International Journal of Paediatric Dentistry 1993; 3 205-2 10

Late development of supernumerary teeth:

a report of two cases
S. M. CHADWICK & N . M. K I L P A T R I C K
Department of Child Dental Health, University of Newcastle upon Tyne

Summary. Two cases are presented of late developing supernumerary teeth. In the
first the patient developed two crops of supernumeraries, both of which were found
on radiographic examination following delay in the normal eruption pattern of the
permanent dentition. The first crop of four supernumerary teeth were in the
maxillary incisor region and were surgically removed; 5 years later four more
supernumerary teeth was found in the maxillary canine and mandibular premolar
regions, which were also surgically extracted. In the second case two supplemental
mandibular premolars were found as an incidental finding on radiographic examina-
tion at the age of 15 years following orthodontic treatment, the patient having
previously had four first premolars extracted; these supernumerary teeth were not
extracted as they were asymptomatic. These cases emphasize the importance of
careful review of patients with a history of supernumerary teeth and, where clinically
indicated, of further radiographic examination.

Introduction have been reported in patients without an associ-

Supernumerary teeth are additional to the normal
number of teeth and may occur in either the
primary or the permanent dentition. Supernumer-
ary teeth may be classified according to either their
position in the dental arch (mesiodens, paramolar
or distomolar [l]) or their form (peg-shaped,
tuberculate, supplemental or odontome [2]).
Supernumerary teeth occur rarely in the primary
dentition but in the permanent dentition their
prevalence has been reported at between 1.5% and
3.5% [3], with the anterior maxillary region being
the most common site for singly-occurring super-
numerary teeth [4]. The presence of supernumer-
ary teeth may be related to a number of systemic
medical conditions or may occur in isolation in
otherwise unaffected individuals. Multiple super-
numerary teeth are most commonly associated
with a congenital syndrome such as Gardiner’s
syndrome, cleidocranial dysostosis or a cleft
palate. However, multiple supernumerary teeth
Correspondence and reprints requests to: Dr S. Chadwick,
DeDartment of Child Dental Health. The Dental school.
Framlington Place, Newcastle upon Tyne NE2 4BW, England.
ated syndrome [5]. The cases presented in this
report show the late development of several super-
numerary teeth not associated with any medical
syndrome.
Case report 1
A 9-year-old boy attended the Department of
Child Dental Health of Newcastle Dental Hospital
concerned about the appearance of his front teeth.
On examination it was found that both his maxil-
lary primary central incisors were retained (Fig. 1).
He had a Class I1 skeletal pattern with average
facial proportions and was in the mixed dentition.
Radiographic investigation revealed the presence
of supernumerary teeth in the midline preventing
the eruption of the permanent central incisors
(Fig. 2). Closer examination using periapical
radiographs confirmed the presence of four super-
numeraries in the midline. It was decided at this
stage to surgically remove the supernumerary
teeth and the maxillary primary central incisors
and canines under general anaesthesia. Following
this the maxillary permanent Central incisors
205
206 S. M. Chadwick & N . M . Kilpatrick

Fig. 1. Patient 1 , aged 9 years. Two maxillary primary central incisors retained.

Fig. 2. Patient 1 , aged 9 years. Orthopantomogram showing presence of supernumeraries preventing the eruption of the
permanent central incisors.

erupted satisfactorily. The patient then failed to premolar and maxillary left canine was noted
attend several review appointments but was seen despite the full eruption of the contralateral teeth.
again 5 years later aged 14 years at which time the Radiographic examination showed the develop-
failure to erupt of the mandibular right first ment of two more supernumerary teeth in the
 Late development of supernumerary teeth 207

Fig. 3(a). Patient I , aged 14 years. Orthopantomogram showing development o f further supernumeraries in the manidibular
right premolar and maxillary left canine areas.

Fig. 3(b). Patient 1, aged 14 years. Periapical radiograph confirming the presence o f two supernumerary teeth in the maxillary
left canine region.

maxillary left canine region and one in the mandi- fourth supernumerary tooth in the maxillary right
bular right premolar region which were preventing canine region which had not prevented eruption of
the permanent teeth from erupting (Fig. 3a, b). A the canine (Fig. 3a). Under a second general
further, incidental, finding was the presence of a anaesthetic these new supernumerary teeth were
208 S. M . Chadwick & N. M. Kilpatrick

Fig. 4. Patient 2, aged I5 years. Orthopantomogram showing the late development of two supernumeraries in the manidublar
premolar region.

Fig. 5 . Patient 2, aged 10 years. Orthopantomogram showing no supernumerary teeth.


surgically removed, the maxillary left first and the
maxillary right second premolar were extracted
and the maxillary left canine and mandibular right
first premolar were exposed, both of which erupted
satisfactorily. To date ( 5 years on) no further
supernumeraries have developed.
Case report 2
A 13-year-old boy attended the Department of
Child Dental Health at Newcastle Dental Hospital
complaining about the appearance of his teeth. On
examination it was found that he had a Class I1
skeletal pattern, average facial proportions and
midly incompetent lips. The first premolars had
been extracted 2 years earlier and there was now a
Class I1 division I incisor relationship with an
overjet of 10 mm. Radiographic examination
confirmed the absence of the four first premolars
but all other teeth were present. A comprehensive
orthodontic treatment plan was drawn up which
involved upper arch expansion with a removable
appliance, the use of a functional appliance to
reduce the overjet and a final stage of fixed
appliance therapy. On completion of the func-
tional appliance therapy the patient, now aged 15,
decided not to proceed with the fixed appliance
therapy. Records taken at this stage included an
orthopantomogram radiograph which revealed
the presence of two supernumerary teeth in the
mandibular premolar area (Fig. 4). Fig. 5 shows
the radiograph taken when the patient was 10
years old, and close examination fails to show
these supplemental premolars. To date, these
supernumerary teeth are symptomless and there-
fore are being periodically reviewed.
Discussion
The progressive development of supernumerary
teeth is well recognized in people with cleido-
cranial dysostosis and regular radiographic review
of these patients is recommended [ 6 ] . However,
neither of the two patients presented here had any
other features of this syndrome. In the first case the
late-developing supernumeraries were preceded
by an earlier crop. Breckon &Jones [7] reported a
similar case in which a patient had two tuberculate
supernumeraries removed at the age of 8 years,
started a course of orthodontic treatment at 10
years and, when records were taken at the age of 14
Late development of supernumerary teeth 209
years, two more supernumeraries were found to
have developed in the mandibular premolar re-
gion. In the second case presented here, there was
no history of earlier supernumeraries, the diagno-
sis of their presence being an incidental finding on
the post-orthodontic treatment radiographs. It is
interesting to note that had the patient wished to
continue with the final phase of orthodontic treat-
ment, radiographs may not have been taken at this
point. Bodily movement of the erupted teeth in the
mandibular premolar region may subsequently
have been unsuccessful and could have resulted in
damage to the roots of these teeth. A similar case
has recently been reported although it was unclear
if the patient had a history of any previous
supernumeraries nor could the age at which the
extra teeth developed be ascertained [8].
The position of the supernumeraries in the first
case is also interesting. Although the premaxilla
region is the most common area in which single
supernumerary teeth develop, Yusof in 1990 re-
viewed 1 1 cases of multiple “non-syndrome super-
numerary teeth” and found that the mandible was
the most common site for this type of supernumer-
ary [ 5 ] . In the first of the two cases presented here
seven of the eight supernumeraries were sited in
the maxillary incisor and canine region and only
one in the mandibular premolar region.
It is important to remember that a radiograph is
a record of one moment in time only. These two
case reports suggest that, particularly where there
is a history of supernumerary teeth, regular clini-
cal review is advisable. How often further radio-
graphic review should be carried out is uncertain
and should be dependent on the clinical findings.
An opportune time for further radiographic re-
view of the young adult may be at around 16- 18
years when assessment of the third molars is often
desirable. The management of these late-develop-
ing supernumeraries will depend on the age of the
patient and the effect, if any, on the erupted
dentition. The possibility of root resorption and
cyst formation must be borne in mind, and if it is
decided to leave the teeth in situ the patient should
be advised of their presence and be made aware of
the possible sequelae.
Acknowledgements
The authors thank Mr T. G. Bennett and Mr N. E.
Carter for allowing these cases to be presented.
210 S. M. Chadwick & N. M. Kilpatrick
Resume. Deux cas de developpement tardif de
dents surnumeraires sont present&. Dans le pre-
mier cas, deux groupes de quatre dents surnumkr-
aires ont ete decouvertes radiologiquement, aprks
la date normale d’eruption de la dentition perma-
nente. Le premier grope de quatre dents surnumer-
aires a ete trouve dans la region incisive maxillaire
et a ete supprime par chirurgie; cinq annees plus
tard, quatre autres dents surnumeraires ont Ctt
trouvees dans la region canine maxillaire et pre-
molaire a la mandibule et ont ete egalement
extraites. Dans le deuxikme cas, deux premolaires
manibulaires supplementaires ont ete decou-
vertes, par hasard, lors d’un examen radiologique
a l’iige de 15 ans, realise apres un traitement
d’orthodontie. Les quatre premikres premolaires
avaient ete auparavant extraites; ces dents surnu-
meraires n’ont pas etC extraites car asymptbmati-
ques. Ces cas montrent I’mportance du suivi des
patients, ayant eu des dents surnumeraires, et des
examens radiologiques ulterieurs.
Zusammenfassung. Zwei Falle von spat entwickel-
ten uberzahligen Zahnen werden hier presentiert.
Im 1, Fall, hatte der Patient 2 massen von uberzah-
ligen Zahnen entwickelt. Beide waren bei der
Rontgenuntersuchung, als Folge eines verspateten
normalen Durchbruchmusters der permanenten
Zahne, entdeckt worden. Die erste Masse von 4
uberzahligen Zahnen war im Oberkiefer-Frontzah-
nebereich und waren heraus-operiet. Funf Jahre
spater war eine zweite masse von 4 weiteren
uberzahligen Zahnen in dem maxillaren Eckzahn
und mandibularen Premolaren Bereich gefunden
worden. Diese waren auch heraus operiert worden.
Per jufall warden im 2. Fall bei einem 15-jahrigen
nach einer Regulierung 2 uberzahlige mandibular-
Premolaren in der Rontgenaufnahme gefunden.
Diesem Patienten dem zuvor die 4 ersten Premo-
laren extrahiert worden waren, wurden die uber-
zahligen symptomficien Zahne belassen.
Diese Falle betonen die Wichtigkeit der weit-
eren Uberprufung von Patienten mit uberzahligen
Zahnen und nachfolgenden Rontgen unter-
suchungen.
Resumen. Se presentan dos casos de dientes super-
numerarios desarrollados tardiamente. En el
primer caso, el paciente desarrollo dos secuencias
de dientes supernumerarios, ambos diagnostica-
dos radiograficamente durante el examen debido a
la erupcidn retardada de la denticion permanente.
La primera secuencia de cuatro dientes supernu-
merarios se desarrollo en la region incisiva del
maxilar superior y fueron removidos quirurgicam-
ente. Cinco aiios mas tarde, la segunda secuencia
de otros cuatro dientes supernumerarios fue diag-
nosticada en la region maxilar canina y premolar
mandibular 10s cuales fueron tambien removidos
quirurgicamente. En el segundo reporte de caso,
dos premolares mandibulares supernumerarios
fueron diagnosticados radiograficamente en un
niiio de 15 aiios de edad despues del tratamiento
ortodoncico. A1 paciente se les habian extraido
cuatro primeros premolares. Estos dientes super-
numerarios no fueron extraidos ya que estaban
asintomaticos. Estos casos enfatizan la importan-
cia de un examen cuidadoso y la obtenci6n de la
historia de dientes supernumerarios y cuando sea
indicado, el examen radiografico.
References
Gardiner JH. Supernumerary teeth. Transactions ofthe
British Society for the Study of Orthodontics 1961; 15-25.
Mitchell L. Supernumerary teeth. Dental Update 1989; 1 6
65-69.
Brook AH. Dental anomalies of number, form and size:
their prevalence in British schoolchildren. Journal ofthe
International Association ofDentistry for Children 1974;5
37-53.
Saarerman L. The origin of supernumerary teeth. Acta
Odontologica Scandinavica 1950; 4 293-303.
Yusof WZ. Non-syndrome multiple supernumerary teeth.
A literature review. Journal of the Canadian Dental
Association 1990; 56: 147- 149.
Frame K, Evans RIW. Progressive development of super-
numerary teeth in cleidocranial dysplasia. British Journal
of Orthodontics 1989; 16: 103-106.
Breckon JJW, Jones SP. Late forming supernumeraries in
the mandibular premolar region. British Journal of Ortho-
dontics 1991; 18: 329-331.
Pearson MH, Williams MD. Supplemental and con-
genitally absent premolar teeth. (Letter). British Dental
Journal 1990; 169 8.