Multidisciplinary management of an impacted maxillary central incisor associated with supernumerary teeth: a case report

Permanent maxillary central incisor impaction is a rare condition of multifactorial etiology that should be treated on diagnosis. This article describes multidisciplinary treatment of an 11-year-old patient presenting with a permanent maxillary right central incisor that was impacted due to the presence of 2 supernumerary teeth. The diagnosis was reached through clinical evaluation, radiography, and cone beam computed tomography. Treatment involved the surgical removal of the supernumerary teeth followed by traction of the impacted tooth through a combination of removable and fixed orthodontic appliances. Orthodontic treatment was completed after 18 months, resulting in adequate positioning of the right central incisor in the arch. Periodic follow-up visits were scheduled for prophylaxis and oral hygiene reinforcement. After 2 years, the teeth were adequately aligned, the gingiva was healthy, and the patient was esthetically satisfied. The multidisciplinary approach allowed functional and esthetic oral rehabilitation, thus helping the patient to avoid the psychological impact of a missing anterior tooth.

Pre-maxillary hypohyperdontia: a report of two cases

BACKGROUND

Hypodontia and hyperdontia are considered to be at opposite ends of the dental development spectrum. Nevertheless, these anomalies may occur concomitantly (hypohyperdontia).

CASE REPORT

This clinical report describes two case of hypohyperdontia occurring exclusively in the premaxillary region, and the difficulties associated with its diagnosis and management. Following 24 months of follow-up examinations, Case 1 developed a sequential supernumerary tooth in the tooth 35 region.

CONCLUSION

Cases of hypohyperdontia can occur exclusively in the premaxillary region and may be difficult to diagnose. Multidisciplinary treatment planning is essential to facilitate appropriate management, and long-term follow-up is necessary as sequential supernumerary teeth may develop.

Management of Unusual Rotation of Maxillary Central Incisor with Impacted Mesiodens: Case Report

Supernumerary teeth are frequently found in the maxillary anterior region, largely in permanent dentition (rare in deciduous dentition). Shape of the supernumerary teeth may vary from conical, tueberculate, supplemental to odontome. Mesiodens is a conical type of supernumerary teeth located in the maxillary central incisor region and is generally unerupted. Presence of mesiodens may result in rotation, uneruption, or malalignment of adjacent maxillary incisors. In this article, we present a case report of unusual rotation of maxillary central incisor with impacted mesiodens.

Combined Surgical Removal of a Supernumerary Tooth and Orthodontic Traction of an Impacted Maxillary Central Incisor

Impaction of permanent maxillary central incisors is a rare condition that can affect esthetics and oral function. The etiology of impaction is multifactorial and may be related to embryologic reasons, hereditary factors, mechanical obstacles, and pathologic elements, such as the presence of supernumerary teeth. The purpose of this report is to discuss the case of a 10-year-old patient who presented an impacted permanent maxillary right central incisor due to a supernumerary tooth. Surgical removal of the supernumerary tooth and orthodontic traction of the impacted central incisor by the closed eruption technique were performed. After 12 months, the permanent maxillary right central incisor was adequately positioned in the arch. The multidisciplinary treatment allowed the functional and esthetic rehabilitation to happen in a short period of time, thus reducing the patient's psychological impact caused by the lack of an anterior tooth.

[Supernumerary teeth in the maxilla and mandible-an interdisciplinary challenge. Part 1: epidemiology, etiology, classification and associated complications]

Supernumerary teeth develop in addition to the normal dentition and are a therapeutic challenge for pedodontists, orthodontists and oral surgeons alike. Therefore, interdisciplinary treatment concepts are needed for the benefit of the patient. In the present, two-parted literature review on supernumerary teeth, current classification, associated complications, diagnostic steps and different therapeutic approches are presented and discussed. Supernumerary teeth are diagnosed in the primary and permanent dentition. Supernumerary incisors, canines, premolars, and molars, as well as distomolars and mesiodentes can be seen according to the location of the supernumerary teeth. Furthermore, based on the morphology of the supernumeraries four different types can be differentiated: conical, tuberculate, supplemental, and odontoma. Supernumerary teeth often remain asymptomatic, and are only diagnosed incidentally during a routine dental visit on radiographs (often intraoral). Nevertheless, various complications have been reported in the literature for supernumerary teeth such as disturbed eruption, malpositioning/rotation, root resorption of neighbouring teeth, and development of dentigerous cysts in impacted supernumeraries. Root resorption of neighbouring teeth can be radiographically diagnosed in up to 22.8% of the cases.

[Supernumerary teeth in the maxilla and mandible-an interdisciplinary challenge. Part 2: diagnostic pathways and current therapeutic concepts]

Proper localization of supernumerary teeth is very important for the diagnosis, treatment planning, and prior to any surgical intervention. Traditionally, supernumerary teeth were diagnosed and located using two-dimensional (2D) radiographic methods such as panoramic views, cephalometric imaging, and also intraoral (also often occlusal) radiographs. With the introduction of cone beam computed tomography (CBCT) in dental medicine, this three-dimensional (3D) imaging technique is now more and more used for the exact localisation of supernumerary teeth and the diagnosis of root resorption of adjacent teeth. Treatment planning depends on various factors such as the time of diagnosis, the age of the patient, the position of the supernumerary tooth and possible complications. In the present second part of this review article on supernumerary teeth in the maxilla and mandible, the diagnostic workflow and current treatment concepts will be presented and critically discussed.

Fused and Geminated Permanent Maxillary Central Incisors: Prevalence, Treatment Options, and Outcome in Orthodontic Patients

PURPOSE

Developmental disturbances during tooth formation may cause abnormalities in tooth size and shape, resulting in poor dental and facial esthetics. The purpose of this study was to evaluate the prevalence of fused/geminated teeth in the maxillary anterior region of orthodontically treated patients, and present treatment options and their outcome.

METHODS

Pre- and post-treatment facial and intraoral photographs, study models, and panoramic and periapical radiographs of 574 consecutively treated patients (mean age: 13.3 years) from the orthodontic department were examined for the presence of fusion or gemination in the maxillary anterior region.

RESULTS

There were eight patients (1.4 percent) with fused/geminated teeth in the maxillary anterior region.

CONCLUSIONS

The prevalence found is relatively high compared to previous reports. Esthetic consideration is a determining factor for various treatment alternatives. A multidisciplinary approach is imperative for the successful treatment of these dental abnormalities.

The Diagnosis and Management of Multiple Supernumerary Teeth Involving Both Jaws

Supernumerary teeth are frequently seen anomalies however its occurrence in both jaws is rare without being associated with complex syndromes. This case report describes the orthodontic and surgical treatment of a 13-year-old boy with nonsyndromal multiple and abnormal supernumerary teeth. The patient had several erupted and unerupted supernumerary teeth involving both jaws. Two abnormal tuberculate type erupted supernumerary teeth were present at the site of upper central incisors which leads to the impaction of the permanent incisors. In this report, clinical and radiographic evaluation as well as the treatment alternatives of this rare case was presented.

Esthetic management of a primary double tooth using a silicone putty guide: a case report

The term double tooth is often used to describe fusion and gemination. The development of isolated large or joined teeth is not rare, but the literature is confusing when the appropriate terminology is presented. The objective of this paper is to present a case of a primary double tooth in a 5-year-old girl with a history of trauma. The tooth was endodontically treated and esthetic management was carried out using a silicone putty guide.

Treatment of an impacted supernumerary tooth using limited fixed orthodontic appliances

A 42-year and 9-month-old female with an impacted supernumerary tooth was treated with limited fixed orthodontic appliances. As seen in this case, it is possible to successfully treat impacted teeth in adults even though the most common time to treat impactions is during adolescence.

Tuberculate supernumerary teeth: report of a case showing typical and atypical features and the management

Tuberculate supernumerary teeth are found in the maxillary anterior region. They usually result in oral problems such as malocclusion, food impaction, poor aesthetics and cyst formation. There is paucity of literature on this anomaly in our environment. This paper describes a case of tuberculate supernumerary teeth with typical and atypical features of supernumerary teeth in this region. Treatment is carried out with a combination of surgical and orthodontic methods. Early diagnosis and treatment of this anomaly is suggested to avoid more serious consequences and to prevent severe orthodontic complications.

Crown-root fracture of fused primary teeth--a case report

In the primary dentition, traumatic injuries affecting the tooth-supporting structures are common due to increased bone resilience in children. Crown-root fracture, defined as a fracture involving enamel, dentin, and cementum, is uncommon in the primary dentition, comprising only 2% of dental traumas. This article reports the treatment and follow-up of a 2-year-old boy who suffered a traumatic crown-root fracture involving a primary anterior incisor that was fused to a supernumerary tooth.

Hyperdontia in children--case reports

Dental anomalies are craniofacial abnormalities of form, function or position of the teeth, bones and tissues of the jaw and mouth. Dental anomalies can range from missing or stained teeth to cleft palates. The National Institute of Dental and Craniofacial Research (NIDCR) estimates that in the United States a baby is born every hour with a craniofacial defect. Dental anomalies are caused by hereditary, systemic, traumatic or local factors. The abnormalities of the teeth can be divided into those that are influenced by environmental forces and those that are idiopathic or appear hereditary in nature. In many cases the cause and effect are obvious. In others the primary nature of the problem is less distinct.

Endodontic management of maxillary supplementary premolar using cone-beam computed tomography

Extra teeth in dentition is termed as 'supernumerary teeth' and is a very well-known dental developmental anomaly. Supernumerary premolars are a rare anomaly in the maxillofacial complex. Its rarity and complex characteristics often makes it difficult to treat. Radiographs play an important role in assessment of both the location and the typing of supernumerary teeth. This article reports the rare case of 'nonsyndromic bilateral maxillary supernumerary premolars' in which the endodontic management of supernumerary premolar tooth is described. In this case the value of cone-beam computerized tomography is also emphasized.

CLINICAL SIGNIFICANCE

Developmental anomalies can occur in any tooth and supplementary premolars are no exception. The complexity of such teeth has to be considered for planning endodontic treatment to increase the chances of success.

Clinical management of a unique case of fusion between supernumerary canine and maxillary first premolar

Fusion is one of the few developmental disorders that may account for alteration in morphology and number of teeth in the dental arch. This case report presents a unique case of fusion between supernumerary canine and maxillary first premolar, the associated problems, and their comprehensive clinical management.

Interdisciplinary management of dental anomalies: fusion and supernumerary teeth

A 16-year-old boy presented with a fused permanent maxillary left central incisor with a supplemental tooth and an additional supplemental tooth lingual to the permanent maxillary right central incisor. Following leveling, alignment, and endodontic therapy, the maxillary fused left central incisor was sectioned and the mesial portion extracted as planned. Fixed orthodontic treatment commenced after 10 days to align the maxillary anterior segment. After completion, the midline diastema was closed with veneers. This case highlights the treatment options of a fused tooth and the need for multidisciplinary planning and treatment.

Supernumerary cheek teeth (n = 24): clinical features, diagnosis, treatment and outcome in 15 horses

REASONS FOR PERFORMING STUDY

There are few reports of case series of horses with supernumerary cheek teeth (SCT) that document clinical findings, treatment and long-term outcome.

OBJECTIVES

To review the clinical and ancillary diagnostic findings and responses to different treatments in horses with SCT.

METHODS

The case records of 15 horses were reviewed and long-term outcomes obtained by telephone interview.

RESULTS

Fifteen horses with a total of 24 SCT were identified. Two SCT were incidental findings and were not treated. Clinical signs were improved or resolved in 11 of 13 of the teeth treated conservatively and all 6 treated by extraction had a favourable outcome. Four horses were subjected to euthanasia within a short period of diagnosis, either due to a poor prognosis at the outset or failure to respond to initial conservative treatment.

CONCLUSIONS

Some SCT are chance findings and do not cause clinical signs. In those instances where clinical signs of dental disease are mild, conservative treatment including the management of diastema and reduction of overgrowths is often effective. Horses with severe clinical signs attributable to an SCT are likely to require extraction of the offending tooth.

POTENTIAL RELEVANCE

An SCT is an uncommon dental anomaly but should be considered in the differential diagnosis of cases with signs of severe dental disease. The preferred management for SCT is very variable and determined by the severity of the associated changes, but ranges from conservative measures through forceps extraction per os to major facial flap surgery.

Multiple hyperodontia: report of a case with 17 supernumerary teeth with non syndromic association

Supernumerary teeth or hyperodontia is an infrequent developmental alteration that appears in any area of the dental arches and can affect any dental organ. Multiple hyperodontia can be associated with several syndromes such as Gardner's, cleidocranial dysplasia, tricho-rhino phalangic syndrome or in patients with cleft lip and palate. However, it can be present in patients without any systemic pathology. The presence of supernumerary teeth is associated with different alterations in neighboring teeth, being the most common: over retained teeth or delayed eruption, ectopic eruption, dental malposition, occlusal problems, diastemas and rotated neighboring teeth, among a series of associated pathologies. The routine use of radiographic images during examination is a valuable tool that helps make the early diagnosis of these types of abnormalities. Keeping in mind that there are different treatment options, the therapeutic modalities increase. A case of a 20 year old female patient with multiple supernumerary teeth with non syndromic association is presented. The teeth were located in the maxilla and the mandible causing a severe malocclusion.

[Orthodontics in general practice 4. Impaction of maxillary front teeth]

Eruption failures in the maxillary frontal region occur during the mixed dentition period. Dislocation and impaction of central incisors are diagnosed during or at the end of the early mixed dentition stage. These failures can be caused by crowding, premature loss of deciduous teeth, trauma or supernumerary teeth. Occasionally, a preventive orthodontic treatment is desirable to release the obstructed eruption path of a canine. Sometimes, a surgical intervention may be indicated to expose an obstructed central incisor and to remove supernumerary teeth. Retention and impaction of canines are generally discovered late in or after the late mixed dentition stage. In the agenesis of the lateral incisors or peg-shaped teeth, there is frequently impaction of the canines. General dental practitioners must be alert for possible deviations in the pattern of change in dentition right from the early mixed dentition period. Conventional two-dimensional radiographs can sometimes unjustifiably suggest a bad prognosis of an impacted tooth. Cone-beam CT scanning, which gives a three-dimensional image, can provide important additional diagnostic information.

Orthodontic treatment for an unerupted and severely rotated maxillary central incisor. A case report

BACKGROUND

Many reports have indicated the treatment for permanent teeth with disturbed eruption due to the presence of supernumerary teeth. However, successful treatment for an unerupted maxillary incisor with severe rotation and another maxillary incisor with disturbed eruption by a supernumerary tooth is quite rare.

CASE REPORT

We treated a 7-year-old Japanese male with an unerupted and severely rotated maxillary right incisor, along with a maxillary left incisor due to interference with eruption by an inverted supernumerary tooth. Orthodontic treatment using surgical exposure, traction and guidance of the rotated right incisor, and maxillary expansion following extraction of the supernumerary tooth were performed.

FOLLOW-UP

At 27 months following extraction of the supernumerary tooth, and comprehensive orthodontic treatment led the malposititioned central incisors to a functional position and stable occlusion.

Endodontic management of a fused mandibular second molar and paramolar with the aid of spiral computed tomography: a case report

Fusion and gemination are developmental anomalies of the dental hard tissues that might require endodontic and surgical treatment for functional, orthodontic, or esthetic reasons. In this article, we report a rare case of successful endodontic management of unilateral fused mandibular second molar with a paramolar. The rarity with which this entity appears, along with its complex characteristics, often makes it difficult to diagnose and treat. The use of high-end diagnostic imaging modalities such as spiral computed tomography can help the clinician in making a confirmatory diagnosis and determining the treatment plan before undertaking the actual treatment. This case report highlights the usefulness of spiral computed tomography in accurate diagnosis and endodontic management of these unusual cases.

Bilateral triplicated primary central incisors: clinical course and therapy

Uncommon developmental abnormalities such as fused or geminated teeth are of interest for the clinical problems associated with them. A rare case of fusion between maxillary primary central and lateral incisors and a supplemental incisor occurring bilaterally is presented. The patient was a 4-year-old Thai boy. Intraoral examination revealed an abscess and fistula in the region of the fused teeth as a result of periapical osteolysis. Access cavities were prepared as acute procedures. Because of the unpromising prognosis, surgical removal of the teeth was inevitable. For functional, esthetic, and phonetic rehabilitation, an acrylic denture was incorporated.

The restorative management of amelogenesis imperfecta in the mixed dentition

Amelogenesis impefecta is a hereditary condition affecting the formation of enamel in which the rough enamel suface can compromise periodontal health and the esthetics. Affected posterior teeth usually exhibit interproximal space loss which makes restoration of the primary molars difficult. This article describes a technique, using separators to regain interproximal space prior to the placement of stainless steel crowns on the molars of a girl with amelogenesis imperfecta.

Surgical and orthodontic conduct in the treatment of mesiodens: a case report

This article reports a clinical case involving an 8-year-old boy with two mesiodentes. The supernumerary teeth caused both a functional alteration (malocclusion) and an esthetic one (interincisal diastema), both of which affected his quality of living. Surgical removal of the supernumerary teeth and orthodontic follow-up was proposed, in agreement with the treatment established in the literature. This treatment produced satisfactory results in terms of both esthetics and functionality.

Endodontic Management of a Fused Maxillary Lateral Incisor With a Supernumerary Tooth: A Case Report

Fusion is a rare occurrence and its definitive diagnosis is of prime importance for successful root canal treatment. This case report discusses the endodontic and esthetic management of fused maxillary lateral incisor with a supernumerary tooth that presented with spacing between the fused tooth and the adjacent central incisor. Nonsurgical endodontic treatment was performed on the fused teeth followed by postendodontic esthetic restoration. The patient remained symptom-free and there was a reduction in the size of periapical radiolucency after 1 year.

[Supernumerary teeth: report of a rare case and review of the literature]

Supernumerary teeth is a well-recognized clinical phenomenon. Multiple supernumerary teeth are commonly associated with variable syndromes. However the multiple supernumerary teeth reported in mandibular and maxilla premolar region of an 14-year-old female patient without any associated systemic condition/syndrome is a rare case. A review of the literature relating to supernumerary teeth is presented including possible presentations, diagnostic features and treatment options.

Endodontic treatment of a supernumerary tooth fused to a mandibular second molar: a case report

Since abnormal tooth morphology can predispose to caries and periodontal disease, careful management of fused teeth is essential. In this paper we report a rare case of a fused molar and supernumerary tooth and describe its management. Caries was removed from the tooth complex under local anesthesia. The pulp chamber of the supernumerary tooth was exposed without involvement of second molar pulp chamber. The root canal of the supernumerary tooth was prepared using the step back technique and copious irrigation with 2.6% sodium hypochlorite. Obturation using the lateral condensation technique with gutta-percha and AH26 sealer was subsequently performed and final restoration was accomplished with composite resin. Nine months after the treatment, no clinical or radiographic concern is apparent, and the second molar tooth has remained vital.

[Disturbance of dentoalveolar arch formation in the front part of the maxilla due to 11, 21 teeth retention. Treatment]

The cause of disturbance of dentoalveolar arch formation in the front part of the maxilla in one patient was the maxillary central incisors eruption delay due to retention of supernumerary teeth situated in the region of upper central incisors. A positive result of the treatment was achieved with the use of surgical and orthodontic methods. The distinctive feature of the orthodontic method was retained tooth displacement (by traction) into the dentition.

A review of equine dental disorders

Equine dentistry is a very important but until recently rather neglected area of equine practice, with many horses suffering from undiagnosed, painful dental disorders. A thorough clinical examination using a full mouth speculum is a pre-requisite to performing any equine dental procedure. Common incisor disorders include: prolonged retention of deciduous incisors, supernumerary incisors and overjet--the latter usually accompanied by cheek teeth (CT) overgrowths. Overjet can be surgically corrected, but perhaps should not be in breeding animals. In younger horses, traumatically fractured incisors with pulpar exposure may survive by laying down tertiary dentine. Loss or maleruption of incisors can cause uneven occlusal wear that can affect mastication. Idiopathic fractures and apical infection of incisors are rare. The main disorder of canine teeth is the development of calculus of the lower canines, and occasionally, developmental displacements and traumatic fractures. The main indications for extraction of "wolf teeth" (Triadan 05s) are the presence of displaced or enlarged wolf teeth, or their presence in the mandible. Developmental abnormalities of the CT include; rostral positioning of the upper CT rows in relation to the lower CT rows--with resultant development of focal overgrowths on the upper 06s and the lower 11s. Displaced CT develop overgrowths on unopposed aspects of the teeth and also develop periodontal disease in the inevitable abnormal spaces (diastemata) that are present between displaced and normal teeth. Diastemata of the CT due to excessive developmental spacing between the CT or to inadequate compression of the CT rows is a common but under diagnosed problem in many horses and causes very painful periodontal disease and quidding. Supernumerary CT mainly occur at the caudal aspect of the CT rows and periodontal disease commonly occurs around these teeth. Eruption disorders of CT include prolonged retention of remnants of deciduous CT ("caps") and vertical impaction of erupting CT that may lead to large eruption cysts and possibly then to apical infections. Disorders of wear, especially enamel overgrowths ("enamel points"), are the main equine dental disorder and are believed to be largely due to the dietary alterations associated with domestication. If untreated, such disorders will eventually lead to more severe CT disorders such as shearmouth and also to widespread periodontal disease. More focal dental overgrowths will develop opposite any CT not in full opposition to their counterpart, e.g., following maleruption of or loss of a CT. Because of the great length of reserve crown in young (hypsodont) CT, apical infections usually cause infection of the supporting bones and depending on the CT involved, cause facial swellings and fistulae and possibly sinusitis. Diagnosis of apical infection requires radiography, and possibly scintigraphy and other advanced imaging techniques in some early cases. When possible, oral extraction of affected CT is advocated, because it reduces the costs and risks of general anaesthesia and has much less post-extraction sequelae than CT repulsion or buccotomy.

Esthetic enhancement of ceramic crowns with zirconia dowels and cores: a clinical report

There has been an increase in the use of esthetic metal-free ceramic crowns in restoring endodontically treated teeth or teeth with severe coronal destruction. Tooth-colored dowels and cores are used to enhance the esthetic result. This report describes the treatment of a patient with bilateral maxillary supernumerary lateral incisors, a severe malocclusion, and maxillary anterior tooth discoloration. Treatment included heat-pressed, metal-free ceramic crowns supported by zirconia ceramic dowel-and-core foundations.

[Prevalence of talon cusp in patients aged 7-18]

Talon cusp is an uncommon malformation. The aetiology is unknown although it is thought to be the combination of genetic and environmental factors. The purpose of the study was to examine the prevalence of talon cusps in children aged 7-18. 600 model casts were examined in the Pedodontic and Orthodontic Department of the Semmelweis University. Classification of talon cusps used was based on the degree of formation and extension by Hattab et al [6]. 12 talon cusps were found in the group of type 1, two were found in group of type 2 and one in type 3. The prevalence of talon cusps was 2.5%, mostly on the upper permanent lateral incisors. In four cases it was bilateral. The prevalence of talon cusps was more frequent in males compared to females. The early recognition of the anomaly is important from the therapeutic point of view (placement of sealant, periodic reduction of the cusp).

Reshaping a mesiodens

A mesiodens is a supernumerary tooth that is found in the midline of the maxilla. Fifteen percent erupt usually between the ages of 3 and 7. The standard treatment is extraction of the supernumerary to allow the permanent incisors to erupt properly. This case report describes an instance where the primary incisor was prematurely exfoliated due to the eruption of the mesiodens. Because of the favorable position of the mesiodens in the dental arch, it was decided to reshape the supernumerary to resemble a primary incisor. This was accomplished successfully, and the mesiodens is being monitored to assess any need to trim or add to the bonding material as the child grows.

The treatment of fusion and supernumerary maxillary central incisors: a case report

Changes in tooth form may result from heredity, disease, or trauma. Fusion is a union of one or more teeth during development. Gemination means that two separate morphological units are created by division of the tooth germ. Many studies have attempted to discuss the prevalence of double teeth (fusion and gemination) among the persons tested by examining gender, distribution (maxilla or mandible), and whether the anomaly occurred bilaterally or unilaterally. This article describes a case in which one individual was diagnosed with both a supernumerary maxillary central incisor and fusion of a maxillary central incisor.

Endodontic treatment of developmental anomalies in posterior teeth: treatment of geminated/fused teeth--report of two cases

AIM

Gemination or fusion is a rare occurrence in the mandibular posterior teeth. Endodontic treatment of these teeth needs special care and attention to the bizarre anatomy. The aim of this article is to describe the problems encountered and the strategy in treating such cases.

CASE REPORT

Two cases of complex endodontic treatment of fused/geminated teeth are presented. The first is an 11-year-old girl with an anomalous 'double' first mandibular molar and premolar diagnosed as having necrotic pulp with chronic apical abscess of endodontic origin; the second is a 16-year-old boy with 'double' second and supernumerary mandibular molars, who was diagnosed with irreversible pulpitis. Both cases were treated successfully in multiple appointments. The common features and treatment modalities are discussed.

KEY LEARNING POINTS

Failure to diagnose fused/geminated teeth leads to misdiagnosis and a treatment plan that could cause permanent damage and tooth loss. Generally, there is communication between root canal systems of fused/geminated teeth which should be treated as one entity. Use of magnification is an important aid during treatment.

A case of bilateral supplemental maxillary central incisors

A case of bilateral supplemental maxillary central incisors is presented. Treatment comprised of extraction of one supplemental and two lateral incisors, preservation of one supplemental incisor, finishing with a 'Cyclops' arrangement of the teeth. The handling of supernumerary teeth in general is discussed.

The management of supernumerary teeth in childhood--a retrospective study of practice in Bristol Dental Hospital, England and Westmead Dental Hospital, Sydney, Australia

This study compared the treatment provided for patients with supernumerary teeth in Bristol Dental Hospital with those in Westmead Dental Hospital, Sydney, Australia. The records of 63 children referred for removal of a supernumerary tooth in Bristol and 96 children in Westmead were examined, involving a total of 215 supernumerary teeth. Differences in the treatment provided for these patients were found not only between the two centres but also within one centre. There appeared to be no standardised route by which these patients were seen and therefore no standardised pattern of treatment. Contact with all UK Dental Schools indicated that no formal treatment protocol existed for the treatment of children with supernumerary teeth. In addition, a permanent incisor associated with a conical supernumerary tooth was twice as likely to erupt spontaneously as one associated with a supernumerary of tuberculate form. The location of the supernumerary tooth also influenced the likelihood of spontaneous eruption of the associated permanent incisor. There is a need for a prospective randomised controlled trial in the future in order to develop a formal treatment protocol for the management of patients with supernumerary teeth. A multicentre trial is under development.

[Frequency of supernumerary teeth and possibilities of treatment]

According to dental literature, the frequency of supernumerary teeth is 1-3%. The authors analyzed the orthopantomograms of 1875 children and adolescents aged between 6 and 18 years to determine the frequency of supernumerary teeth at the Department of Dentistry for Children and Orthodontics. The frequency was found to be 1.92%. The sequence of frequency of supernumerary teeth was: mesiodens, lateral incisor, central incisor. 77.8% of the supernumerary teeth occurred in the maxilla, 97.2% in the frontal region. Besides the data found, two successful cases of surgical and orthodontic treatment are also presented.

Supernumerary teeth: literature review

A review of the literature on supernumerary teeth in general and supernumerary molars in particular was carried out on prevalence, aetiology, complications and the treatment of supernumerary teeth. Additional teeth are relatively common and are usually of simple conical shape (supernumerary teeth) but may resemble teeth of the normal size and shape. The aim of this review is to provide reference material for dental practitioners in Zimbabwe.

Survey of dental treatments for pediatric patients referred to the pediatric dental clinic of a dental school hospital

This survey was conducted to clarify which dental treatments in children are regarded as difficult by general dentistry practitioners. The subjects were 615 children who first visited Tokyo Dental College Chiba Hospital from January 1995 to August 1999 with reference letters. There were 615 children in the study; 571 (92.8%) came from Chiba City where our hospital is located and the 11 regions surrounding Chiba City. The prime reasons for referral in the order of frequency were treatments of dental caries, malalignment/malocclusion, traumatized teeth, supernumerary teeth, retarded eruption/impacted teeth, abnormal direction of erupted teeth, congenitally missing teeth, prolonged retention of deciduous teeth, and abnormal frenulum. Patients with dental caries or traumatized teeth in the deciduous dentition period and those with malalignment/malocclusion, supernumerary teeth, or retarded eruption/impacted teeth in the mixed dentition period were often referred to medical organizations specializing in pediatric dentistry because of the difficulties in controlling the patients' behavior and in providing adequate treatment. The information about pediatric dental treatments considered difficult by general dentists revealed by this survey appears to be useful and needs to be incorporated in the programs for clinical training of undergraduate students and education of postgraduate students.

Orthodontic treatment of a patient with multiple supernumerary teeth and mental retardation

Supernumerary teeth may lead to impaction or ectopic eruption of maxillary incisors, crowding, oronasal fistula, follicular cyst, migration of adjacent teeth and root resorption. In this presentation, an 11-year-old male patient with 4 supernumerary teeth in the maxillary anterior region and a slight mental retardation problem will be presented. After extraction of the supernumerary teeth, the large space created by distal migration of central incisors was closed by orthodontic treatment. Although initial patient compliance was weak and caused difficulties in the course of treatment, orthodontic treatment was completed successfully.

Cleidocranial dysplasia: modern concepts of treatment and a report of an orthodontic resistant case requiring a restorative solution

A case is presented of a young boy with cleidocranial dysplasia, whose multiple supernumerary teeth prevented the eruption of most of his permanent teeth. His maxillary incisor teeth failed to erupt following removal of anterior supernumerary elements and orthodontic traction. Lack of abutment teeth and a difficult maxillary base made prosthetic treatment almost impossible. A horseshoe acrylic denture retained by milled crowns bonded to the deciduous canines and a maxillary first molar proved a very successful restoration. The problems of treating this group of patients are discussed.

Supernumerary teeth--an overview of classification, diagnosis and management

Most supernumerary teeth are located in the anterior maxillary region. They are classified according to their form and location. Their presence may give rise to a variety of clinical problems. Detection of supernumerary teeth is best achieved by thorough clinical and radiographic examination. Their management should form part of a comprehensive treatment plan. This article presents an overview of the clinical problems associated with supernumerary teeth and includes a discussion of the classification, diagnosis and management of this difficult clinical entity.

[Supernumerary teeth and orthodontic treatment]

According to the orthodontist supernumerary teeth on dental arches necessitate a special analysis of the occlusion to decide which to keep and which ones to pull out. Then he must solve the problem of the new occlusion to have. Thus in this study the authors, from their personal experiences of treatment of cases about supernumerary teeth go through the matter.

Equine dental disease part 2: a long-term study of 400 cases: disorders of development and eruption and variations in position of the cheek teeth

Of 400 referred horses with dental disorders, 349 cases suffered from primary disorders of their cheek teeth, ninety of these from disorders of development or eruption, or displacements. These included 20 cases with rostral maxillary and caudal mandibular cheek teeth overgrowths, 16 with diastemata, 15 with grossly enlarged mandibular 'eruption cysts', 4 with grossly enlarged maxillary cheek teeth 'eruption cysts', 10 cases with supernumerary cheek teeth and 23 cases with displaced cheek teeth. These displacements were believed to be developmental in 16 cases and acquired in the remaining 7 cases. Long-term response to treatments, that included removal of overgrowths and extraction of teeth with deep secondary periodontal disease was excellent for most disorders except diastemata.

Equine dental disease part 1: a long-term study of 400 cases: disorders of incisor, canine and first premolar teeth

A review of 400 horses referred because of dental disorders showed 44 cases to suffer from primary disorders of their incisors and 11 from canine or 1st premolar teeth disorders. The remaining 345 horses suffered from primary disorders of the cheek teeth. Disorders of incisors included traumatic damage to teeth and their supporting bones, retained deciduous, displaced and supernumerary incisors; brachygnathia and abnormalities of wear, with most of the latter disorders being secondary to primary disorders of the cheek teeth Only 3 cases of apical infection of incisors were recognised. Most cases of fractured incisors responded well to conservative therapy. Retained deciduous incisors were extracted, but most cases with supernumerary and displaced incisors, or brachygnathia were treated conservatively. Most disorders of the canine and 1st premolar were developmental displacements that caused bitting problems (abnormalities of head movement associated with the bit), and these cases responded well to extraction of the displaced teeth.

Mesiodens in the primary dentition--a case report

Supernumerary teeth are among the most significant dental anomalies affecting the primary and the permanent dentitions. Mesiodens is a supernumerary tooth with a cone shaped crown and a short root. Though it occurs frequently in the permanent dentition, it is extremely rare in the primary dentition. The exact etiology is still obscure and not well understood. Supernumerary teeth occur as isolated dental findings or as part of a syndrome. The frequency with which supernumerary teeth occur and the effects they have on development of normal occlusion justify the radiographic examination of preschool children. Early removal of such teeth is recommended if they impede the eruption of adjacent permanent teeth, appear inverted or rudimentary, associated with certain pathologic conditions or are symptomatic.