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Report of a case of multiple supernumerary teeth
REPORT
OF A CASE
OF MULTIPLE
H. C. BERESDT,
I).J).S.,
SUPERNUMERARY ~J~KJSALEJI,
TEETH
ISRAEL
A
MONG a group of immigrant children who underwent a t,horough medical examination, the case of I). S. is of special interest. The boy was I2 years old and the youngesb of 5 children. He was born in Iraq. The malposition of the teeth on the left, side, the missing lateral incisor on the right side, and the eruption of supernumerary teeth indicated the need for detailed examination. Anamnesis-According to the patient his parents, as well as his brother and sisters, had normal teeth. As none of the family is living in Israel a verification of these facts could not be obtained. For the same reason facts about the patieht ‘s early years could not be gathered. Examination.-The patient was of normal build and weight; his mental development was good. There was no reason to assume endocrine disturbances, a fact which was confirmed by general examination. Descent of testicles was according to age. There was no abnormal appearance of hands, feet, hair, iris, or perspiratory glands. Mouth.-The distance between the base of the nose and the mouth seemed slightly enlarged (Fig. 1). The gingivae showed a normal and healthy condition. The teeth were free of caries. No extractions had been performed. In the lower jaw the 14 teeth had grown normally without torsiversion and spacing. In t,he upper jaw the development on bot,h sides distal from the first premolar was normal. The center of maldevelopment was found only in the central part of the upper jaw (Figs. 2, 3, and 4). Mesial from 4 j a small canine, -.0 -21, had erupted in torsiversion of about 90°, and buccal from this tooth was erupting a broad canine, 3 I. As the central incisor, /- 1 , was very broad, it map be assumed that 3 /, being very broad as well, was the genuine canine and 0 / was a supernumerary canine. Me&al from --0 / the deciduous canine, ITT I, persisted. About 6 mm. from it the deciduous I j, too, had not been shed and was covered labially by a tooth, called 0 1, which was smaller than the following 11 mm. broad !_l,. / 1 showed a torsiversion of about 60° and the buccal surface of the acljacentT2, 9 mm. broad, was distally verted by 130’. Between 12 and 14 a tootk 10 was placed, the form of which was that of a lateral incisor, its edges not being triangular and without the typical palatinal cuspid of a canine. Buccal from this tooth again, as on the right side, the permanent canine, 13, was erupting. X-ray Examination.-X-rays of the lower jaw revealed normal development and no unerupted teeth. In the upper jaw both sides were undisturbed distal from the first premolar. From the x-ray (Fig. 5) and the drawing 1132
Figs.
l-10.
1134
H.
C.
BERENDT
(Fig. 5a) could be seen the double contour of 3 1 and 0 I. Between their roots and that of 4 j a tooth germ, called K 1, was visible in an early stage of development. The Got of III / was not resorbed. Tn the x-ray (Fig. 6) and drawing (Fig. 6a) the region between III 1and 0 / could be seen best. A broad unerupted tooth with the profile of a premolar, to be referred to as P I, was lying transversely. The contours of two teeth, a broader and a sma& one, were nasal, one obscuring the other. (‘omparing these teeth with the erupted / 1 and / 2 we are justified in assuming that these teeth were the impacted-i/ and --2 j, and that they could not erupt, being impeded by the transversely lying tooth, P 1, and by another supernumerary tooth, Z ,I, which was lying mesial to them, as well as sagittal and caudal. Under the foregoing assumption the visible tooth 0 1 is not the genuine central incisor but another supernumerary tooth. Toget,her with 12, seen in the x-ray (Fig. 7) behind ) 3 , we find altogether sis supernumerary teeth.
Therapy.-In planning the therapy of this case surgical and orthodontic methods had to be considered. It. was necessary also to take into consideradevelopment, which could bring an tion the factor of time for the “natural” It was decided to extract thr deciduous teet.h, amelioration of the conditions. III I and I /, and the visible teeth, 0 1 and 10. By means of an operation I’ 1 and Z / should be eliminat,ed to make an opportunity for the possible eruption of 1 1 and 2 I. When these extractions were performed it was found that the tooth, El, was lying with its occlusal surface against the mesiul edge of @ /, as can be seen in Fig. 8, which was taken during the operation. The crown was shaped like that of a lower molar with only one incompleted root. The root was three-chambered, The t,ooth, Z 1, was four~d lying with its root against - @ 1 in sagittal direction, its crown caudal. In Fig. 9 all the extracted permanent teeth are shown. The germ, g-1, between 4 1 and 3 / has been allowed to remain for the time being. After t,he surgical elimination of P / and Z / the @ / was loosened owing to lack of bony environment, but, it,s est,raet,ion wits postponed, taking into consideration the patient’s appearance during the time interval until 1 / and 2 ! would erupt either naturally or by orthodontic means. Fig. 10 shows the &ation of these teeth after the operation. Further x-rays will be made from time to time to follow up any changes in the position of the incisors and to determine when 0 / has to be ext,racted to avoid interOrth&lontic treatment will be started in ference with the erupting incisors. due course. Conclusion Variations in the appearance of canines are thought to be very rare.5 Absence of canines in cases of anodontia partialis is considered to occur seldom, though in a number of cases I had occasion to observe that the canines were missing.l The duplication of 3 j in the present case is nevertheless a very rare occurrence. There is no apparent reason for the torsiversion of 1 1 and 12. Neither the impacted teeth nor the occlusion can be made responsible for it. The forces which give the erupting teeth their usual impulse of direction have
MULTIPLE
SUPERNUMERARY
1135
TEETH
been disturbed on the left side of the central part of the upper the other side of the jaw the disturbance has predominantly duplication of tooth germs. Summary A case is presented The most upper jaw. and molar-shaped tooth shape of the teeth were
with 6 supernumerary teeth in the central part of the remarkable facts are a duplication of the right canine in the region of the right incisors. The position and as follows : Position
Molar
jaw, while on resulted in a
of
Premolar One
Region None
Teeth
Region germ
___~
Central Region Fiveteeth
Shape of Teeth 1 Normally
Peg-shaped One
Developed Three
1
Oversized One
Undefined One
References 1. Berendt,
H. C.:
Report
AND ORAL PATH.%
of Seven
Cases
of Anodontia
Partialis,
ORAL SUN., ORAL MED.,
1435,195O.
Dental Surgery and Pathology, London, 1931, J. F., and Sprawson, E.: mans, Green & Co. 3. McBride, W. C., Juvenile Dentistry, London, Henry Kimpton. Principles of Orthodontics, Philadelphia, 1943, J. B. Lippincott 4. Salzmann, J. A.: pany. Oral Pathology, ed. 2, St: Louis, 1944, The C. V. Mosby Company. 5. Thoma, K. H.: 2. Colyer,
36. BEN-YEHUDA STR.
LongCom-
OF A CASE
OF MULTIPLE
H. C. BERESDT,
I).J).S.,
SUPERNUMERARY ~J~KJSALEJI,
TEETH
ISRAEL
A
MONG a group of immigrant children who underwent a t,horough medical examination, the case of I). S. is of special interest. The boy was I2 years old and the youngesb of 5 children. He was born in Iraq. The malposition of the teeth on the left, side, the missing lateral incisor on the right side, and the eruption of supernumerary teeth indicated the need for detailed examination. Anamnesis-According to the patient his parents, as well as his brother and sisters, had normal teeth. As none of the family is living in Israel a verification of these facts could not be obtained. For the same reason facts about the patieht ‘s early years could not be gathered. Examination.-The patient was of normal build and weight; his mental development was good. There was no reason to assume endocrine disturbances, a fact which was confirmed by general examination. Descent of testicles was according to age. There was no abnormal appearance of hands, feet, hair, iris, or perspiratory glands. Mouth.-The distance between the base of the nose and the mouth seemed slightly enlarged (Fig. 1). The gingivae showed a normal and healthy condition. The teeth were free of caries. No extractions had been performed. In the lower jaw the 14 teeth had grown normally without torsiversion and spacing. In t,he upper jaw the development on bot,h sides distal from the first premolar was normal. The center of maldevelopment was found only in the central part of the upper jaw (Figs. 2, 3, and 4). Mesial from 4 j a small canine, -.0 -21, had erupted in torsiversion of about 90°, and buccal from this tooth was erupting a broad canine, 3 I. As the central incisor, /- 1 , was very broad, it map be assumed that 3 /, being very broad as well, was the genuine canine and 0 / was a supernumerary canine. Me&al from --0 / the deciduous canine, ITT I, persisted. About 6 mm. from it the deciduous I j, too, had not been shed and was covered labially by a tooth, called 0 1, which was smaller than the following 11 mm. broad !_l,. / 1 showed a torsiversion of about 60° and the buccal surface of the acljacentT2, 9 mm. broad, was distally verted by 130’. Between 12 and 14 a tootk 10 was placed, the form of which was that of a lateral incisor, its edges not being triangular and without the typical palatinal cuspid of a canine. Buccal from this tooth again, as on the right side, the permanent canine, 13, was erupting. X-ray Examination.-X-rays of the lower jaw revealed normal development and no unerupted teeth. In the upper jaw both sides were undisturbed distal from the first premolar. From the x-ray (Fig. 5) and the drawing 1132
Figs.
l-10.
1134
H.
C.
BERENDT
(Fig. 5a) could be seen the double contour of 3 1 and 0 I. Between their roots and that of 4 j a tooth germ, called K 1, was visible in an early stage of development. The Got of III / was not resorbed. Tn the x-ray (Fig. 6) and drawing (Fig. 6a) the region between III 1and 0 / could be seen best. A broad unerupted tooth with the profile of a premolar, to be referred to as P I, was lying transversely. The contours of two teeth, a broader and a sma& one, were nasal, one obscuring the other. (‘omparing these teeth with the erupted / 1 and / 2 we are justified in assuming that these teeth were the impacted-i/ and --2 j, and that they could not erupt, being impeded by the transversely lying tooth, P 1, and by another supernumerary tooth, Z ,I, which was lying mesial to them, as well as sagittal and caudal. Under the foregoing assumption the visible tooth 0 1 is not the genuine central incisor but another supernumerary tooth. Toget,her with 12, seen in the x-ray (Fig. 7) behind ) 3 , we find altogether sis supernumerary teeth.
Therapy.-In planning the therapy of this case surgical and orthodontic methods had to be considered. It. was necessary also to take into consideradevelopment, which could bring an tion the factor of time for the “natural” It was decided to extract thr deciduous teet.h, amelioration of the conditions. III I and I /, and the visible teeth, 0 1 and 10. By means of an operation I’ 1 and Z / should be eliminat,ed to make an opportunity for the possible eruption of 1 1 and 2 I. When these extractions were performed it was found that the tooth, El, was lying with its occlusal surface against the mesiul edge of @ /, as can be seen in Fig. 8, which was taken during the operation. The crown was shaped like that of a lower molar with only one incompleted root. The root was three-chambered, The t,ooth, Z 1, was four~d lying with its root against - @ 1 in sagittal direction, its crown caudal. In Fig. 9 all the extracted permanent teeth are shown. The germ, g-1, between 4 1 and 3 / has been allowed to remain for the time being. After t,he surgical elimination of P / and Z / the @ / was loosened owing to lack of bony environment, but, it,s est,raet,ion wits postponed, taking into consideration the patient’s appearance during the time interval until 1 / and 2 ! would erupt either naturally or by orthodontic means. Fig. 10 shows the &ation of these teeth after the operation. Further x-rays will be made from time to time to follow up any changes in the position of the incisors and to determine when 0 / has to be ext,racted to avoid interOrth&lontic treatment will be started in ference with the erupting incisors. due course. Conclusion Variations in the appearance of canines are thought to be very rare.5 Absence of canines in cases of anodontia partialis is considered to occur seldom, though in a number of cases I had occasion to observe that the canines were missing.l The duplication of 3 j in the present case is nevertheless a very rare occurrence. There is no apparent reason for the torsiversion of 1 1 and 12. Neither the impacted teeth nor the occlusion can be made responsible for it. The forces which give the erupting teeth their usual impulse of direction have
MULTIPLE
SUPERNUMERARY
1135
TEETH
been disturbed on the left side of the central part of the upper the other side of the jaw the disturbance has predominantly duplication of tooth germs. Summary A case is presented The most upper jaw. and molar-shaped tooth shape of the teeth were
with 6 supernumerary teeth in the central part of the remarkable facts are a duplication of the right canine in the region of the right incisors. The position and as follows : Position
Molar
jaw, while on resulted in a
of
Premolar One
Region None
Teeth
Region germ
___~
Central Region Fiveteeth
Shape of Teeth 1 Normally
Peg-shaped One
Developed Three
1
Oversized One
Undefined One
References 1. Berendt,
H. C.:
Report
AND ORAL PATH.%
of Seven
Cases
of Anodontia
Partialis,
ORAL SUN., ORAL MED.,
1435,195O.
Dental Surgery and Pathology, London, 1931, J. F., and Sprawson, E.: mans, Green & Co. 3. McBride, W. C., Juvenile Dentistry, London, Henry Kimpton. Principles of Orthodontics, Philadelphia, 1943, J. B. Lippincott 4. Salzmann, J. A.: pany. Oral Pathology, ed. 2, St: Louis, 1944, The C. V. Mosby Company. 5. Thoma, K. H.: 2. Colyer,
36. BEN-YEHUDA STR.
LongCom-