Surgical Management of Super Numerary Tooth and an Impacted Maxillary Permanent Central Incisor: A Case Report| Stephy Publishers

 


SOJ Dental and Oral Disorder - (SOJDOD) | Stephy Publishers

Abstract

Impaction of Maxillary Permanent incisor due to super numrary tooth is not a common entity encountered in dental practice but when present, it poses a disturbing esthetic dilemma to children and their parents. Early diagnosis and interception in these cases is the best way for their management. The purpose of this report is to describe the diagnosis and the clinical management of an impacted supernumerary tooth, which impeded the eruption of the permanent maxillary central incisor.

Keywords

Dentistry, Tooth, Treatment

Introduction

Super numerary tooth, or hyper dontiais defined as a development a anomaly of number characterized by the presence of an extra tooth in addition when compared to the normal formula.1,2 The termmesiodens refers to a super numerary tooth located in the anterior region between the maxillary central incisors. It presents clinically the most frequent of all the super numerary teeth.3 A mesiodensis the most common cause of central incisor impaction, followed by odontomas and trauma.3

The exact etiology of mesiodens tooth remains unclear. Several hypotheses have been established for the formation of super numerary teeth which include egenetic and environmental factors, syndromic conditions and disturbances in dental development.4,5 A sex-linked pattern has also been suggested, as males are affected twice as frequently as females.3

The most common clinical complications of mesiodens include: central diastema, crowding, rotation, dislocation, delayed eruption of permanent incisor, abnormal tooth eruption, abnormal occlusion development, resorption of the roots of the adjacent incisors and cystic degeneration.3,6

The timing of the surgical removal of super numerary teeth remains highly controversial.1,2 Interceptive treatment has been advocated by some clinicians who believe that early extraction before radical formation of the permanent central incisor increases the chances of spontaneous eruption. Others have advocated delayed treatment or late removal after completion of the formation of the root of permanent incisor, to lower the risk of iatrogenic surgical damage to the permanent central’s apical development.7,8

The aim of this article was to present the diagnostic elements of super numerary tooth and the different therapeutic management.

Case Presentation

A 10-year-old girl presented to the Department of Pedodontics and Preventive Dentistry, at the Faculty of Dental Medicine of Monastir (Tunisia) with the chief complaint of unerupted left permanent maxillary central incisor (21) and the persistence of the deciduous tooth (61). The patient had no significant medical and family history. Extra oral examination revealed a convex facial profile and the presence of good facial balance in all proportions. Clinical examination revealed mixed dentition stage, retained deciduous left central incisor, missing permanent left central incisor and a midline shift towards the left (Figure 1). The permanent right central incisor, the right and the left lateral incisors and permanent first molars were fully erupted.


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