PRACTICEcase study I t is widely assumed that the development of supernumerary teeth may involve a genetic factor. 1 Supernumerary teeth are relatively common in the general population and appear to be more likely to occur in patients with a family history of such teeth.In the Caucasian population the incidence of supernumerary teeth ranges from 1% to 3%. The mesiodens is the most frequent supernumerary tooth with a prevalence of 0.15% to 1.9%. 2 Mesiodens appears to be more common in males than in females with a male-female ratio of 2:1. 3 Familial occurrence of mesiodens is reported to involve more than one sibling, or one generation. 2,[4][5][6] In some cases, this anomaly has also been seen in more than one generation. 7 There are many publications that focus on clinical, radiological and surgical or surgical-orthodontic aspects of the treatment of mesiodentes. However, the etiology and the genetic considerations of this dental anomaly remains unclear.In this report, we present a rare case of two sisters, in both of whom a pair of mesiodentes caused the retention of permanent incisors. Unfortunately, no information was available concerning similar anomalies among their forebears.
Case reports
Case 1In a 13-year-old-girl, referred with delayed eruption of the permanent central maxillary incisors, both deciduous central maxillary incisors were present. A review of her medical history showed nothing remarkable. Radiography showed that two supernumerary teeth in the anterior maxilla were preventing the eruption of the permanent incisors. The supernumerary teeth were removed surgically, and removal of bone was performed to facilitate the rapid eruption of the permanent incisors.
Case 2In the maxillary arch of the 8-year-old-sister of the subject of Case 1, the permanent central incisors had erupted without the deciduous central incisors having exfoliated.Radiography showed a pair of supernumerary teeth in the same positions as in Case 1, though with less developed roots. The general morphology and position of the supernumerary teeth were identical in the radiographs of both sisters ( Fig. 1 and Fig. 2). Again, surgical removal of the supernumerary teeth was followed by removal of bone.In neither case did histological examination show the dental tissues of the supernumerary teeth to differ from those of normal teeth.
DiscussionSeveral theories have been proposed for the etiology of hyperdontia: theory of differentiation, theory of concrescence, post permanent theory, dichotomy theory and hyperactivity theory. However the hyperactivity theory, which states that supernumerary teeth are derived from independent local hyperactivity of the dental lamina, has been more accepted. According to this hypothesis the lingual extension of an additional tooth bud leads to a eumorphic mesiodens, while the rudimentary form arises from proliferation of epithelial remnants of the dental lamina induced by pressure of the dentition. 8,9 There appears to be evidence to suggest a familial predisposition to producing extra teeth. Many p...