Australian Dental Journal 1998;43:(1):17-19
Multiple supernumerary teeth. Case report
Matthew Hopcraft, BDSc(Melb)*
Abstract
The presence of supernumerary teeth, although not
uncommon, occurs usually in the premaxillary
region. Furthermore, examples of multiple super-
numerary teeth in one patient are rare. A case
involving the presence of multiple supernumerary
teeth in all quadrants is described.
Key words: Supernumerary teeth, case report.
(Received for publication September 1996. Accepted
November 1996.)
Introduction
The literature reports the incidence of super-
numerary teeth to vary between 1.6 and 3.1 per
cent.1-4 Although they can occur in either the
primary or permanent dentition, Clayton2 found
them to occur about twice as often in the latter.
They can be found anywhere in the dentition,
however, there is a predisposition for them to occur
in the premaxillary region. Luten4 found that 97 per
cent of supernumerary teeth were located in the
anterior region with only 3 per cent representing
premolars, while Bodin and Thomsson3 found 10.9
per cent of supernumerary teeth to be premolars. In
this study,3 6.2 per cent of the total number of
supernumerary teeth were molars. Patients with one
supernumerary tooth were the most frequent
although bilateral cases were found. There appeared
to be an increased frequency for males of nearly 2:1,3
with an increased incidence in the maxilla compared
with the mandible reported at between 6:11 to
11:1.3-6
There are several published case reports on the
occurrence of multiple supernumerary teeth in the
premolar region7,8 but this dental anomaly appears to
be relatively rare.
Generally supernumerary teeth can be classified
as either supplemental or rudimentary. Supplemental
teeth have a morphology similar to a tooth of the
normal dentition, while rudimentary teeth are small
*Captain, Royal Australian Army Dental Corps.
Australian Dental Journal 1998;43:1.
and conical. In most cases, supernumerary premolars
tend to be supplemental.
There is argument as to the aetiology of super-
numerary teeth, with theories including hyperactivity
of the dental lamina, proliferation of the remains of
the dental lamina, atavism (reversion to the ancestral
human dentition), splitting of the tooth bud
(dichotomy theory) and a combination of genetic
and environmental factors.9,10
Case repor t
An 18 year old Caucasian male presented for an
initial dental examination which involved taking
bitewing and panoramic radiographs. The panoramic
radiograph showed the presence of ten super-
numerary teeth in all four quadrants (Fig. 1). On
clinical examination it was found that all the permanent
teeth including the third molars had erupted.
Maxillary and mandibular occlusal radiographs were
taken to confirm the location of the supernumerary
teeth and to exclude supernumeraries in the
premaxillary region (Fig. 2, 3).
The first quadrant showed the presence of two
supernumerary teeth. One was a fourth molar, or
distomolar, exhibiting a fully formed crown and
lying in the right maxillary tuberosity at about the
apical tip of the 18. A supernumerary premolar had
also erupted palatally to and between the 14 and 15.
This tooth exhibited the normal morphology of a
premolar but was slightly smaller in size. The
gingiva around these teeth appeared healthy, with
periodontal probing depths of 2 mm and no
bleeding.
There was also a fourth molar in the second
quadrant, again in the tuberosity and at the level of
the apical third of the roots of the 28. Two
unerupted supernumerary premolars were found in
the second quadrant, palatal to the 24 and 25. These
teeth had fully formed crowns that appeared to be
conical in shape and smaller than those of a normal
premolar. The crowns were situated at the level of
the apical third of the roots of the first and second
premolars.
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 Fig. 1.–Panoramic radiograph showing distribution of the supernumerary teeth.
Two supernumerary teeth were found in the left
mandibular premolar region. Both had fully formed
crowns and partly formed roots, and appeared to be
of the same size and morphology of a normal
premolar. These teeth were unerupted and lingually
positioned. One was situated between the 34 and 35
approximately halfway up the root of the 34, and the
other was situated between the 35 and 36 at the level
of the apical third of the roots of the 35 and 36.
In the right mandibular premolar region there
were three unerupted supernumerary teeth, all with
fully formed crowns and partly formed roots. Again
the morphology and size appeared similar to that of
normal premolars. One was at the apical third of the
Fig. 2.–Maxillary occlusal radiograph.
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roots of the 46, with the other two approximately
halfway up the roots of the 44 and 45.
Discussion
A total of ten supernumerary teeth were present.
Eight appeared to have some resemblance to normal
tooth morphology, while two appeared conical and
small in size.
Even though the majority of supernumerary teeth
appear in the maxilla, supernumerary premolars
have a predisposition for the mandible. 3 In this case,
however, there were three additional maxillary
premolars and five mandibular premolars. This is
Fig. 3.–Mandibular occlusal radiograph.
Australian Dental Journal 1998;43:1.
unusual both in the number and distribution of the
supernumerary teeth, given that in Bodin’s study of
21 609 subjects, only 30 had supernumerary teeth in
the premolar region compared with 290 who had
supernumerary anterior teeth.11 Multiple super-
numerary premolars are relatively rare, and Bodin
found more than half his cases had only one super-
numerary tooth, with only two patients having more
than two supernumeraries.
The literature appears to favour surgical removal
of unerupted supernumerary teeth,9,12 although this
may cause damage to adjacent structures, particu-
larly in the mandibular premolar region.9 This must
be weighed up against the possible pathological
sequelae associated with supernumerary teeth. It has
been shown that this can occur in 42 per cent of
cases – 19 per cent of premolar cases and 53 per cent
of molar cases.11 Cyst formation (9 per cent) and
damage to neighbouring teeth (13 per cent) were of
greatest concern with premolar cases, while
inflammation and/or pain (24 per cent) and damage
to adjacent teeth (29 per cent) were predominant in
molars.
With the incidence of pathological sequelae being
relatively low for the premolar cases, it may be
prudent to radiographically monitor these teeth
whilst surgical removal should be seriously
considered for the supernumerary molars.
References
1. Grahnen H, Lindahl B. Supernumerary teeth in the permanent
dentition. Odontol Rev 1961;12:290-4.
Australian Dental Journal 1998;43:1.
2. Clayton JM. Congenital dental anomalies occurring in 3,557
children. J Dent Child 1956;23:206-8.
3. Bodin I, Julin P, Thomsson M. Hyperdontia: I. Frequency and
distribution of supernumerary teeth among 21,609 patients.
Dentomaxillofac Radiol 1978;7:15-7.
4. Luten JR. The prevalence of supernumerary teeth in primary
and mixed dentitions. J Dent Child 1967;34:346-53.
5. Bodin I, Julin P, Thomsson M. Hyperdontia: II. Supernumerary
molars. Dentomaxillofac Radiol 1978;7:83-6.
6. Schulze C. Incidence of supernumerary teeth. Dent Abstr
1961;6:237.
7. Oehlers FAC. A case of multiple supernumerary teeth. Br Dent
J 1951;90:211-2.
8. Lin TY. Seven supernumerary premolars. Report of a case. Br
Dent J 1967;123:437-8.
9. King NM, Lee AMP, Wan PKC. Multiple supernumerary
premolars: their occurrence in three patients. Aust Dent J
1993;38:11-16.
10. Zhu JF, Marcuchamer M, Kink DL, Henry RJ. Supernumerary
and congenitally absent teeth: a literature review. J Clin Paed
Dent 1996;20:87-95.
11. Bodin I, Julin P, Thomsson M. Hyperdontia: IV. Supernumerary
premolars. Dentomaxillofac Radiol 1981;10:99-103.
12. Nazif MM, Ruffalo RC, Zullo T. Impacted supernumerary
teeth: a survey of 50 cases. J Am Dent Assoc 1983;106:201-4.
Address for correspondence/reprints:
Dr Matthew Hopcraft,
Watsonia Dental Services,
Simpson Barracks,
Macleod, Victoria 3085.
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