Nonsyndromic bilateral multiple retained primary incisors in mandibular arch: Rare case report

D Deepa; Nazar Rana; KV Arun Kumar

doi:10.4103/2249-4987.192227

Users Online: 229

CASE REPORT

Year : 2016 | Volume : 8 | Issue : 2 | Page : 79-81

Nonsyndromic bilateral multiple retained primary incisors in mandibular arch: Rare case report

D Deepa¹, Nazar Rana¹, KV Arun Kumar²
¹ Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
² Department of Oral and Maxillofacial Surgery, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India

Date of Web Publication

13-Oct-2016

Correspondence Address:
D Deepa
Department of Periodontology, Subharti Dental College and Hospital, Meerut - 250 005, Uttar Pradesh
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/2249-4987.192227

Abstract

A disturbed eruption process creates a clinical situation that is challenging to diagnose and treat. The clinical arena of tooth eruption disorders includes both syndromic and nonsyndromic problems varying from delayed eruption to a complete failure of eruption or sometimes retained primary teeth. This paper reports a rare case of retained bilateral primary incisors on mandibular arch in a systemically healthy patient with eruption of the permanent central and lateral incisors bilaterally.

Keywords: Bilateral, nonsyndromic, primary incisors, rare case, retained teeth

How to cite this article:
Deepa D, Rana N, Arun Kumar K V. Nonsyndromic bilateral multiple retained primary incisors in mandibular arch: Rare case report. J Oral Res Rev 2016;8:79-81

How to cite this URL:
Deepa D, Rana N, Arun Kumar K V. Nonsyndromic bilateral multiple retained primary incisors in mandibular arch: Rare case report. J Oral Res Rev [serial online] 2016 [cited 2021 Feb 27];8:79-81. Available from: https://www.jorr.org/text.asp?2016/8/2/79/192227

Introduction

Tooth eruption has been defined as the movement of a tooth in an axial and occlusal direction from its developmental position within the jaw to its final functional position in the occlusal plane. ^[1] The eruption pattern of deciduous and permanent teeth is usually comprehensive and takes place at different chronological age levels. A significant deviation in the eruption of tooth, premature eruption, and delayed tooth eruption is commonly noted in clinical practice. ^[2]

A primary tooth in some cases can be retained beyond the time of normal exfoliation which results in an extended life for that tooth and the condition is known as "persistence." A retained deciduous tooth, with good crown, roots, and supporting alveolar bone, can render an adult patient many years of service. However, persistence teeth can lead to some clinical problems including periodontitis, profound caries, esthetic and phonetic problems and ankyloses. ^[3]

The common causes regarding the persistence of primary teeth are that primary teeth may be retained for a variety of reasons and the most common being the developmental absence of the permanent successor, ^[4] also reasons may be impaction or intrabony migration of the successor tooth also plays a role in the retention of the teeth. ^[5],[6],[7]]

Other causes for the persistence of primary teeth include translation or transmigration of successor teeth, existence of pathology, such as cysts, tumors, and odontoma under the primary tooth that results in the impaction of successor teeth and microdontia of permanent dentition, partially or totally. ^[8]

This paper reports a rare occurrence of nonsyndromic bilateral retained mandibular primary incisors in a systemically healthy patient.

Case Report

A 30-year-old male patient presented to the Department of Periodontology for a routine check-up and oral prophylaxis. On intraoral examination, there was crowding in the lower anterior teeth region. Thorough clinical examination revealed the presence of retained primary central and lateral incisors on both right and left sides [Figure 1]a and b. Further examination confirmed the presence of permanent central and lateral incisors on both sides placed lingual to the primary incisors. Radiographic examination confirmed the same on the intraoral periapical radiograph also showing the complete formation of roots of permanent teeth [Figure 2]. Medical and family history were noncontributory. The patient was asymptomatic except difficulty in maintaining the oral hygiene. There were no mobility or caries lesions of the over-retained primary teeth except gingival recession of primary incisors. Maxillary arch showed full set of incisors, premolars, and molars with no variations of retained teeth [Figure 3]. Treatment plan was discussed with the patient explaining the consequences of over-retained primary teeth. The patient was advised for the extraction of the primary incisors and further orthodontic alignment of the permanent teeth. Since the patient was asymptomatic, he was not readily willing for the extraction. However, the patient is under observation.

Figure 1: (a and b) Intraoral clinical photograph showing retained mandibular primary central and lateral incisors bilaterally

Click here to view

Figure 2: Intraoral periapical radiograph confirming the presence of retained mandibular primary incisors and also permanent incisors

Click here to view

Figure 3: Intraoral clinical photograph showing complete set of permanent teeth in maxillary arch with no primary teeth

Click here to view

Discussion

Multiple unerupted permanent teeth is a rare finding and frequently found to be associated with syndromes such as cleidocranial dysplasia, Gardner syndrome, Zimmerman-Laband syndrome, and Noonan's syndrome. ^[9],[10] Primary teeth are retained in conditions such as hemifacial atrophy, hypopituitarism, hypothyroidism, cherubism, gingival fibromatosis, and cleft palate. ^[10]

The congenital absence of the permanent successor teeth was found to be the most common reason for the persistence of primary teeth, followed by impaction, abnormal position, and late eruption of successor teeth. In addition, the primary mandibular second molars were the most frequently retained deciduous teeth, followed by the right and left primary maxillary canines and second molars on both sides according to the results of the study conducted by Aktan et al. ^[8] The persistence of other primary teeth was relatively rare. ^[8]

O'Connell and Torske described a case with full retarded eruption of both deciduous and permanent dentition. ^[11] Dalampiras et al. described a case of a 13-year-old boy with retained primary teeth and retarded eruption complete permanent dentition. ^[12]

Impaction of succedaneous teeth due to over retention of primary teeth has been reported widely in the literature. ^[9] Involvement of both succedaneous and nonsuccedaneous teeth establishes a fact that failure of eruption of teeth or lack of eruptive forces led to retention of primary teeth. The presence of over-retained primary teeth is considered a consequence rather than a cause for the failure of eruption.

Early diagnosis and necessary treatment of retained primary teeth would prevent the complexities in the further dental management.

Conclusion

Over-retained primary teeth may pose difficulty in maintaining the oral hygiene to noneruption or delayed eruption of permanent teeth. Therefore, early diagnosis, proper evaluation, and appropriate treatment are essential. Treatment may vary from simple extraction to extraction followed by orthodontic treatment. This case presented a rare occurrence of retained primary incisors with eruption of permanent incisors as well in a healthy male patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Cahill DR. Eruption pathway formation in the presence of experimental tooth impaction in puppies. Anat Rec 1969;164:67-77. [PUBMED]
2.	Cunha RF, Boer FA, Torriani DD, Frossard WT. Natal and neonatal teeth: Review of the literature. Pediatr Dent 2001;23:158-62.
3.	Sletten DW, Smith BM, Southard KA, Casko JS, Southard TE. Retained deciduous mandibular molars in adults: A radiographic study of long-term changes. Am J Orthod Dentofacial Orthop 2003;124:625-30.
4.	Robinson S, Chan MF. New teeth from old: Treatment options for retained primary teeth. Br Dent J 2009;207:315-20.
5.	Joshi MR. Transmigrant mandibular canines: A record of 28 cases and a retrospective review of the literature. Angle Orthod 2001;71:12-22. [PUBMED]
6.	Shapira Y, Kuftinec MM. Intrabony migration of impacted teeth. Angle Orthod 2003;73:738-43.
7.	Aktan AM, Kara S, Akgunlu F, Isman E, Malkoc S. Unusual cases of the transmigrated mandibular canines: Report of 4 cases. Eur J Dent 2008;2:122-6.
8.	Aktan AM, Kara I, Sener I, Bereket C, Celik S, Kirtay M, et al. An evaluation of factors associated with persistent primary teeth. Eur J Orthod 2012;34:208-12.
9.	Zuccati GC, Doldo T. Multiple bilateral impactions in an adolescent girl. Am J Orthod Dentofacial Orthop 2010;137 4 Suppl: S163-72.
10.	Cooper SC, Flaitz CM, Johnston DA, Lee B, Hecht JT. A natural history of cleidocranial dysplasia. Am J Med Genet 2001;104:1-6.
11.	O'Connell AC, Torske KR. Primary failure of tooth eruption: A unique case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:714-20.
12.	Dalampiras S, Christina B, Stanko P. Full retarded eruption of permanent dentition: Report of a rare case (8-year follow up). Eur J Dent Med 2012;4:34-7.