to type, shape, and orientation of ST. RESULTS: ST were radiographically detected in 93 patients, for a prevalence of 9.7%. Premolar shaped ST were more common (p = 0.003). GT was detected in 104 (77.2%) of impacted ST and mostly found straight in shape (49.0%). It was most frequently observed in peridens (n = 51, 49.0%) followed by mesiodens (n = 41, 39.4%) and more frequently seen in premolar-like ST (n = 44, 42.3%). The mean length of the GT in mandible was 2.8 mm, the mean length of the GT in maxilla was 1.0 mm (p < 0.001). The mean angle of the GT in mandible was 17.0, and the mean angle of the GT in maxilla was 43.0 (p = 0.004). CONCLUSIONS: CBCT can be used for evaluations in dental practice to provide comprehensive information about ST and their GT characteristics. Clinicians should be able to identify the characteristics of GTs on CBCT for dental treatments, especially traction and extraction of ST.

Computer-Assisted Preoperative Simulation and Augmented Reality for Extraction of Impacted Supernumerary Teeth: A Clinical Case Report of Two Cases.

Delayed eruption, malocclusion, poor oral hygiene, and formation of follicular cysts are some complications associated with an impacted supernumerary tooth (ST). Although surgical extraction is one of the methods to prevent these complications, it can also lead to fractured roots or has a risk of permanent injury to young teeth and gingiva. Recently, computer-assisted preoperative simulation has been helpful in planning the surgery for precise extraction of impacted ST guided with 3-dimensional images. Herein, we present 2 cases of extraction of severely impacted ST guided by preoperative computer-assisted simulation and intraoperative augmented reality. While being minimally invasive, the augmented reality-guided system can precisely highlight the tooth position. The therapeutic aspects of these procedures have also been discussed.

Imaging analysis of 1 138 supernumerary teeth by using cone-beam computed tomography.

OBJECTIVES: This study aims to analyze and summarize the characteristics of supernumerary teeth by using cone-beam computed tomography (CBCT). METHODS: A total of 718 patients with 1 138 supernumerary teeth were retrospectively collected. Age, gender, number, location, morphology, eruption status, and accompanying symptoms of the supernumerary teeth were statistically analyzed. The relationship relative to jaws, gender, and eruption status were analyzed and discussed. RESULTS: The average age of the patients was 9.54±5.32 years, and the male to female ratio was 2.88∶1. About 77.02% of the patients sought medical advice during the mixed dentition period, and 50.70% had one supernumerary tooth. These supernumeraries were most commonly conical in shape, and 85.76% of them were in the incisor region, 92.09% in the upper jaw, 46.75% in inverted position, and 86.20% unerupted. Overall, 65.29% of them had fully developed roots, and 60.63% had an impact on adjacent structures. Significant differences were found in eruption status, morphology, zoning, direction, root development, and impact on adjacent structures between the supernumerary teeth located in the upper and lower jaws (P<0.05). Significant differences were also detected in gender, morphology, zoning, orientation, root development, and impact on adjacent structures between erupted and unerupted teeth (P<0.05). The incidence of supernumerary teeth in the incisor region was higher in males than that in females. Moreover, the root of supernumeraries was more completely developed in males than in females (P<0.05). CONCLUSIONS: For supernumerary teeth, CBCT images can provide accurate three-dimensional radiographic data and are valuable for clinical diagnosis and treatment planning.

Detection and diagnosis of cleidocranial dysplasia by panoramic radiography: a retrospective study.

BACKGROUND: Cleidocranial dysplasia (CCD) is a rare and underdiagnosed congenital disorder in dentistry. The purpose of this study was to illustrate and quantify the maxillofacial bone abnormalities detected on panoramic radiographs from a relatively large retrospective case series and to provide a series of diagnostic references for dentists to indicate the presence of disease and help in making an early and accurate diagnosis. METHODS: The dental panoramic radiographs of thirty CCD patients aged 11 to 45 years (18 males and 12 females) were examined retrospectively. The dentition states, including supernumerary teeth and impacted teeth, were recorded. Twelve quantified measurements were adopted to determine the abnormalities of maxillofacial bones, including the degree of the zygomatic arch downward bend, bicondylar breadth, ramal height, mandibular height, mandibular aspect ratio, mandibular body height, condylar height, coronoid height, distance between the coronoid process and the condyle, bigonial width, gonial angle and best-fit gonial circle diameter. The Wilcoxon rank-sum test was used to compare the findings of the CCD patients with those of their matched controls (n = 300). RESULTS: Supernumerary teeth were detected in 27 patients (90.0%), and all 30 patients presented impacted teeth. Compared to the matched controls, the CCD patients had a significantly larger degree of zygomatic arch downward bend (ZAD), a larger diameter of the best-fit gonial circle (BGC), and a shorter distance between the coronoid process and the condyle (DCC) in panoramic radiographs (P < 0.001). According to the reference cutoff values established from the 5th or 95th percentile of the measurements in the control group, ZAD higher than 6.90 mm, DDC less than 22.37 mm and BGC higher than 52.41 mm were significantly associated with the CCD features identified. Other panoramic measurements were not significantly different between the two groups. CONCLUSIONS: Panoramic radiographs had great value in the diagnosis of CCD. In this study, we identified some dental and maxillofacial features on panoramic radiographs from a relatively large retrospective case series of CCD. A series of reliable quantitative indicators were provided for dentists that can indicate the presence of disease and improve the diagnostic specificity.

Epidemiological, Clinical and Radiographic Features of Supernumerary Teeth in Nonsyndromic Bosnian and Herzegovinian Population: a Monocentric Study.

Background: Supernumerary teeth (ST) represent one of the most common developmental anomalies among humans. Objective: In this study, we set a goal to investigate ST prevalence in the Bosnian and Herzegovinian population along with characteristics and complications that ST can cause. Methods: This retrospective study was based on panoramic radiographs, CBCT images, and dental records. Analyzed ST characteristics were: type, morphology, location, eruption state, location in the arch, orientation, and associated clinical complications. Statistical analysis included univariate analysis and bivariate analysis using Fisher's exact test with a confidence interval of 95% (p<0.05). Results: On a sample of 10.237 patients, ST teeth appear in 100 patients with a prevalence of 0.98%. Out of 138 analyzed ST mesiodens was the most frequent (43.47%). The most common location of the ST was maxilla (77.53%). The majority of ST were impacted (90.5%) but with no complications (71.7%). There was statistically significant relationship (p<0.001) between the type of ST and location (mesiodens and distomolars were mostly found in the maxilla). The relationship between ST type and morphology was also statistically significant (p<0.001)-mesiodens was associated with conical morphology, parapremolar with supplementary, and distomolar with tuberculate morphology. The occurrence of ST-associated retention of adjacent teeth was correlated to the type of tooth (p<0.001). Conclusion: The present study found prevalence of ST in B&H population to be low. Although associated pathology was not high early diagnosis allows optimal patient management which reduces later complications.

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.

RUNX2 Nonsense Mutation Associated with Cleidocranial Dysplasia with Unusual Dental Features.

Purpose: The purpose of this case report is to describe a RUNX2 nonsense mutation associated with cleidocranial dysplasia (CCD) with unusual dental features. The patient was a 12-year-old Brazilian girl who sought dental care due to over-retention of primary teeth and absence of erupted permanent teeth. Clinical and radiographic examinations revealed multiple impacted permanent teeth, a prominent cingulum of the permanent impacted maxillary incisors and enamel defects (hypoplasia and hypomineralization) in addition to skeletal abnormalities. No supernumerary teeth were present. The diagnostic hypothesis of CCD was raised and the patient was refer- red to the genetic medical service, where the diagnosis was cofirmed. After RUNX2 genetic screening, including polymerase chain reaction and sequencing of both DNA strands, a heterozygous nonsense mutation was identified in exon 2 (c.193 C>T [Q65X]). This article reports unusual dental features in a patient with CCD.