Surgical management of multiple supernumerary teeth and an impacted maxillary permanent central incisor

Hyperdontia is the condition of having supernumerary teeth, or teeth which appear in addition to the regular number of teeth. It is a developmental anomaly and has been argued to arise from multiple aetiologies. The most common site is the maxillary incisor region; but the prevalence of more than three teeth supernumerary tooth is less than 1%. A case of 13 year male patient is reported with a multiple impacted supernumerary tooth in maxillary anterior region hindering the eruption of right permanent central incisor. The supernumerary tooth was treated via surgical approach followed by an interim prosthesis for permanent central incisor which later on erupted in due course of time. Background Supernumerary teeth may be defined as any teeth or tooth substance in excess of the usual configuration of 20 deciduous and 32 permanent teeth. The presence of supernumerary teeth in the premaxillary region often poses unique diagnostic and managerial concerns for the practitioner. Rarely is the surplus number compensated by an absence or deficiency of other teeth. Therefore, the dysfunctional nature of supernumerary teeth and their ability to create a variety of pathological disturbances in the normal eruption and position of adjacent teeth warrants their early detection and prudent management. Approximately 76-86% of cases represent single-tooth hyperdontia, with two supernumerary teeth noted in 12-23% and three or more extra teeth noted in less than 1% of cases. Multiple supernumerary teeth are also associated with many syndromes like cleidocranial dysplasia and Gardner’s syndrome etc. However, it is rare to find multiple supernumeraries in individuals with no other associated disease or syndrome. In such cases, the maxillary anterior region is the common site of occurrence. The exact aetiology is not clearly understood. The supernumerary teeth result from any disturbance in the initiation and proliferation stages of odontogenesis. There are several theories regarding the development of a supernumerary tooth-phylogenetic reversion (atavism) theory, dichotomy of tooth germ theory and hyperactivity of the dental lamina. The latter being the most accepted theory, states that the remnants of dental lamina or palatal offshoots of active dental lamina are induced to develop into an extra tooth bud, which results in the formation of a supernumerary tooth. Genetics is also considered to contribute to the development of supernumerary teeth, as these have been diagnosed in twins, siblings and sequential generations of a family. Classification of supernumerary teeth may be on the basis of position or form. Positional variations include mesiodens, paramolars, distomolars and parapremolars. Variations in form consist of conical types, tuberculate types, supplemental teeth and odontomes. Supernumerary teeth may, therefore, vary from a simple odontome, through a conical or tuberculate tooth to a supplemental tooth which closely resembles a normal tooth. Also, the site and number of supernumeraries can vary greatly. This report presents a case of a non-syndromic male patient with multiple supernumerary teeth and a permanent impacted tooth in the maxillary anterior region.