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Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 124-127

Interceptive orthodontics for malaligned anteriors due to supplemental lateral incisor

Department of Pedodontics and Preventive Dentistry, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Date of Submission20-Jan-2020
Date of Decision18-Feb-2020
Date of Acceptance17-Mar-2020
Date of Web Publication21-May-2020

Correspondence Address:
Dr. Heena Sarangal
Department of Pediatric Dentistry, Post Graduate Institute of Medical Sciences, Rohtak, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjos.SJOralSci_2_20

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Supernumerary teeth are defined as the teeth that exceed the normal dentition, regardless of their morphology and location. They may closely resemble the teeth of the group to which it belongs, that is, molars, premolars, and anterior teeth. The most common complications associated are impaction, delayed eruption, crowding, and diastema. A case is presented where the diagnosis and extraction of the supplemental lateral incisor was done followed by 2 × 4 fixed orthodontic. Early intervention with 2 × 4 appliance is a potential treatment option for future, as it is a versatile, short-phase fixed appliance with clinical effectiveness and efficacy.

Keywords: Interceptive orthodontics, supernumerary tooth, supplemental tooth, 2 × 4 appliance

How to cite this article:
Sarangal H, Namdev R, Rohilla M. Interceptive orthodontics for malaligned anteriors due to supplemental lateral incisor. Saudi J Oral Sci 2020;7:124-7

How to cite this URL:
Sarangal H, Namdev R, Rohilla M. Interceptive orthodontics for malaligned anteriors due to supplemental lateral incisor. Saudi J Oral Sci [serial online] 2020 [cited 2023 Feb 6];7:124-7. Available from: https://www.saudijos.org/text.asp?2020/7/2/124/284657

  Introduction Top

Supernumerary and hyperdontia is the development of one or more teeth in excess of the normal dentition. Supernumerary tooth/teeth which are present in the arch and morphologically similar to the adjacent tooth/teeth are called supplemental teeth. They bear resemblance to the teeth they are associated with.[1] The prevalence of supernumerary teeth in permanent dentition is 1%–4%, and in deciduous dentition, it is 0.2%–1.9%.[2] Supernumerary teeth can be unilateral or bilateral, single or multiple and may affect one or both jaws. They are mostly seen in the maxillary arch than the mandibular arch with strong predilection of the premaxillary region.[2] This case report describes the occurrence of nonsyndromic, unilateral, supplemental left lateral incisor extraction followed by orthodontic treatment. The timely interceptive orthodontics done after the extraction for the malalignment helps in esthetic, psychological, and occlusion harmony. Supernumerary teeth are often associated with complications such as rotated teeth, impacted permanent teeth, and diastema. Therefore, segmental orthodontics postextraction improves esthetic and occlusion of the patient during the mixed dentition period.

  Case Report Top

A 10-year-old boy reported with malaligned upper anterior teeth. On intraoral examination, 21 was protruded labially due to the presence of the left supplemental lateral incisor [Figure 1]. The teeth present in the maxillary arch were 16, 55, 54, 53, 12, 11, 21, 22, 63, 64, 65, 26, and left supplemental lateral incisor [Figure 2]. No dental caries were present. There were no orofacial deformities, mental retardation, or any other medical conditions indicating syndromic association. Family history was statistically nonsignificant. An intraoral periapical radiograph of the region 22 was carried out to detect any radiographical deformity [Figure 3]. It was planned to extract the supplemental tooth followed by orthodontic alignment of all the four anteriors with 2 × 4 appliance after taking informed consent from the patient's parents. The supplemental tooth was extracted under local anesthesia. The upper first permanent molars were banded (stainless steel preformed bands) and edgewise brackets (MBT orthodontic bracket system) were bonded on the 12, 11, 21, and 22 [Figure 4]. The 0.016 NiTi edgewise round wire was placed followed by 17 × 25” NiTi edgewise wire and 19 × 25” NiTi edgewise wire. After the initial alignment was achieved with NiTi wires, the space created after the extraction of supplemental tooth was utilized in alignment and retraction of proclined central incisor, and therefore, no space was left postoperatively. Further, the 19 × 25” edgewise stainless steel wire was placed for 1 month till the results were stabilized. Fixed lingual bonded retainer [Figure 5] was given for 6 months when active orthodontic treatment was completed [Figure 6].
Figure 1: Frontal view of dentition showing labially protruded 21 and left supplemental lateral incisor (S)

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Figure 2: Occlusal view of dentition showing left supplemental lateral incisor (S)

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Figure 3: An Intra Oral Peri Apical X-ray (IOPA) showing supplemental tooth (S)

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Figure 4: Frontal view of dentition showing edgewise brackets and 016 NiTi wire

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Figure 5: Occlusal view of dentition showing fixed lingual bonded retainer

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Figure 6: Frontal view of dentition showing alignment of the anterior teeth

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  Discussion Top

Supernumerary teeth may be defined as the existence of an excessive number of teeth in relation to the normal dental formula and they may bear morphological resemblance with the normal tooth/teeth to which they are associated with. The most commonly found supernumerary tooth is mesiodens with the prevalence rate of 0.15%–1.9%.[1] The prevalence of supernumerary teeth was found to be 0.4%–3.4% in Asians and 1.24% in South Indians.[1] Supernumerary canines and laterals are rare with an incidence of 2.8% in comparison to other supernumerary teeth. The frequency of the occurrence of supernumerary teeth in the maxilla is 8.2–10 times more than in the mandible.[1] The classifications of supernumerary are on the basis of position and morphology. On the basis of position, supernumerary teeth include mesiodens, paramolars, distomolars, and parapremolars. On the basis of morphology, Primosch classified supernumerary into two types: supplemental (normal shape and size) and rudimentary (abnormal shape and size).[2] Unerupted supplemental tooth has been associated with many pathological conditions such as dentigerous cyst formation, widened follicular spaces, dental pulp necrosis, root resorption, and ankylosis, whereas erupted supplemental tooth can result in esthetic issues such as crowding, rotation, and labial tipping of the anterior teeth.[3]

The etiology of supernumerary teeth is still not clear. Different theories have been found in the literature to describe the etiology of supernumerary teeth such as atavism theory, dichotomy theory, and dental lamina hyperactivity theory. However, the most accepted theory is dental lamina hyperactivity theory, which stated that supernumerary teeth are the result of local, independent, and conditioned hyperactivity of the dental lamina. Genetics also plays a role in the formation of supernumerary teeth since they have been seen in siblings, twins, and gradual generations of the family.[1],[3]

Syndromes or anomalies associated with supernumerary teeth are cleft lip and palate, cleidocranial dysplasia, Gardner's syndrome and to a lesser extent with Fabry–Anderson's syndrome, chondroectodermal dysplasia, Ehlers–Danlos syndrome, incontinentia pigmenti, and trichorhinophalangeal syndrome.[3],[4]

Early detection and management of the supernumerary tooth is important to avoid and minimize any orthodontic problems and dental pathologies. Treatment planning depends on the type and location of the supernumerary tooth. Erupted supplemental tooth may present great problems due to close resemblance with the associated tooth, it may become difficult to differentiate between normal and supplemental tooth. If both the teeth are in healthy condition clinically and radiographically, then the tooth which is present most displaced from the line of the arch should be extracted, if it is causing any esthetic and functional problem.[4]

The 2 × 4 appliance is a part of the interceptive orthodontic therapy. It is a versatile, short-phase fixed appliance with clinical effectiveness and efficacy. It has many advantages over the other techniques. It helps in the rapid correction of early malocclusion. It provides total control over the tooth positioning and alignment and does not require any adjustment by the patient at home and patient's compliance.[5] The need for early interventional/interceptive orthodontics includes less, simple, and shortened future treatment. It is easier to correct an orthodontic problem if diagnosed at an early age. In the present case report, complication associated with the supernumerary teeth was labial proclination of 21. After the extraction of the supplemental lateral incisor, orthodontic correction with 2 × 4 appliance was done for the alignment of the anterior teeth. The patient was satisfied esthetically after the completion of the orthodontic treatment.

  Conclusion Top

Supplemental teeth are characterized by a similar form and function of the adjacent tooth with no anatomical difference. Early and careful detection for the management of supplemental tooth is important for esthetic and functional purposes. The treatment objectives can be easily achieved within a short period with the use of 2 × 4 appliance when the full permanent dentition has not yet been erupted.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Chalakkal P, Krishnan R, De Souza N, Da Costa GC. A rare occurrence of supplementary maxillary lateral incisors and a detailed review on supernumerary teeth. J Oral Maxillofac Pathol 2018;22:149.  Back to cited text no. 1
[PUBMED]  [Full text]  
Primosch RE. Anterior supernumerary teeth-assessment and surgical intervention in children. Pediatr Dent 1981;3:204-15.  Back to cited text no. 2
Arandi NZ. A supplemental permanent unilateral maxillary lateral incisor: A case report. IJSS Case Reports and Reviews 2017;3:4-6.  Back to cited text no. 3
Nagpal A, Hans MK, Shetty S, Kaur N, Kumar S. Non-syndromic bilateral supplemental maxillary lateral incisors: A rare case. J Clin Diagn Res 2013;7:1812-3.  Back to cited text no. 4
Solanki PJ, Choudhari SR, Vaghela CM, Saxena SI. Use of two by four appliance: A treatment modality for the correction of malaligned maxillary anterior teeth during mixed dentition period. Int J Dev Res 2017;7:17729-32.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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