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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 10  |  Issue : 1  |  Page : 24-27

Bilateral supernumerary primary maxillary canines


1 Department of Pedodontics and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
2 Department of Periodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
3 Department of Dentistry, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
4 Department of Orthodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India

Date of Web Publication2-Feb-2018

Correspondence Address:
Santanu Mukhopadhyay
2/1D, Merlin Uttara, 94/7K GT Road, Kotrung (Hindmotor), Hooghly - 712 233, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_27_17

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  Abstract 

Supernumerary teeth are more common in the permanent than in primary dentition. In the primary dentition, the anomaly is most frequently observed in the maxillary lateral incisor region, followed by the maxillary midline where they are termed as mesiodens. Supernumerary teeth in the primary canine region are rare. This paper describes a rare case of nonsyndromic supernumerary primary maxillary canine distributed bilaterally in a 4-year-old boy. Both the supernumeraries resembled size and shape of normal primary canine. The right supplemental canine is high labially placed, whereas the left one is seen normally aligned in the dental arch distal to lateral incisor. One of the most significant sequelae of primary supernumerary teeth is their duplication in the permanent series. Radiographic examination of supernumerary primary canine did not indicate any such anomaly in the permanent dentition. The patient was kept under observation.

Keywords: Maxillary canine, primary dentition, supernumerary teeth


How to cite this article:
Mukhopadhyay S, Biswas C, Haldar M, Roy P. Bilateral supernumerary primary maxillary canines. J Oral Res Rev 2018;10:24-7

How to cite this URL:
Mukhopadhyay S, Biswas C, Haldar M, Roy P. Bilateral supernumerary primary maxillary canines. J Oral Res Rev [serial online] 2018 [cited 2019 Jul 16];10:24-7. Available from: http://www.jorr.org/text.asp?2018/10/1/24/224538


  Introduction Top


A supernumerary tooth is one that is present in addition to the normal series of teeth.[1] They may occur in males or females, single or multiples, and in one or both jaws.[1],[2],[3],[4] Cases involving one or two supernumeraries are more common in the anterior maxilla, while multiple supernumeraries are more frequently seen in the mandibular premolar region.[4],[5]

The exact etiology of supernumerary teeth is not clearly known. Several theories such as atavism, dichotomy or abnormal splitting of tooth bud, environmental factors, and hyperactivity of dental lamina have been suggested earlier.[1],[2] Genetic factors also play an important role in supernumerary tooth formation. The anomaly has been reported to be found in association with syndromes such as Gardner syndrome, Down's syndrome, cleidocranial dysplasia, Ellis–van Creveld syndrome, and cleft lip and palate.[1],[2],[3],[4]

Problems associated with supernumerary tooth are malocclusion, periodontal problems due to difficulty in cleaning teeth, esthetics, incompetent lips, resorption of roots of adjacent teeth, and cyst formation. Among common population, there is a concept that highly placed supernumerary canine is a sign of luck just like dimple in cheek where they say that they will have a good relationship between partners.

The prevalence of supernumerary teeth in the primary dentition varies from 0.05% in the Japanese, 0.8% in the British and the Belgian children, and 0.4% in the Bengali population.[6],[7],[8],[9] The maxillary lateral incisors are the most frequently observed supernumeraries in the primary dentition. In addition, in 35%–50% of cases, primary supernumeraries display permanent supernumeraries in the same location.[10],[11]

To date, very few cases describing supernumerary primary canines were reported. Parker reported a unilateral supernumerary maxillary canine in both the primary and permanent dentition.[12] Ismail described a 10-year-old male patient having supernumerary maxillary canines with bilateral distribution.[13] Roberts et al. reported a 22-month-old boy with bilateral supplemental maxillary canines along with a supernumerary maxillary central incisor.[14] Ferguson and Hauk described a 4-year-old boy whose intraoral examination revealed a supernumerary maxillary left primary canine.[15] Hayduk and Stout showed an 8-year-old female presenting two maxillary supernumerary primary canines.[16] Santos et al. observed a 7-year-old boy showing a bilateral distribution of supernumerary teeth in the maxillary canine region.[17] The patient also had two unerupted supernumerary maxillary permanent canines. In this article, we describe supernumerary primary canines distributed bilaterally in the maxilla in a 4-year-old boy.


  Case Report Top


A 4-year-old boy reported with the chief complaint of an irregular arrangement of teeth in his upper jaw. Detailed clinical examination of the patient did not reveal any systemic disease or syndrome. There was no history of consanguineous marriage or any abnormal events during pregnancy. Review of his family history was negative for any hereditary or developmental diseases. The boy exhibited normal intelligence levels for his age. His intraoral examination showed a primary dentition with normal mandibular arch and a crowded maxillary arch. The maxillary primate space was absent. Two supernumerary teeth were seen in the canine region resembling size and shape of the primary canine [Figure 1]a and [Figure 1]b. There were 22 teeth altogether, 12 in the upper arch and 10 in the lower arch [Figure 2]. The teeth were of normal color and did not exhibit any other morphological abnormality. Periapical and panoramic radiographs were subsequently obtained. Radiological examination revealed bilateral supernumerary maxillary primary supplemental canines [Figure 3]. The right supplemental canine is high labially placed, whereas the left one is seen well aligned in the dental arch distal to lateral incisor. Mesial step primary second molar relation was observed. Normal number of developing permanent tooth buds is seen underneath the primary counterparts. Since the parents did not bother about the presence of two supplemental canines, we advised the parents for periodic checkups of the patient.
Figure 1: (a) High labially placed supplemental supernumerary right primary canine. (b) Well-aligned supplemental supernumerary left primary canine

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Figure 2: Maxillary arch indicating the presence of 12 primary teeth with supernumeraries in the canine region

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Figure 3: Orthopantomogram showing bilateral distribution of maxillary supernumerary canines

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  Discussion Top


Although supernumerary teeth may occur in any region of the dental arch, they have the predilection for certain sites. These anomalies are estimated to occur more frequently in the maxilla than in the mandible and are commonly seen in the premaxilla. Furthermore, mesiodens are the most frequently observed supernumeraries in the permanent dentition, accounting for 80% of all supernumeraries.[18] As stated earlier, maxillary lateral incisors prevail over other supernumeraries in the primary dentition. Permanent supernumeraries are more common in boys while primary supernumerary teeth have no known gender predilection.[19] In addition, 73% of primary supernumerary teeth erupt, whereas only 13%–34% of all permanent supernumeraries tend to erupt.[20]

Based on morphology, supernumerary teeth are classified into three types: conical, tuberculate, and supplemental. According to Rajab and Hamdan, supplemental supernumeraries account for only 7% of cases.[20] In our patient, both the supplemental canine crown has pointed cusp and morphologically similar to primary canines.

Supernumerary teeth are infrequent in the primary than in the permanent dentition. One probable explanation according to Humerfelt et al. is that the most primary supernumeraries tend to get overlooked because they are of normal shape and are well aligned in the dental arch.[21] Moreover, many children have their dental checkups during the eruption of permanent teeth. By that time, well-aligned supplemental supernumerary teeth might have been exfoliated.

Diagnoses of supernumerary teeth are made by clinical and radiographic examination of dental arches. Since many primary supernumerary teeth are associated with anomalies in the permanent dentition, the importance of radiographic examination cannot be overlooked.

A supernumerary tooth may remain symptomless or gives rise to a variety of complications. Local disturbances associated with supernumerary teeth include interference with the eruption of permanent teeth, root resorption and rotation of adjacent teeth, malocclusion, unesthetic appearance, crowding, psychological trauma, and even dentigerous cyst formation.[2],[22] Fortunately, none of these complications was seen in our 4-year-old child patient.

One of the most significant sequelae of primary supernumerary teeth is their duplication in the permanent series.[9] Fortunately, no such complications were seen in this patient in radiographic pictures.

Management of supernumerary teeth depends on type and their position in the dental arch and the possible effect on adjacent teeth.[2] Moreover, the best time for intervention of such cases depends on careful evaluation of each situation.[17] Exodontia of the anomalous tooth is indicated when complications develop or likely to develop. Many authors advocate early removal of supernumeraries to minimize complications in future.[2],[3],[9],[17] However, a well-aligned supplemental supernumerary tooth is not indicated for extraction although they should periodically be observed. We could not carry out extraction of supernumerary teeth in our patient, rather follow-up visits were recommended.


  Conclusion Top


Supernumerary canines in the primary dentition are rare. Our patient had a bilateral distribution of supplemental supernumerary primary canines. Since primary supernumeraries are associated with supernumeraries in the permanent dentition, radiographic examination is necessary. In the present case, radiographs ruled out the presence of any such anomalies in the permanent dentition. Since the parents did not want extraction of the anomalous teeth, periodic observation of the supernumeraries was recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Liu JF. Characteristics of premaxillary supernumerary teeth: A survey of 112 cases. ASDC J Dent Child 1995;62:262-5.  Back to cited text no. 1
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Leco Berrocal MI, Martín Morales JF, Martínez González JM. An observational study of the frequency of supernumerary teeth in a population of 2000 patients. Med Oral Patol Oral Cir Bucal 2007;12:E134-8.  Back to cited text no. 18
    
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Gannepalli A, Ayinampudi BK, Perkari S, Appala A, Podduturi SR. Talon cusp on palatally erupted mesiodens. J Oral Res Rev 2017;9:85-8.  Back to cited text no. 19
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Humerfelt D, Hurlen B, Humerfelt S. Hyperdontia in children below four years of age: A radiographic study. ASDC J Dent Child 1985;52:121-4.  Back to cited text no. 21
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