Orthodontic management of non-syndromic multiple supernumerary teeth
This paper reports a case of a 23-year-old man who reported with a chief complaint of spacing in the anterior maxillary region []. An intraoral examination showed two supernumerary teeth on the palatal aspect of the maxillary premolar region bilaterally and one supernumerary tooth on the buccal aspect of the right maxillary molar region, thus constituting three fully erupted supernumerary teeth in the maxillary arch [] and a supernumerary tooth at the lingual aspect of premolars in the mandibular arch on the right side []. There was no relevant medical history and the patient was otherwise healthy. Physical and extra-oral examinations revealed no additional abnormalities wherefore, conditions such as cleidocranial dysostosis, Gardner's syndrome, ectodermal dysplasia and Apert's syndrome were excluded. There was no familial history of supernumeraries elicited by the patient. A panoramic radiograph revealed three impacted supernumerary teeth in the mandibular posterior region, of which one was on the right side and two on the left side of the mandible []. The maxilla showed one impacted supernumerary tooth in the right premolar region and one on the left side between lateral incisor and canine, thus making five impacted supernumeraries in the oral cavity. This resulted in a dental formula of 40 teeth (32 normal, 8 supernumeraries [5 impacted and 3 erupted]). The treatment of the patient began with the extraction of erupted maxillary and mandibular supernumeraries followed by fixed appliance therapy. Straight wire appliance (0.022 Roth prescription) was used. The impacted supernumeraries were left in situ as they were not asymptomatic. Space closure was performed using class III elastics and echains []. A permanent lingual retainer was placed after debonding [Figures and ]. He was advised on the need for periodic recall and observation for any cystic changes with the impacted supernumeraries.