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Extra cusps or the central cusps have been recognized as supernumerary cusps by many authors. Extra cusps are usually seen on premolars. Central cusps are of clinical importance as it could be associated with some anomalies that can lead to clinical complications. Extra or accessory cusps rarely pose any problem to the dentist. Even though, it may...
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... 11-year-male reported to the Department of Pedodontics and Preventive dentistry, College of Dental Sciences, Davangere, Karnataka, India with the chief complaint of forwardly placed anterior teeth. The medical and past dental histories were non-contributory. On intraoral examination, no abnormalities of soft tissues were found. The patient was in the mixed dentition period with good oral hygiene. A detailed dental evaluation was carried out, and it was noted that the patient had the maxillary anterior protruded. Maxillary right fi rst primary molar had internal resorption. In addition to the above fi ndings, a large central projection of a cusp was seen on the occlusal surface of the left and right maxillary fi rst permanent molars [ Figure 1]. The projection was 3 mm × 3 mm in size with a rhomboid base and was present at the center of the oblique ridge. The tip of the extra cusp lies one mm above the level of the other cusps of the teeth [ Figure 2]. The presence of a similar cusp was observed on both right and left primary second molar, it was more of the bulge over the occlusal ridge and resembled a cusp [ Figure 3]. The corresponding primary molar and permanent fi rst molar of the mandibular arch did not exhibit any depression on the occlusal surface. Radiographic examination revealed no pulpal extension into the central cusp [ Figure 4]. Grooves surrounding the accessory central cusps did not show any evidence of caries. The patient was advised for extraction of maxillary right primary fi rst molar. Preventive measures such as oral hygiene and fl uoride applications were instituted. Patient and parent were informed about the extra cusp and complications associated with it and advised for regular ...
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Citations
... 9,18 DE is a disturbance of tooth formation that is composed of enamel, dentin, and pulp, appears clinically as evaginatus odontoma, occlusal pearl, enamel pearls, tuberculated cusp, accessory tubercle, accessory cusp, and Leong's premolar. [19][20][21] The most inclusive classification of DE was done by Schulze in 1987; it depends on the male, was observed with a single extra cuspal projection on the occlusal surface of the left and right maxillary FPMs; the projection size was 3 × 3 mm with a rhomboid base. 19 A similar finding was revealed in Japan, a case of a 9-year-old child with the occurrence of bilateral central projection on the occlusal surface of maxillary FPMs and maxillary primary second molars. ...
... [19][20][21] The most inclusive classification of DE was done by Schulze in 1987; it depends on the male, was observed with a single extra cuspal projection on the occlusal surface of the left and right maxillary FPMs; the projection size was 3 × 3 mm with a rhomboid base. 19 A similar finding was revealed in Japan, a case of a 9-year-old child with the occurrence of bilateral central projection on the occlusal surface of maxillary FPMs and maxillary primary second molars. 2 In Nepal, a reported case of a 20-year-old female with the occurrence of bilateral tubercle cusp on lower premolars with pulpal involvements; therefore, root an important tooth and the key of occlusion because of their role in establishing occlusion, and their early loss will affect the other teeth as well. ...
Supernumerary cusps are morphological variations classified into three patterns; Carabelli’s cusp, dens evaginatus (DE), and talon cusps. DE is a
disturbance of tooth formation that appears as an accessory tuberculated cusp composed of enamel, dentin, and pulp tissue. The first permanent
molars (FPMs) may show alteration in their shape or structure. However, the alteration could be observed as accessory cusps on the occlusal
surface or accessory roots or hypomineralization as molar incisor hypomineralization. DE is a rare dental anomaly that can occur in primary or
permanent dentitions. It is infrequently seen on anterior teeth or premolars. However, their occurrence on molars is rarer. This presented a rare
case of bilateral double supernumerary cusps on the right and the left maxillary FPMs of a 6-year-old Libyan boy, while the mandibular FPMs
appeared with normal cusps. The aims of this study were to report and discuss the diagnostic methods and the management of this anomaly. In
addition, shed light on the importance of early diagnosis and follow-up observation. That could help in reducing the potential dental problems
and to improve patients’ quality of life
... 9,18 DE is a disturbance of tooth formation that is composed of enamel, dentin, and pulp, appears clinically as evaginatus odontoma, occlusal pearl, enamel pearls, tuberculated cusp, accessory tubercle, accessory cusp, and Leong's premolar. [19][20][21] The most inclusive classification of DE was done by Schulze in 1987; it depends on the male, was observed with a single extra cuspal projection on the occlusal surface of the left and right maxillary FPMs; the projection size was 3 × 3 mm with a rhomboid base. 19 A similar finding was revealed in Japan, a case of a 9-year-old child with the occurrence of bilateral central projection on the occlusal surface of maxillary FPMs and maxillary primary second molars. ...
... [19][20][21] The most inclusive classification of DE was done by Schulze in 1987; it depends on the male, was observed with a single extra cuspal projection on the occlusal surface of the left and right maxillary FPMs; the projection size was 3 × 3 mm with a rhomboid base. 19 A similar finding was revealed in Japan, a case of a 9-year-old child with the occurrence of bilateral central projection on the occlusal surface of maxillary FPMs and maxillary primary second molars. 2 In Nepal, a reported case of a 20-year-old female with the occurrence of bilateral tubercle cusp on lower premolars with pulpal involvements; therefore, root an important tooth and the key of occlusion because of their role in establishing occlusion, and their early loss will affect the other teeth as well. ...
Supernumerary cusps are morphological variations classified into three patterns; Carrabelle cusp, dens evaginates (DE), and talon cusps. DE is a disturbance of tooth formation that appears as an accessory tuberculated cusp composed of enamel, dentin, and pulp tissue. The first permanent molars (FPMs) may show alteration in their shape or structure. However, the alteration could be observed as accessory cusps on the occlusal surface or accessory roots or hypo-mineralization as molar incisor hypo-mineralization. Dens evaginates is rare dental anomalies that can be occur in primary or permanent dentitions. It is infrequently seen on anterior teeth or premolars. However, there occurrence on molars are rarer. This presented a rare case of bilateral double supernumerary cusps on the right and the left maxillary FPMs of 6 years Libyan boy, while the mandibular FPMs appeared with normal cusps. The aims of this study were to report and discuss the diagnostic methods and the management of this anomaly. In addition, shed light on the importance of early diagnosis and follow up observation. That could help in reducing the potential dental problems and to improve patients’ quality life
... Recent studies have shown that the gene expressions (Paired box gene -PAX and Msh homeobox -MSX genes) and gene mutation acting at different levels of tooth formation are responsible for the development and shape of the tooth morphology. [4,5] The altered proliferation and folding of inner enamel epithelium along with adjacent ectomesenchymal cells of the dental papilla during the bell stage of tooth development results in the formation of a supplemental solid elevations on the tooth surface. Transient signaling centers in the epithelial cell clusters along with the primary and secondary enamel knots, serve as a regulatory function in the epithelium which corresponds to the initiation of the individual cusp formation, thereby defining the tooth morphology. ...
... It later gets disappeared by the expression of p21 which is induced by the mesenchymal BMP-4. [4,5] Activator from the primary enamel knot regulates the expression of secondary enamel knots. The resultant cusp morphogenesis and positions appear to be determined sequentially and cusps that formed later are typically small. ...
... Supernumerary cusp formed on the maxillary or mandibular anterior teeth is often referred to as talon cusp and supernumerary cusp formed on the occlusal surface of the premolar or molar is referred to as dens evaginatus. [2,5] Central cusp is a tapered projection on the central fossa caused by local hyperplasia of internal enamel epithelial cell and mesenchymal cell during the tooth development. [1] Other acronyms for central cusp are "occlusal supernumerary cusp," "dens evaginatus," "premolar odontome," "occlusal tubercle," "accessory central cusp," "tuberculated premolar" and "Leong's premolar." ...
Teeth arise by complex and progressive interactions between the ectoderm, oral epithelium and underlying mesenchyme. However, it may show variations and changes in morphological structure. A 6-year-old female child patient came for the treatment of her carious tooth. Intraoral examination revealed supernumerary cusp on occlusal surface of the maxillary right second primary molar. Incidence of supernumerary cusp is a rare condition formed by abnormal proliferation and folding of inner enamel epithelium during morphodifferentiation stage of the tooth development. Conservative cavity preparation and restorative treatment protocol were carried out to treat this case. Early diagnosis, management and timely recall of these rare anomalies will help to avoid potential complications, resulting from faster carious progression in these teeth due to the presence of many fissures and early pulpal extensions into the cuspal area.
... These molecules cause the initiation of secondary enamel knots that mark the cusp formation at early bell stage. 8 The involved tooth is composed of normal enamel and dentin, either with varying extensions of pulp tissue or without a pulp horn. 2 Talon cusp can also occur in association with other dental anomalies such as peg-shaped lateral incisors, agenesis of canines, mesiodens, complex odontomas and megadont. Clinical presentation ranges from an enlarged cingulum to a large well-delineated cusp extending beyond the incisal edge of tooth. ...
Dental anomalies affecting the teeth are relatively common.
Simultaneous occurrence of multiple dental abnormalities in a single tooth is uncommon and
relatively rare. One such abnormality routinely encountered in dental clinics is the talon
cusp. It is also referred to as dens evaginatus, characterized by the presence of an accessory
cusp-like structure projecting from the cingulum of anterior teeth. It has an increased
predilection for maxillary teeth and permanent dentition. Although numerous cases of talon
cusp have been reported in the literature, occurrence of multiple talon cusps in maxillary
central incisors has not been found in the literature. This case report highlights the
presence of talon cusps in maxillary anterior teeth with multiple impacted supernumerary
teeth.
... Thus, 3D imaging systems have provided dental practitioners to visualize supernumerary teeth having more details and better contrast. 8,15 CONCLUSION Extra teeth are less common but can lead to numerous complications. The dentist should recognize the signs as early as possible, particularly those that can cause problems or complications in eruption as seen in the presented case, and should perform proper investigations and treatment. ...
Teeth in excess number than the normal count are called supernumerary teeth. They can be either unilateral or bilateral and single or multiple, found at any place in the dental arch, but most commonly found in the anterior maxillary region. Supernumerary teeth are commonly associated with syndromes when present in more numbers, but can be idiopathic. The present study shows a case report of a 16-year-old female patient who reported with overretained deciduous teeth. A panoramic radiograph showed multiple impacted supernumerary teeth. Based on clinical features and radiographic examination, a diagnosis of idiopathic hyperdontia was given. In such types of patients, management must be planned by a multidisciplinary approach.
How to cite the article
Al-Iryani GM, Ali FM. Twelve Impacted Supernumerary Teeth in a Nonsyndromic Patient: A Rare Case Report. J Contemp Dent Pract 2017;18(4):342-344.
... The current view is that the enamel knot represents an organizational center, which orchestrates cuspal morphogenesis, patterning the cusps and hence the shape of the tooth crown. [7][8][9] Only one case has been reported a detailing projection of tooth from the mesial surface of premolar, 8 and this is the first case of projections on both mesial and the distal surface of maxillary premolar in dental literature. The etiology of the present case might be similar to the other DE presentations, which include both genetic and environmental factors, and this case could have been just a rare oddity. ...
