Cases

Supernumerary Teeth

Synonyms. Synonyms for supernumerary teeth include hyperdontia, distodens, mesiodens, peridens, parateeth, and supplemental teeth. Disease Mechanism. Supernumerary teeth are teeth that develop in addition to the normal complement as a result of excess dental lamina in the jaws. The tooth or teeth that develop may be morphologically normal or abnormal. When supernumerary teeth have normal morphologic features, the term supplemental is sometimes used. Supernumerary teeth that occur between the maxillary central incisors are termed mesiodens, those that occur in the premolar area are peridens, and those that occur in the molar area are distodens. Clinical Features. Supernumerary teeth are easily identified by counting and identifying all the teeth in the jaws. They occur in 1% to 4% of the population, may have a greater incidence in Asians and Native American and indigenous populations, and occur twice as often in males. Although supernumerary teeth can arise in either the deciduous or the permanent dentitions, they are more common in the permanent dentition and can arise anywhere in either jaw. Single supernumerary teeth are most common in the anterior maxilla, where they are referred to as mesiodens, and in the maxillary molar region , whereas multiple supernumerary teeth occur most frequently in the premolar regions, usually in the mandible and usually positioned in the lingual aspect of the alveolar process. Supernumerary teeth are usually discovered on images because they may interfere with normal tooth eruption. When a supernumerary tooth does erupt, it commonly does so outside the normal arch form because of space restrictions. Imaging Features. The imaging features of supernumerary teeth are variable. They may appear entirely normal in both size and shape, but they may also be smaller in size compared with the adjacent normal dentition or have a conical shape with the appearance of a canine tooth. In extreme cases, the supernumerary teeth may appear grossly deformed. Images may reveal supernumerary teeth in the deciduous dentition after 3 or 4 years of age when the deciduous teeth have formed or in the permanent dentition of children older than 9 to 12 years. In addition to periapical images, occlusal and cone-beam computed tomographic (CBCT) images may aid in determining the location and number of unerupted supernumerary teeth. Care should be taken to review panoramic images for supernumerary teeth because these may be obscured in the anterior maxillae by the image of the cervical spine, or they may appear distorted if they lie outside the focal trough. Differential Diagnosis. Multiple supernumerary teeth have been associated with numerous genetically inherited syndromes, including cleidocranial dysplasia, familial adenomatous polyposis (Gardner’s syndrome) , and pyknodysostosis. Management. The management of supernumerary teeth depends on many factors, including their potential effect on the developing normal dentition, their position and number, and the potential complications that may result from surgical intervention. If supernumerary teeth erupt, they can cause malalignment of the normal dentition. Supernumerary teeth that remain in the jaws may cause root resorption of adjacent teeth and their follicles may develop dentigerous cysts or interfere with the normal eruption sequence. All the preceding factors influence the decision either to remove a supernumerary tooth or to keep it under observation.

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Periapical images of inverted mesiodens.
Minimum Invasive Dentistry

As one considers the aforementioned, it becomes apparent that for every treatment, the concept of MID can be applied. Broken teeth, especially at the gum line, need not be extracted but can be super-erupted for a feral effect, then restored . An anterior tooth with loss of a papilla due to a periodontal pocket can have that papilla restored without surgery, and a good result can be obtained by super-erupting the tooth. A less invasive orthodontic procedure (Invisalign) is now available for the patient who has difficulty with periodontal conditions and must floss. Every implant in a dentulous mouth saves 1 or more abutment teeth from preparation. Each onlay may preserve a large amount of tooth structure compared to a crown. The first procedure each dental student does for a patient is a cavity preparation. The G.V. Black model was to remove more of the tooth than the decay dictated in order to obtain resistance form and retention. Modern dentistry has made that model obsolete, and Dr. Black would, in his wisdom, be an advocate of changing his model to meet the new standard of care now possible. With technology leading the way to discovery, a Diagnodent helps find the location(s) of the decay on a tooth surface and quantify it. Is there any reason to prepare a whole central groove of a bicuspid or molar if the caries is only located in a small area of that surface? Marginal ridges of teeth have been shown to provide up to 50% of the support for cusps,7 so why would one want to invade that area if not necessary? When interproximal caries is found on an x-ray, tunnel preps can work well and be restored with a resin-reinforced glass ionomer.

Conservative Dentistry Dental Materials + 1 more

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