Short communications & case reports Simultaneous presence of partial anodontia and supernumerary teeth N. D. Spyrymulos. D.D.S., Dr.Odont..* A .I. Pumkns. D.D.S., A. P. Angelopo~~lns. D.D.S.. M.S.. Ph.D.. *** Athens, Greece DENTAL
SCHOOL.
UNIVERSITY
* * and
OF ATHENS
The literature is reviewed and three cases of simultaneous presence of partial anodontia and supernumerary teeth are reported. In all three cases the abnormality involved both the maxilla and the mandible. The role of the panoramic radiograph in the detection of rare cases of this kind is emphasized and illustrated.
T
rue anodontia, or congenital absence of teeth. is a developmental disturbance in the number of teeth, caused by absence of the dental lamina (total anodontia) or nondevelopment of the enamel organ of certain teeth (partial anodontia or oligondontia) due to genetic factors, environmental factors, or a combination of the two.’ Some of the environmental factors that may cause partial anodontia are scarlet fever, congenital syphilis, injuries to the jaws. and irradiation. It can sometimes be associated with other developmental disturbances that involve usually the fingernails, the iris of the eye, the hair, the sweat glands, and other organs derived from the ectoderm.23 Although partial anodontia can rarely be observed in the deciduous dentition. usually it is more common in the permanent one. It can be unilateral or, more often, bilateral (in pairs of teeth) and may affect, in order of frequency, the premolars (60 percent), the upper lateral incisors (37 percent), the third molars, and the rest of the teeth. ’ An opposite situation is observed when supernumerary teeth result from the formation of a greater than normal number of tooth buds. The etiology is *Senior instructor. Oral Diagnostic Clinic **Instructor. Oral Diagnostic Clinic. ***Professor and Chairman, Department of Stomatology
0030.4220/79/070053+04$00.40/0
0
1979 The C V Mo+hy Co
obscure, and there is no scientific evidence supporting a genetic influence in the production of supernumerary teeth Supernumerary teeth may be found in various locations of the jaws. The most common supernumerary tooth is the mesiodens. Supernumerary teeth also may be found in the palate and the incisive suture and in other areas, such as the nasal cavity, the ophthalmic conchae. and the maxillary sinus. They are often associated with certain pathologic conditions, such as cleidocranial dysostosis, cleft lip and cleft palate, and Gardner’s syndrome. They may be present in the deciduous or, more often, in the permanent dentition of both jaws (more frequently in the upper), unilaterally or bilaterally. in symmetric or asymmetric areas in the dental arch or in mal-position. In shape and size they may be similar to the regular teeth, or they may differ completely and have an irregular size and shape. According to the time of their appearance, the supernumerary teeth are classified as predeciduous, similar to permanent, postpermanent, and complementary; according to their positions, they are classified as mesiodens, paramolars, postmolars, and impacted. The simultaneous presence of partial anodontia and supernumerary teeth is rare, and only three cases have been reported in the Greek- and English-language lit53
Oral Surg. July. 1979
Fig. 1. In this case, there is congenital absence of
and there is a supernumerary lower incisor.
Fig. 2. In this case. there is congenital abacncc of the upper right canine and lower right second premolar, and there is a supernumerary rcvcrse mcsiodcna.
Volume 48 Number
Simultaneous partial anodontia and supernumerary teeth
55
Fig. 3. In this case, there is a supernumerary upper left lateral incisor and the lower left central incisor is congenitally missing.
erature. Mumms5 described a case with anodontia of the upper left and right lateral incisors and a supernumerary upper left second premolar. Camilleri’ described also a case with anodontia of both upper lateral incisors and the simultaneous presence of a SUpemumerary toothlike structure (odontoid) in the midline of the maxilla. In both of these cases, the anodontia and the supernumerary teeth were located in the upper jaw. The third case described in the literature by Nathanail involved anodontia of the lower left and right second premolars and a supernumerary mesiodens. In this article three cases of simultaneous presence of anodontia and supernumerary teeth will be described. All cases are from the records of the Oral Diagnosis Clinic of the Dental School of the University of Athens. In all three cases there were no other abnormalities involving the organs of ectodermal origin. CASE REPORTS Case 1
The patient was a 16.year-old girl whose past history included no extractions by a dentist. Clinical examination
revealed the prolonged presence of a, the absence of 42 45 and the presenceof a supernumerarylower incisor. 54 5’ --IA panoramicx-ray film revealedthe absenceof tooth buds for ‘fi
(Fig. 1).
Case 2
This patient was a 15-year-old boy whose past history included extraction of the lower left first molar because of “se-
vere pain.” No other extractions were performed. Clinical examination disclosed the absenceof the upper right canine and the lower right second premolar.
The panoramic radiograph revealed the absenceof tooth buds for the upper left and lower left and right third molars. A supernumerarymesiodenswas also observed(Fig. 2). Case 3
The patient, a 13-year-old boy, was found on clinical examination to have a supernumerary upper left lateral incisor
and prolonged presenceof the p.
The p was not present
in the mouth.
The panoramic radiograph, revealed the presenceof the lower left secondpremolar (impacted) and the absenceof the bud for the lower left central incisor (Fig. 3).
56
Spyropoulos,
Patsakas,
and Angeloportlos
DISCUSSION
The simultaneous presence of partial anodontia or oligodontia and supernumerary teeth is very rare, as only three cases have been reported in the literature. This article presents three similar cases in which the oligodontia and the supernumerary teeth involved both the maxilla and the mandible and no other signs of ectodermal dysplasia were observed. The clinical examination alone would have been inadequate to reveal the combined abnormality. Regular periapical radiographs might also have been inadequate. especially in the second case, because of the lack of any indication in the upper incisor area and the location of the supernumerary mesiodens. Actually, the use of panoramic radiographs in each of the three cases presented here made it possible to have a complete picture of the situation. In the case described by Nathanail,’ the oligodontia present in the lower jaw and the supernumerary tooth in the upper jaw (mesiodens) were also detected by a panoramic radiograph. We may assume, therefore, that the routine use of panoramic radiographs might lead to an increase in the detection of otherwise unrecognized cases.
Oral Surg. July, 1979
these cases supplemented the clinical examinations and revealed the combined abnormalities which, in all three cases, involved both the upper and the lower jaws, a rather rare situation. As supernumerary teeth may sometimes be markedly misplaced and missed in the regular periapical radiographs, the routine use of panoramic radiographs is very helpful in the detection of cases of this kind. REFERENCES I Shafer, W C.. Hine. M. K., and Levy, B. M.: A Textbook of Oral Pathology, ed. 3, Philadelphia, 1974, W. B. Saunders Company, p. 41. 2. Mitsis. F.: Dental Pathology and Therapeutics, Athens, 1972. G. Parissianos, p. 146 (in Greek). 3. Angelopoulos, A. P.: Textbook of Oral Diagnosis, Athens, 1978, Medical Publications Litsas, p. 30 (in Greek). 4. Monteil, M.: Agenesie de la dent permanente: Statistiques effectutes sur 4.000 sujets, Stomatologia (Athens) 34: 195208, 1977. 5. Mumms, D. A.: A Case of Partial Anodontia and Supernumerary Tooth Present in the Same Jaw, Dent. Pratt. 1S: 3442, 1967. 6. Camilleri, G. E.: Concomitant Hypodontia and Hyperdontia, Br. Dent. J. 123: 338-349, 1967. 7. Nathanail, P. K.: Contribution to the Study of the Morphologic Abnormalities of the Permanent Dentition, Thesis, University of Athens. 1970 (in Greek). Reprint
SUMMARY
Three cases of the simultaneous presence of supernumerary teeth and the congenital absence of other teeth have been reported. Panoramic radiographs in
requests to:
Dr. N. D. Spyropoulos Oral Diagnosis Clinic Dental School, University of Athens Thivon 2 - Goudi Athens 2 - 608. Greece
SCHOOL.
UNIVERSITY
* * and
OF ATHENS
The literature is reviewed and three cases of simultaneous presence of partial anodontia and supernumerary teeth are reported. In all three cases the abnormality involved both the maxilla and the mandible. The role of the panoramic radiograph in the detection of rare cases of this kind is emphasized and illustrated.
T
rue anodontia, or congenital absence of teeth. is a developmental disturbance in the number of teeth, caused by absence of the dental lamina (total anodontia) or nondevelopment of the enamel organ of certain teeth (partial anodontia or oligondontia) due to genetic factors, environmental factors, or a combination of the two.’ Some of the environmental factors that may cause partial anodontia are scarlet fever, congenital syphilis, injuries to the jaws. and irradiation. It can sometimes be associated with other developmental disturbances that involve usually the fingernails, the iris of the eye, the hair, the sweat glands, and other organs derived from the ectoderm.23 Although partial anodontia can rarely be observed in the deciduous dentition. usually it is more common in the permanent one. It can be unilateral or, more often, bilateral (in pairs of teeth) and may affect, in order of frequency, the premolars (60 percent), the upper lateral incisors (37 percent), the third molars, and the rest of the teeth. ’ An opposite situation is observed when supernumerary teeth result from the formation of a greater than normal number of tooth buds. The etiology is *Senior instructor. Oral Diagnostic Clinic **Instructor. Oral Diagnostic Clinic. ***Professor and Chairman, Department of Stomatology
0030.4220/79/070053+04$00.40/0
0
1979 The C V Mo+hy Co
obscure, and there is no scientific evidence supporting a genetic influence in the production of supernumerary teeth Supernumerary teeth may be found in various locations of the jaws. The most common supernumerary tooth is the mesiodens. Supernumerary teeth also may be found in the palate and the incisive suture and in other areas, such as the nasal cavity, the ophthalmic conchae. and the maxillary sinus. They are often associated with certain pathologic conditions, such as cleidocranial dysostosis, cleft lip and cleft palate, and Gardner’s syndrome. They may be present in the deciduous or, more often, in the permanent dentition of both jaws (more frequently in the upper), unilaterally or bilaterally. in symmetric or asymmetric areas in the dental arch or in mal-position. In shape and size they may be similar to the regular teeth, or they may differ completely and have an irregular size and shape. According to the time of their appearance, the supernumerary teeth are classified as predeciduous, similar to permanent, postpermanent, and complementary; according to their positions, they are classified as mesiodens, paramolars, postmolars, and impacted. The simultaneous presence of partial anodontia and supernumerary teeth is rare, and only three cases have been reported in the Greek- and English-language lit53
Oral Surg. July. 1979
Fig. 1. In this case, there is congenital absence of
and there is a supernumerary lower incisor.
Fig. 2. In this case. there is congenital abacncc of the upper right canine and lower right second premolar, and there is a supernumerary rcvcrse mcsiodcna.
Volume 48 Number
Simultaneous partial anodontia and supernumerary teeth
55
Fig. 3. In this case, there is a supernumerary upper left lateral incisor and the lower left central incisor is congenitally missing.
erature. Mumms5 described a case with anodontia of the upper left and right lateral incisors and a supernumerary upper left second premolar. Camilleri’ described also a case with anodontia of both upper lateral incisors and the simultaneous presence of a SUpemumerary toothlike structure (odontoid) in the midline of the maxilla. In both of these cases, the anodontia and the supernumerary teeth were located in the upper jaw. The third case described in the literature by Nathanail involved anodontia of the lower left and right second premolars and a supernumerary mesiodens. In this article three cases of simultaneous presence of anodontia and supernumerary teeth will be described. All cases are from the records of the Oral Diagnosis Clinic of the Dental School of the University of Athens. In all three cases there were no other abnormalities involving the organs of ectodermal origin. CASE REPORTS Case 1
The patient was a 16.year-old girl whose past history included no extractions by a dentist. Clinical examination
revealed the prolonged presence of a, the absence of 42 45 and the presenceof a supernumerarylower incisor. 54 5’ --IA panoramicx-ray film revealedthe absenceof tooth buds for ‘fi
(Fig. 1).
Case 2
This patient was a 15-year-old boy whose past history included extraction of the lower left first molar because of “se-
vere pain.” No other extractions were performed. Clinical examination disclosed the absenceof the upper right canine and the lower right second premolar.
The panoramic radiograph revealed the absenceof tooth buds for the upper left and lower left and right third molars. A supernumerarymesiodenswas also observed(Fig. 2). Case 3
The patient, a 13-year-old boy, was found on clinical examination to have a supernumerary upper left lateral incisor
and prolonged presenceof the p.
The p was not present
in the mouth.
The panoramic radiograph, revealed the presenceof the lower left secondpremolar (impacted) and the absenceof the bud for the lower left central incisor (Fig. 3).
56
Spyropoulos,
Patsakas,
and Angeloportlos
DISCUSSION
The simultaneous presence of partial anodontia or oligodontia and supernumerary teeth is very rare, as only three cases have been reported in the literature. This article presents three similar cases in which the oligodontia and the supernumerary teeth involved both the maxilla and the mandible and no other signs of ectodermal dysplasia were observed. The clinical examination alone would have been inadequate to reveal the combined abnormality. Regular periapical radiographs might also have been inadequate. especially in the second case, because of the lack of any indication in the upper incisor area and the location of the supernumerary mesiodens. Actually, the use of panoramic radiographs in each of the three cases presented here made it possible to have a complete picture of the situation. In the case described by Nathanail,’ the oligodontia present in the lower jaw and the supernumerary tooth in the upper jaw (mesiodens) were also detected by a panoramic radiograph. We may assume, therefore, that the routine use of panoramic radiographs might lead to an increase in the detection of otherwise unrecognized cases.
Oral Surg. July, 1979
these cases supplemented the clinical examinations and revealed the combined abnormalities which, in all three cases, involved both the upper and the lower jaws, a rather rare situation. As supernumerary teeth may sometimes be markedly misplaced and missed in the regular periapical radiographs, the routine use of panoramic radiographs is very helpful in the detection of cases of this kind. REFERENCES I Shafer, W C.. Hine. M. K., and Levy, B. M.: A Textbook of Oral Pathology, ed. 3, Philadelphia, 1974, W. B. Saunders Company, p. 41. 2. Mitsis. F.: Dental Pathology and Therapeutics, Athens, 1972. G. Parissianos, p. 146 (in Greek). 3. Angelopoulos, A. P.: Textbook of Oral Diagnosis, Athens, 1978, Medical Publications Litsas, p. 30 (in Greek). 4. Monteil, M.: Agenesie de la dent permanente: Statistiques effectutes sur 4.000 sujets, Stomatologia (Athens) 34: 195208, 1977. 5. Mumms, D. A.: A Case of Partial Anodontia and Supernumerary Tooth Present in the Same Jaw, Dent. Pratt. 1S: 3442, 1967. 6. Camilleri, G. E.: Concomitant Hypodontia and Hyperdontia, Br. Dent. J. 123: 338-349, 1967. 7. Nathanail, P. K.: Contribution to the Study of the Morphologic Abnormalities of the Permanent Dentition, Thesis, University of Athens. 1970 (in Greek). Reprint
SUMMARY
Three cases of the simultaneous presence of supernumerary teeth and the congenital absence of other teeth have been reported. Panoramic radiographs in
requests to:
Dr. N. D. Spyropoulos Oral Diagnosis Clinic Dental School, University of Athens Thivon 2 - Goudi Athens 2 - 608. Greece
