Abnormalities of tooth number

Two types

(1). Congenital absence of teeth

(2). Supernumerary teeth

 ( I ). Congenital absence of teeth

• Anodontia

• Hypodontia or Partial Anodontia (oligodontia)

 Anodontia

- Congenital absence of all teeth

- Very rare

- Usually associated with hereditary ectodermal dysplasia

- May involve both the deciduous & permanent dentition

 Hypodontia or Partial Anodontia

- Congenital absence of one or of several teeth

- More common

- Etiology of single missing teeth unknown

 Hypodontia or Partial Anodontia

- Familial tendency

- May be evidence of an evolutionary trend toward

fewer teeth
- Sometime hereditary ectodermal dysplasia

- [In these instances – few teeth (+)] but may be deformed or

misshapen, usually cone shaped

- Sometime X' ray at an early age

[ tooth buds are sensitive to 'x' ray radiation]

- Hypodontia in primary dentition is less common than in the

permanent dentition

- if occur, usually maxillary lateral, mandibular lateral and

mandibular canines

- Close correlation both missing deciduous and their permanent

successors
- Usually no treatment

- Hypodontia in permanent teeth

- Usually maxillary lateral, mandibular second

premolars
- May be unilateral or bilateral

- Absence of lateral incisor often associated with a

small peg shaped contra-lateral tooth

- Effect of hypodontia depend on amount of crowding

 Treatment (+) (-)

- Depend on crowding (+) or (-)

For lateral incisor

In an uncrowded arch.

- Partial denture / later replaced by a bridge

[ monitor eruption path of canine clinically and radiographically]

- Extraction of primary canine if permanent canine move mesially

For lateral incisor

In a crowded arch

- Fit a prosthesis and treat the crowding when premolars erupt

or,

- Allow the canine to erupt into the lateral incisor space but the

final appearance is often disappointing

[ large permanent canine & bulbous first premolar palatal cusp ]

- Careful grinding or modify with composite

For second premolar
In an uncrowded arch

- Depend on condition of second molar

- If sound – No Treatment

- If prognosis is poor ELA during mixed dentition.

- but space closure may be not complete orthodontic

treatment needed to complete or to improve angulation of first

permanent molar before construction a bridge

For second premolar

In a crowded arch

- Absence of premolar, especially if bilateral, is an

advantage in an arch that would otherwise be crowded

 (II). Supernumerary teeth

- Extra teeth

- More common in permanent than in primary tooth.

- May develop from a third tooth bud arising from dental lamina

- Sometime hereditary tendency (+)

- Multiple supernumerary teeth may be characteristically found

in cleidocranial dysostosis
 Prevalence

- 0.2 to 0.8 % in deciduous dentition

- 2.1 % permanent dentition

(Male : Female - 2 : 1)

- 90 to 98 % are in the maxilla

(Maxilla : mandible – 5 : 1)
- 90 % located in premaxilla

- Associated syndrome - Cleidocranial dysosteosis

- Gardner’s syndrome

- Cleft lip and cleft palate

- In Gardner's syndrome impacted supernumerary

& permanent teeth are (+)

 Classification
- (1). many variety of shape

- Conical small, peg shaped

- Tuberculate short, barrel-shaped

- Supplemental resembling a normal tooth

- Odontomes variable shapes

- Majority conical or tuberculate

- (2). Found in any location single or paired erupted

or unerupted or even inverted

- Mesiodens in midline

- Paramolar usually small buccally, lingually or

interproximally in molar region

- Clinically supernumerary teeth interfere with eruption

of or cause displacement or rotation of adjacent teeth

- Mesiodens (Mesiodentes)

Presence in the midline of premaxilla

- Paramolar

Interproximal space between premolars & molars

- Distomolar (or) Distodens

Distal to last molar

 Causes

(1). Genetic

(2). Associated with some syndrome

(3). Number of theories

- Dichotomy theory
 Complication
(1). Crowding

(2). Failure of eruption

(3). Displacement of permanent teeth

(4). Diastema

(5). Cystic formation

(6). Root resorption

(7). Nasal or orbital eruption (very rare)

(8). Cross bite

(9). Changes in occlusion ( esp.: canine relationship )

 Investigation or x’ ray
(1) OPG (panoramic view) OPG can detect unerupted

multiple supernumerary in Gardener’s syndrome

(2) Standard occlusal view

(3) Periapical view - to assess vertical level.

(4) Parallax view - for identification or localization.

 Treatment

- Depend on type and position, potential effect on adjacent teeth.

(1). No treatment not interfering the adjacent teeth

(inverted)

( but periodic x’ ray to detect undesirable changes )

(2). Await eruption and extract (Most conical)

(3). Surgical removal - Timing of treatment

- Early removal (<6yr) give normal developing

tooth to erupt into its normal position but risk of

damaging adjacent developing teeth during

surgery
- Delayed treatment normal tooth

displaced or rotated and allow adjacent teeth

to drift into the space .

The 'S' tooth is removed later, less eruption potential the
impacted normal tooth will have

- If adequate space (+) space maintainer

- If inadequate move adjacent teeth distally after

ELA of primary canines .

- If space enough - incisor will erupt , but if has be

displaced will not erupt and require
surgery and orthodontic extrusion .
Deciduous dentition

- Hornified epithelial structures without roots

- can easily be removed

Post permanent dentition

- result of delayed eruption of retained or

embedded teeth or multiple unerupted

supernumerary
End