Citación:LeónRamírezLL,CalvoPérezD,BustoChineaMG,AbreuPachón

L.Supernumeraryteethinthemidline,aninterestingcaseforclinicalpractice.Revdosdic[Internet].2023[citado:fechadeacceso];6(1):e398

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Correspondenciaa:LianneLauradeLeón

Ramírezliannelaur a@nauta.cu

Revisadopor:JoséDanielVillegasMaestre

UniversidaddeCienciasMédicasdeGranma

Dr.JoséCarlosAlvarezHernándezUniversidaddeCienciasMédicasdeGranma

Editoracorrectora:MSc. Iris MaríaBatistaRamírezUniversidaddeCienciasMédicasdeGranma

Keywords:Diagnosis;Supernumerarytooth;Toothextraction;Incisor;Orthodontics.

Palabrasclave:Diagnóstico;Diente supernumerario;Extraccióndental;Incisivo;Ortodoncia.

Recepción:2022/09/20Aceptación:2023/02/12Publicación:2023/03/19

Supernumerary teeth in the midline, an interesting case for clinicalpractice

Dientes supernumerarios en la línea media, un caso interesanteparalaprácticaclínica

Lianne Laura de León Ramírez1 ,Damarys Calvo Pérez2 ,MariselGarcíadelBustoChinea2 ,LilianaAbreuPachón1

1Universidad de Ciencias Médicas de Matanzas, Facultad de Ciencias Médicas de Matanzas“Dr.JuanGuiterasGener”.Matanzas.Cuba.

2Universidad de Ciencias Médicas de Matanzas, Hospital Pediátrico Docente:“Eliseo NoelCamaño”.Matanzas,Cuba

ABSTRACT

Introduction:sometimes patients with supernumerary teeth come to the dental clinic. For this reason, knowledge of the morphological characteristics of each dental group is useful to di- fferentiate them from those of the normal arch.Case Presentation: the case of an apparentlyhealthy 12-year-old male patient who attended the Maxillofacial Surgery service, referred from PrimaryHealthCarefortheextractionof“asupernumerary”waspresented.Uponquestio- ning,themotherstatedthatthechildreceivedorthodonticcarearoundeightyearsofageand thatunderthistreatmenthewasindicatedandperformedsurgery“becausehehadanextra tooth.”Oncethecasewasassessed,thepresenceoftwosupplementarysupernumerariesin the maxillary midline was diagnosed. The tooth that had been extracted during the previous orthodontic treatment, referred by the mother, was the upper left central incisor (21) and not a supernumerary. The ectopic 11 was extracted, to leave in the dental arch the two supernumera-riesthatwereofsimilaranatomyandwerecompletelyerupted.Conclusions:itwasconcluded thatsupernumeraryteethofthemidline,whentheyhaveanatomicalcharacteristicssimilarto thosethatnormallyoccupythedentalarch,canbeconfusedwiththese;hencetheimportance of a thorough clinical assessment.

RESUMEN

Introducción:enocasionesacudenalaclínicadentalpacientescondientessupernumerarios. Por ello, el conocimiento de las características morfológicas de cada grupo dentario es útil para diferenciarlosconlosdelaarcadanormal.Presentacióndecaso:sepresentaelcasodeun paciente masculino de 12 años aparentemente sano que acude al servicio de Cirugía Maxilofacial, remitido de la Atención Primaria de Salud para la extracción de “un supernumerario”. Al ser interrogada la madre, esta refirió que el niño recibió atención de ortodoncia alrededor de los ocho años y que bajo ese tratamiento se le indicó y se le operó “porque tenía un diente extra”. Una vez valoradoelcaso,sediagnosticólapresenciadedossupernumerariossuplementariosenlínea media maxilar. El diente que había sido extraído durante el tratamiento de ortodoncia anterior, referido por la madre, era el incisivo central superior izquierdo (21) y no un supernumerario. Se extrajoel11ectópico,paradejarenlaarcadadentarialosdossupernumerariosqueerande similaranatomíayestabancompletamenteerupcionados.Conclusiones:seconcluyequelos dientessupernumerariosdelalíneamedia,cuandotienencaracterísticasanatómicassimilaresa los que normalmente ocupan la arcada dentaria, pueden confundirse con estos; de ahí la importancia de una evaluación clínica exhaustiva.

INTRODUCTION

Supernumerary teeth (ST) also known as hyperdontia are those that exceed the number of normal teeth in the oral cavity. In human history they have been frequently obser- vedsincePaleolithictimes(1,2).

They have been grouped and classified according to their form in supplementary and dysmorphic; and the lattersubclassifiedas:conoid,tuberculateandrudimentary(3).

The prevalence of ST varies markedly in the permanent dentition as well as between the populations studied; an interval between 0,5 to 3,8 % in the world population is calculated. They predominate mainly in males and it is common to find them in the anterior region of the maxilla. They can be single, multiple, unilateral or bilateral. Those located in the midline of the maxilla are called mesiodens and their prevalence is 0,15 to 1,9 % in the general popula- tion. Mesiodens occurs in 0,45 % of Caucasians; 0,4 % in Finns;1,44%inNorwegiansand2,2%inHispanics(2,3,4,5).

In Latin America there is no general report of the total pre- valence in the population, however, according to Gálvez Cubas et al(6). there are different reports published in each region;forexample,inMexico2,8%ofDSisregistered, in Venezuela and Colombia, 5,15 % and 1,1 % respecti-vely.InCuba,thescientificliterature(7,8)onlyincludescase reports that do not allow determining the incidence of STin the population.

The diagnosis of ST requires the development of an ade- quate clinical history, an exhaustive clinical and radiologi- cal evaluation, as well as performing it as early as possi- ble(3). Also, important aspects must be taken into account, such as: the orthodontic indication, the anatomical loca- tion, the morphology, the dental angulation and the pre- sence of rotations(4).

The treatment of a supernumerary tooth, although it is usually an extraction, should not underestimate the mul- tivariate analysis. A comprehensive surgical-orthodontic therapeutic plan should be drawn up, taking into account the type of ST, its position, its potential effect on adjacentteethandtherelationshipwithproximalteeth(3,9).

Sometimessituationsofpatientswithsupernumerary teethoccurinthedentaloffice.Forthisreason,knowledge ofthemorphologicalcharacteristicsofeachdentalgroup is useful to differentiate them from those of the normal arch. Highlighting the importance of its correct diagnosis, since this is the determinant of therapeutic decision-ma- king, avoids making certain errors in clinical practice; hen- ce the importance of its communication to the scientificcommunity.

PRESENTATIONOFTHECASE

Male patient, 12 years old, black race, apparently healthy, who attended the consultation of the Maxillofacial Surgery service of the Pediatric Teaching Hospital: “Eliseo Noel Camaño”, of Matanzas province, referred from the PrimaryHealthCarefortheextractionof“asupernumerary”.

Upon questioning, the mother stated that the childreceived orthodontic care around eight years of age and that under this treatment he was indicated and underwentsurgery“becausehehadanextratooth.”

Theintraoralclinicalexaminationrevealedthepresence of two teeth in the area of the upper central incisors with smaller crowns in relation to the crown of the lateral incisors and with a slight anomaly in their shape, slight distobuccalrotationandindistoversion.Inaddition, the presence of an ectopic tooth was observed in vestibulogression between 11 and 12, with a large crown, with an appearance similar to that of the upper central incisors. Edge-to-edge bite in the incisive area, therefore protrudingandexceeding0mm(Fig.1).

Figure 1.Intraoral view, the presence of an ectopictooth in upper arch.

Periapical X-rays of the area are distinguished (Fig.2) observing that the teeth that were in the position of the central ones had much smaller roots than those of the adjacentlateralones,whiletherootofthe“ectopictooth”wassimilartotheofacentralincisor.

Figure 2.Periapical X-rays, the root of the ectopic toothislarge,straightandrobust.

The interrogation, clinical and radiographic examination allowed to diagnose the presence of two supplementary supernumeraries in the maxillary midline; in this case, the presenceofabilateralmesiodens.

It was concluded that the “extra” tooth that had been extracted during previous orthodontic treatment, referred by the mother, was the upper left central incisor (21) and not a supernumerary.

Ensuring the aesthetics of the patient at this time was paramount;withnootheralternative,theectopic11 wasextracted,thusleavingthetwosupernumeraries in the dental arch, which had similar anatomy and were completelyerupted.

During the operative approach there were no complications and the patient showed a satisfactory evolution afterdentalextraction.

After the total recovery of the intervened area, a joint orthodontic-prosthetic treatment was started in order toobtainanoptimalaestheticandfunctionalresult.

The prosthetic treatment was necessary due to the microdontia of the supernumeraries; therefore, it was necessary to make two aesthetic and functional capcrowns, which after labializing them with the orthodontic movement,achievedafunctionaloverhangandoverhang.

For the dissemination of this article, the informed consent ofthepatient’slegalguardianwasobtained,taking

into account the ethical standards established in the Declaration of Helsinki.

DISCUSSION

McBeain et al(10). mentions that the incidence of supernumerary teeth is higher in male patients, which coincides with the present clinical case. The results reported by Amoroso(11)disagree in this sense since heobtainedahigherprevalenceofthefemalesex.

Dias dos Santos et al(12). states that supernumerary teethare more prevalent in the permanent dentition. In the present study, the supernumerary teeth belong to thisdentition.

Romero et al(2). reports the different locations of supernumerary teeth, with the midline of the maxilla (mesiodens) being the most common; as presented in the patientstudied.

The scientific literature points out the complications associatedwithamesiodens,amongthem,thedeviation of the eruption of the tooth; which is evidenced in thevestibularregressionof11presentedinthisreport(1).

According to Azuara et al(5). the supernumerary teeth, in general, remain impacted, which differs from what was found in the present case, since the two supplementary teethwerecompletelyerupted.

Oropeza(1) reports reports that dysmorphic supernumeraries occur more frequently; however, theteeth in question had a morphology similar to that of the maxillary central incisors (supplemental supernumerary). The similarity of a supernumerary tooth with one of the normalarchcancauseconfusionwhenitcomestoissuing adiagnosis,asithappenedatthebeginninginthiscase.

There are defining characteristics that allow the clinicianto differentiate a supplemental supernumerary tooth from one of the normal arch, such as the length and thickness of the root; hence the importance attributed by the authorsto their knowledge.

Patientswithsupernumeraryteethrequiremultidisciplinary treatment, where orthodontists, pediatric dentists, oral surgeons and radiologists must interact; in order to achieve successful results(11). For Azuara et al(5). the treatment plan mustconsideramultidisciplinaryapproach,inwhichthe

participationoftheorthodontistisessential.

In orthodontics, as in most specialties of medical sciences, theparticularitiesofeachindividualareestimated andinterdisciplinarymanagementiscarriedoutto achieve comprehensive care, in this case: orthodontics,maxillofacial surgery and prosthetics(13).

According to what was stated by Pulido et al(13). early diagnosis is considered essential in this entity, with interdisciplinary management where there is an adequate approach technique and correct planning, improving the patient’sprognosis.

Before proceeding with the extraction of a tooth, the following must be carried out: a correct clinical history, an adequate exploration of the oral cavity, especially of the tooth to be extracted and of the neighboring anatomical structures and, within the complementary studies, a detailed radiographic study. In order to reach conclusions andestablishadiagnosis,anextensiveassessmentofthe case must be made and, when necessary, receive thecriteriaofotherspecialistsusinginterdisciplinarity.

The educational message of the article warns in making diagnostic and therapeutic decisions to guarantee good dentalpractices.

CONCLUSIONS

The supernumerary teeth of the midline, when they have anatomical characteristics similar to those that normally occupythedentalarch,canbeconfusedwiththese;hencetheimportanceofathoroughclinicalassessment.

STATEMENTOFFUNDINGSOURCES

Nofundingwasreceivedforthedevelopmentofthiswork.

CONFLICTOFINTERESTSTATEMENT

The authors declare no conflicts of interest. This manus- cript has not been published in whole or in part, nor is it beingevaluatedbyanotherjournal.

AUTHORS`CONTRIBUTION

Lianne Laura de León Ramírez: conceptualization, data curation, formal analysis, research, methodology, project management,writing-revisionandediting.

Damarys Calvo Pérez: data collection, resources,supervision,validation,writing-originaldraft.

MariselGarcíadelBustoChinea:visualization,validation, writing-originaldraft.

LilianaAbreuPachón:visualization,validation,writing- review and editing.

Revdosdic.enero-marzo2023;6(1):e398 RNPS:2490 ISSN2788-6786

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