CASE REPORT

https://doi.org/10.5005/jp-journals-10063-0134
CODS Journal of Dentistry
Volume 14 | Issue 1 | Year 2022

Management of Horizontally Placed Supernumerary Tooth Obstructing Central Incisor Eruption: Case Report

UdayaKumar Deepika1, Prasanna K Sahoo2, Prayas Ray3, Soumit Kumar Hora4, Inshep B Pradhan5, Althwaf Shajahan6

1-6Department of Pedodontics and Preventive Dentistry, SCB Dental College and Hospital, Cuttack, Odisha, India

Corresponding Author: UdayaKumar Deepika, Department of Pedodontics and Preventive Dentistry, SCB Dental College and Hospital, Cuttack, Odisha, India, Phone: +91 8105875117, e-mail: kamatdeep93@gmail.com

Received on: 04 January 2023; Accepted on: 30 January 2023; Published on: 02 March 2023

ABSTRACT

Hyperdontia is a dental anomaly with the excess number of teeth. The most common hyperdontia is a supernumerary tooth (ST) present in between the upper central incisors named as mesiodens. ST is associated with the ectopic positioning of the permanent teeth resulting in delayed eruption or cyst formation. These ST will be evidenced in the radiograph to evaluate the orientation (vertical, horizontal, oblique) and position (buccal to tooth, palatal to tooth, apical to tooth). This case report represents the supplemental mesiodens placed horizontally buccal to the adjacent lateral incisor displacing the permanent central incisor which was orthodontically managed.

How to cite this article: Deepika U, Sahoo PK, Ray P, et al. Management of Horizontally Placed Supernumerary Tooth Obstructing Central Incisor Eruption: Case Report. CODS J Dent 2022;14(1):27-30.

Source of support: Nil

Conflict of interest: None

Patient consent statement: The author(s) have obtained written informed consent from the patient’s parents/legal guardians for publication of the case report details and related images.

Keywords: Displaced teeth, Impacted permanent teeth, Supernumerary teeth.

INTRODUCTION

An ST is a tooth formed in excess from tooth germ in the dental arch which is either single or multiple. It may occur in both dentitions and can be unilateral or bilateral. Several hypotheses are proposed on the occurrence of ST, which is unclear.1,2 ST disturbs the eruption of the typical teeth structure and is associated with complications such as overcrowding and cyst formation. The earlier treatment can prevent this complication; some authors suggest that it would be hazardous to developing tooth germs. The exact placement of ST along with the adjacent teeth, nerves, blood vessels, and vital structures plays a major role in surgical intervention.3

This case report describes the removal of the ST which resulted in the impaction of the permanent central incisor followed by aligning that central incisor in the arch.

CASE DESCRIPTION

A 14-year-old male patient was presented to the Outpatient Clinic of Pediatric and Preventive Dentistry at SCB Dental College and Hospital, Cuttack, Odisha, India. The chief complaint of the patient was missing the upper front tooth. The medical and dental history was not contributory. The intraoral examination reported a clinically missing upper left central incisor (21). The occlusal and intraoral periapical radiographs revealed the horizontally impacted ST obstructing the eruption of the left permanent central incisor (21) (Fig. 1).

Figs 1A to D: (A and B) Frontal and maxillary occlusal view revealing missing left central incisor. (C and D) Occlusal radiograph and IOPA revealing impacted left permanent central incisor (red arrow), horizontally impacted ST (yellow arrow)

Treatment Plan

  • Surgical removal of the horizontally impacted ST.

  • Surgical exposure of the unerupted left central incisor.

  • Orthodontic alignment of the left central incisor into the arch.

Treatment Process

Left side infraorbital and naso-palatal block was given using lignocaine with 1:1,00,000 adrenaline. The mucoperiosteal flap was raised with the periosteal elevator. The cone-shaped ST which was horizontally placed on the buccal aspect of the left permanent lateral incisor was removed without disturbing the impacted left permanent central incisor. The flap was repositioned and sutured interruptedly with 3–0 silk material. The patient was prescribed analgesics and antibiotics for 5 days. After 1 week, suture removal was done (Fig. 2). Due to the coronavirus disease of 2019 pandemic, the patient was not able to report for 6 months.

Figs 2A to E: (A) Surgically exposed impacted ST, left permanent central incisor. (B) Removed conical shaped ST. (C) Sutured with periodontal pack. (D and E) After 6 months, frontal and maxillary occlusal view revealing space lost in the region of 21

After 6 months, when the patient reported there was inadequate space for the accommodation of the left permanent central incisor (21). Orthodontic McLaughlin, Bennett and Trevisi (MBT) brackets (0.022 slots) were bonded on the teeth. The left lateral incisor (22) was distalized to create adequate space for the central incisor. There was a mild upper arch expansion on the subsequent wire sequence. After 3 months, the space was gained. The obliquely impacted left central incisor was surgically exposed and the bracket was bonded. It was initially aligned in a transverse direction followed by the occlusal movement. After 4 months, the left central incisor was aligned with the arch (Fig. 3).

Figs 3A to G: (A and B) Frontal and maxillary occlusal view representing space regained for the eruption of 21. (C) Surgically exposed 21 with bonded brackets. (D and E) Clinically exposed 21 extruded with the elastic chain to the occlusal level. (F and G) Frontal and maxillary occlusal view revealing aligned 21

DISCUSSION

The ST was classified based on various factors such as morphology, location, position, and orientation.4 The treatment options for ST depend on the dental status, orientation, and position of the ST, patient’s age, dental status of adjacent teeth, occlusal relationship, and arch length. The complications associated with surgical removal of an impacted tooth include damage to adjacent teeth, root fracture, neuropathy, sinus involvement, and osseous defect.5 Two different opinions in the management of ST are either removal of a tooth as early as identification or should wait until complete root formation of adjacent teeth.6 In this case, the cone shaped ST was positioned on the buccal aspect of the lateral incisor (22).

The different treatment options available for the management of the impacted central incisor are extraction of the impacted tooth followed by prosthetic rehabilitation,7 extractions of the impacted central incisor, followed by repositioning of the lateral incisor in a central place with mesial canine, and premolar movement, then coronoplasty and finally surgical recovery of the impacted tooth.8 The latter was opted by parents in this case, to prevent space discrepancy in the upper arch following the extraction of the central incisor. The surgical techniques used to expose the impacted teeth are open and closed techniques. In this case, the open technique was used where the tooth was exposed for the placement of the bracket. The permanent maxillary left central incisor (21) remained unerupted, so an orthodontic bracket and elastic chain were used to facilitate orthodontic traction.

CONCLUSION

To preserve the alveolar ridge and esthetic in the case of the ST obstructing the eruption of the central incisor surgical-orthodontic management is the better and best treatment option.

REFERENCES

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2. King NM, Lee AM, Wan PK. Multiple supernumerary premolars: their occurrence in three patients. Aust Dent J 1993;38(1):11–16. DOI: 10.1111/j.1834-7819.1993.tb05445.x

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6. Högström A, Andersson L. Complications related to surgical removal of anterior supernumerary teeth in children. ASDC J Dent Child 1987;54(5):341–343. PMID: 3478360.

7. Corsalini M, Di Venere D, Carossa M, et al. Comparative clinical study between zirconium-ceramic and metal-ceramic fixed rehabilitations. Oral Implantol 2018;11(3):150–160. Retrieved from: https://www.oimplantology.org/oimp/article/vie.

8. Pavoni C, Franchi L, Laganà G, et al. Management of impacted incisors following surgery to remove obstacles to eruption: a prospective clinical trial. Pediatr Dent 2013;35(4):364–368. PMID: 23930638.

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