Anterior supernumerary teeth – assessment and surgical intervention in children

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Dan Boboia Date: 8/20/09
Article title: Anterior supernumerary teeth – assessment and surgical intervention in children
Author(s): Robert Primosch, DDS, MS
Journal: Pediatric Dentistry
Volume (number): 3:2
Month, Year: 11, 1981
Major topic: Review the current literature regarding the current diagnostic assessment and surgical management of anterior supernumerary teeth to provide a consensus of opinion
Type of paper: Lit. Review
Prevalence:
1-3% of patients have supernumerary teeth, 90-98% in maxilla, 90% in the premaxilla; mesiodens is the most common; 5 times less likely to occur in primary dentition.
Diagnosis and Assessment:
Use the buccal object or S.L.O.B. to determine the position of the supernumerary tooth
The high prevalence of anterior supernumerary teeth in the primary and early mixed dentitions of 6-9 year old children justifies the mandatory inclusion of a maxillary occlusal radiographs for screening.
Complications:
7-20% of supernumerary teeth have no associated pathology
Some complications include nasal eruption (rare) and cystic degeneration (4-9%)
Interference with normal eruption (30-60%) and position of adjacent teeth is common. Loss of vitality, diastema, formation, displacement (22-63%) and impaction are all potential problems as well.
The most common problem is interference with normal occlusion
82% of teeth involved will be displaced into a labial position
Timing of Removal:
Immediate vs. Delayed approach
Immediate: to remove as soon as diagnosis occurs (before 6 years of age); disadvantages include potential damage to adjacent teeth causing devitalization or root malformation, inability of a young child to tolerate the surgical procedure, performance of unnecessary surgery if future complications develop. A longitudinal study of 375 cases concluded that removal before 5 years of age was superior to delayed removal (over 7 years of age). The study demonstrated that the prevalence of future complications, like displacement and retarded eruption, was reduced by 39% and additional orthodontic treatment was reduced by 45%. In addition there was less partial bone loss when surgery was performed.
Delayed: observe until adjacent root formation is complete (between 8-10 years of age); increases the risk for loss of eruption potential of the central incisors, loss of anterior arch space or midline shift, more extensive surgical and orthodontic treatment for correction.
Surgical Exposure of Erupted Incisors:
75% of unerupted teeth will erupt spontaneously once a supernumerary tooth is removed. Full eruption is likely to naturally in 1.5 to 3 years. The majority of these incisors erupt about 1mm short of the occlusal plane. This phenomenon is attributed to a matured gingival fiber system.
The rate of natural eruption is influenced most by the height of apical displacement and the maintenance of sufficient arch space; the patient’s chronological age, degree of root maturity, root inclination, and curvature are not an issue. A thickened follicle around an unerupted tooth is likely to create a barrier to eruption (removal of the fibrous tissue will result in rapid eruption). 85% of permanent incisors will erupt spontaneously after surgical exposure. An apically repositioned flap rather then a “window technique” must me used in order to preserve attached keratinized gingival tissue cervical to the crown.
Recommendations for Treament:
Surgical removal of supernumerary tooth should occur immediately following recognition. Exception : midline conical shaped teeth with excellent prognosis for uninhibited eruption, highly placed teeth without evidence of associated complications. Surgical exposure of the unerupted crown should only occur if there is sufficient lack of erupted movement following a reasonable period of time (6 months) and enough arch space for eruption. Orthodontic traction should be used to intervene incases not displaying enough spontaneous eruption.
Assessment of article: Good review