Abstract
We experienced a very rare case of a patient with three impacted supernumerary teeth in the midline region of the maxilla. The patient, a boy, was 9 yrs 8 months old when he was first seen. His chief complaint was mid-line diastema. His past medical history showed nothing of significance. Family history showed nothing of significance; his parents and younger sister showed no abnormality in the number of teeth. The intraoral findings were as follows: The patient was at the III A stage. The maxillary central incisors were 5.6 mm apart. The bilateral lateral incisors were erupting on the lingual side and showed a cross-bite with the mandible. X-ray examination revealed no abnormalities in the number of teeth other than the three supernumerary teeth in the maxillary mid-line region. One supernumerary tooth was found on the mesiolingual side of the right central incisor in the normal direction. The second supernumerary tooth was inverted and extended from the neck of the left central incisor to the palate, and the third supernumerary tooth was located somewhat right of the midline, lying horizontally with the apex directed toward the labial side and with the crown directed toward the palate. At the apex of each erupted maxillary central incisor, there was stenosis narrowing at one third of the area of the root apex due to the supernumerary teeth. The three supernumerary teeth were extracted from the palate under local anesthesia.
The extracted supernumerary tooth that had been in a normal direction was 15.38 mm long,5.85mm wide, of the incisor type, and with the apex unclosed. The extracted supernumerary tooth that had been inverted was 14.15 mm long 6.10 mm wide, of the canine type, and with the apex closed. There was resorption in the apex of this tooth, which had presumably been in contact with the horizontal supernumerary tooth. The extracted supernumerary tooth that had been horizontal was 14.84mm long 6.20 mm wide, of the canine type, and with the apex closed. The distal third of the apex of this tooth was curved toward the labial side. During the past 64 years, there have only been 15 reported in Japan of the cases of three supernumerary teeth without any systemic disease, including the present case. This abnormality is extremely rare. One month after extraction, occlusal guidance to improve the malocclusion was begun to obtain a better outcome.
