Orthodontic
Management of
Supernumerary Teeth

Supernumerary teeth are defined as teeth formed in excess of the normal dental complement in a normal primary or permanent dentition. This phenomenon, also known as hyperdontia, is a disorder of odontogenesis that develops at the stage of initiation during teeth formation. This abnormality develops because of continued bud formation of the enamel organ or excessive proliferation of cells. Excessive cell proliferation or continued budding can be responsible for a variety of irregularities in the primary and transitional dentition.

The presence of an extra tooth in the dental arch has great potential to disrupt normal occlusal development. Early detection and intervention to remove the supernumerary tooth, or monitoring until the proper time for extraction, is a type of interceptive or guidance treatment that can be performed at early ages.

Prevalence

Supernumerary teeth are relatively common in the general population. They can affect both the primary and the permanent dentitions. The association of multiple hyperdontia with different syndromes, such as Gardner syndrome, cleidocranial syndrome, or facial fissures, has also been reported widely in the literature^1–4; however, supernumerary teeth can also appear in nonsyndromic situations.

Supernumerary teeth may occur singly or in multiples, unilaterally or bilaterally, and in one or both arches. The occurrence of one or two supernumerary teeth is most common in the anterior region of the maxilla, followed by the mandibular premolar region. When multiple (more than three) supernumerary teeth are present, the most common site affected is the mandibular premolar region.

The incidence of one or two supernumerary teeth occurred most frequently in the maxillary anterior region (46.9% of the patients); this was followed by supernumerary premolars (24.1%), then supernumerary molars (18%), and, finally, supernumerary paramolars in 5.6% of cases.⁵ Yusof⁵ reported that hyperdontia from different ethnic groups varies widely, from 0.1% to 3.8%. This range could be due to the methodology for detection or the population studied in different reports.

Table 8-1 is a comparison of reports of hyperdontia in various populations. In a study performed in Rochester, NY, panoramic radiographs of children distributed among three racial/ethnic groups (whites, blacks, and Hispanics) were randomly selected from the records of 800 children aged 6 to 17 years (Bahreman AA, Jensen MO, Lothyan JD, unpublished data, 2007). The radiographs were evaluated for the presence of hyperdontia and hypodontia. Hyperdontia was found in 2.25% of the total group.

Multiple supernumerary teeth are not a common occurrence, although a single supernumerary tooth or a few such teeth in a single patient have been widely reported in the literature. The occurrence of supernumerary teeth is less frequent than the congenital absence of teeth, and supernumerary teeth occur twice as often in men as in women. Hyperdontia occurs more often in the maxilla than in the mandible, particularly in the maxillary anterior region. The condition is very rare in the primary dentition.

The most common site for supernumerary teeth is the maxillary incisor area. The occurrence of supernumerary teeth in several members of the same family has been also observed, which indicates a familial pattern.

All reports indicate that hyperdontia is more prevalent in males than in females. Table 8-2 shows the sex distribution of hyperdontia in the subjects of the author’s investigation. Among the three racial/ethnic populations, the distribution of supernumerary teeth was highest in the white group, followed by the black group; the prevalence was lowest in the Hispanic group (Table 8-3). A comparison of the distribution of hyperdontia by race/ethnicity and sex is found in Table 8-4. The highest prevalence rates were found among white males and black males.

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