Clinical case
A 9-year-old child attends because the upper left central incisor has not erupted. The contralateral incisor erupted one year ago. Examination shows a retained primary incisor and a small midline diastema. Radiographs show a conical supernumerary tooth obstructing the eruption path.
Pathophysiology
Hyperdontia is thought to result from excessive or abnormal proliferation of the dental lamina. The additional tooth may develop as a simple conical structure or as a more organised tooth resembling the normal dental series.
Supernumerary teeth are particularly important because they can obstruct eruption, displace adjacent teeth and cause crowding.
Epidemiology and Risk Factors
Non-modifiable | Modifiable |
|---|---|
Family history | No modifiable risks factors |
Male sex | |
Cleft lip and palate |
Clinical Features
Hyperdontia is the presence of additional teeth beyond the normal dental complement. These additional teeth are called supernumerary teeth. A supernumerary tooth may be simple and conical or may resemble a normal tooth.
A supplemental tooth is a supernumerary tooth with normal morphology.
Symptoms | Signs |
|---|---|
Delayed eruption | Labial, buccal or palatal eruption |
Extra erupted tooth | Midline diastema |
Crowding | Retained primary tooth |
Poor aesthetics | Displacement or rotation |
Investigations
Primary investigations:
Full medical and dental history
Clinical examination
Radiographs: OPG to assess number, position and associated impaction; periapical for more localised assessment; upper occlusal radiographs can be useful for anterior maxillary supernumerary teeth
Gold standard investigation:
Diagnosis is based on clinical and radiographic identification of additional teeth.
Investigations to consider:
Cone beam CT for complex localisation and surgical planning
Orthodontic assessment