A variety of supernumerary teeth that erupt ectopically either buccally or lingually to the normal arch ... impaction; ectopic eruption; tooth displacement; root. 3,4.
E:/R Mehra/Baba Farid Dental Journal/2013/Vol. 4 No.3 Oct. 2013/Case Report/Dr. Monika Gupta.cdr 25.10.13
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CASE REPORT PERIDENS: REVIEW OF ETIOPATHOGENESIS AND CLINICAL PRESENTATIONS - SIX CASE REPORTS
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ABSTRACT
This paper stresses upon review of etiopathogenesis of supernumerary teeth development such as heredity factors, genetics, environmental factors, numerous developmental disorders, mutations, phylogeny, and dichotomy theories of tooth germ differentiaion, dysregulation of Hedgehog FGF, Wnt, TNF and BMP families and growth morphogenetic proteins (BMPs and FGF family). This paper enlightens the budding young dynamic dental professionals about etiopathogenesis of developmental alterations of supernumerary. KEY WORDS: Peridens, Etiopathogenesis, Supernumerary, developmental alteration,
Supernumerary teeth are occasionally encountered in general clinical practice. They are either completely impacted, to be revealed through radiographic findings or variably erupted along the dental arch. These are present as additions to deciduous and permanent sets of dentitions. Presence of supernumerary teeth is associated with interference in normal tooth eruption; impaction; ectopic eruption; tooth displacement; root resorption and formation of dentigerous cyst. Supernumerary teeth were first reported between A.Ds 23 & 79. They can be variously classified based upon: a) the time of appearance, b) position on arch, c) shape or morphology. On morphological basis, supernumerary teeth can be classified into four types: (a) Conical (b) Tuberculate (c) Odontome (d) Supplemental. Based on position,(a) Mesiodens (occurring between the maxillary incisors), (b) Paramolar (alongside a molar) and (c) Distomolar (present distally to third molar): Supernumerary teeth that erupt ectopically i.e, either buccally or lingually to the normal arch are known as “peridens”1. These are more prevalent in the permanent dentition (1-3%) as compared to primary dentition (0.8%)2. This clinical review highlights peridens in variable presentations and also focuses on proposed etiologies like heredity factors, genetic component, polygenic, environmental factors, numerous developmental disorders, mutations, phylogenetic theory, dichotomy theory of tooth germ formation, dysregulation of
Professor & HOD Reader 3 Reader 4 P G Student 2
Supernumerary teeth are infrequent developmental alterations manifesting either within or along the dental arches. They may involve any region; or may be associated with syndromic or non-syndromic conditions. All supplementary teeth are supernumerary teeth but not all supernumerary teeth can be supplementary teeth. A variety of supernumerary teeth that erupt ectopically either buccally or lingually to the normal arch is known as peridens.
INTRODUCTION:
DAS DEBDUTTA1 GUPTA MONIKA2 CHATTERJEE SHAILJA3 JAIN NEETU4
Address for Correspondence :
DR. MONIKA GUPTA, Reader (Oral & Maxillofacial Surgery), Maharaja Ganga Singh Dental College & Research Centre, Sri Ganganagar, Rajasthan, India
Hedgehog FGF, Wnt, TNF and BMP families and growth morphogenic proteins (BMPs and FGF family). This literature update focuses on peridens identification and their implications on oral health.
ETIOLOGICAL FACTORS CAUSING SUPERNUMERARY TOOTH GENESIS : One of the important etiologies is hereditary however, there are reported familial occurances and prevalence of identical supernumeraries in monozygotic twins3,4. They also exibit a polygenic inheritance pattern with environmental factors playing an important role. Multiple supernumerary teeth have been associated with developmental disorders such as cleft lip and palate, syndromes like Apert, Angio-osteohypertrophy, cleidocranial dysplasia, craniometaphyseal dysplasia, Crouzon, Curtius, Down's, Ehlers-Danlos, FabryAnderson, Fucosidosis, Gardner, Hallermann-Streiff, Klippel-Trenaunay-Weber, Laband, Nance-Horan, Oral-facial-digital type I and III, Sturge-Weber, and Tricho-rhino-phalangeal5. Theories explaining the histogenesis of supernumerary teeth include phylogenic and dichotomy theories. Dichotomy theory of tooth formation states that splitting of a tooth bud into two equal or differently sized parts results in two teeth of equal size or variable sizes, one normal and one dysmorphic tooth4. This theory is supported by animal experiments. The phylogenic theory is based upon atavistic occurance. The most accepted theory states that supernumerary teeth are
BFUDJ, Volume 4, Number 3, Oct., 2013 formed as a result of local, independent or conditioned hyperactivity of the dental lamina5,6.
ROLE OF NEURAL CREST CELLS IN TOOTH FORMATION: Neural crest cell transmigrate into the first brachial arches where they under the influence of domain determining genes, Lhx-1 and Lhx-2 cluster into areas determining tooth development9. Improper regulation and signaling of these pathways, result in inappropriate placement and tooth morphology7,8,9. During early tooth development, BMPs and FGF expression signaling takes place interchangeably between epithelial and mesenchymal tissues. The dysregulated expression of the regulatory proteins along with others like MSX-1/MSX-2, BMP-2/BMP-4 results in an aberrant development of tooth and related structures. The development of supernumerary teeth in unsual sites is the some total of this disarranged expression10,11,12. This review cites six such clinical findings (Table 1.).
CONCLUSION: Correct interpretation of supernumerary and other such hard tissue anomalies is essential for a definitive diagnosis and treatment planning. An early diagnosis is important for sake of minimization of any risk of complications such as pathogenic cyst formation, displacement of permanent teeth and root resorption. However, sometimes surgical extractions are not deemed necessary due to their benign presence in oral
109 cavity; however such cases require regular follow-up.
REFERENCES: 1.
White S, Pharoah M, O'Connor D. Oral radiology: principles and interpretation. 2nd ed: Mosby St. Louis, Londo
2.
Hall A and Onn A. The development of supernumerary teeth in the mandible in cases with a history of supernumeraries in the pre-maxillary region. J of Ortho 2006;33:250-5.
3.
Langowska-Adamczyk H, Karmanska B. Similar locations of impacted and supernumerary teeth in monozygotic twins: a report of 2 cases. Am J Orthod Dentofacial Orthop 2001; 119:6770.
4.
Bailleul-Forestier I, Molla M, Verloes A, Berdal A. The ge-netic basis of inherited anomalies of the teeth. Part 1: clinical and molecular aspects of non-syndromic dental disorders. Eur J Med Genet 2008;51:273-9.
5.
Marya CM, Kumar BR. Familial occurrence of mesiodentes with unusual findings: case reports. Quintessence Int 1998;29:49-51.
6.
Thesleff I. Tooth morphogenesis. Advances in Dental Research1995;9(3 suppl):12.
7.
Cobourne MT. The genetic controle of early odontogenesis. Br. J of Orthodon 1999; 26: 21-8.
8.
Sharpe PT. Neural crest & tooth morphogenesis. Adv Dent Res2001; 15: 4-7.
9.
Mitchell JM, Hieklin DM, Doughty PM, Deckett JW et.al. The P homeobox gene is critical for molar tooth morphogenesis. T Dent Res 2006; 10: 886-93.
10. Lidral AC and Reising BC. The role of MSX-1 in human tooth agenesis. J Dent Res 2002; 81(4): 274-8. 11. Everett MM and Miller WA. Enamel matrix proteins in normal and abnormal amelogenesis. J Dent Res 1979; 58: 991-996. 12. Bawden JW, Moran RA, Deaton TG and Saour CM. Immunohistochemical localization of signal transduction pathways during amelogenesis: An inintial exploration. Adv Dent Res 1996; 10: 105-110.
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TABLES
Table 1: Depicting variable peridens manifestations S. No.
Age/gender
Site
Radiographic findings
1
15/M
Bilateral maxillary anterior
Two bilaterally impacted
region; palatally
horizontally in relation to the root of maxillary
(Figure -1A).
central incisors on the palate (Figure -1B).
Maxillary anterior right
Tooth -like structure in horizontal orientation in
region; labially
relation to root of maxillary
(Figure -2A)
(figure-2B).
Bilateral mandibular
Two impacted peridens
2
3
22/M
34/F
anterior
region,
labially
(Figure -3A)
peridens incisors oriented
right lateral incisor
resembling canine were
also noted on both right and left side near the rd middle 3 of roots of the permanent canine in t
he
mandible (Figure -3B). 4
5
6
23/F
19/M
28/F
Mandibular right premolar
Lingually impacted peridens between the roots of
region; lingually
44 and 45
(Figure -4A)
(Figure -4B).
Posterior maxilla right side;
Peridens on the buccal aspect of impacted 18.
buccally (Figure -5A).
(Figure -5B).
Maxillary
right posterior
;
Peridens on the distal side of an impacted 18
-
-
impacted (Figure 6A).
(Figure 6B).
LEGENDS
Figure-1A Intraoral: bilaterally two bony hard swellings present palatally one on each side of the midline.
Figure-1B Standard occlusal view: two central impacted peridens
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Figure-2A Intraoral: labially erupted lateral incisor peridens
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Figure-2B IOPA view: tooth like structure horizontally overlying maxillary right lateral incisor
Figure-3B OPG: two impacted peridens supernumerary canines on both right and left side near the middle 3rd of roots of the permanent canine in the mandible Figure-3A Intra oral: showing all 32 teeth.
Figure-4A Intraoral: lingually impacted peridens supernumerary premolar in the mandible.
Figure-4B Standard occlusal view: Right lingually impacted peridens supernumerary premolar in the mandible.
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Figure-5A Intraoral: partially erupted peridens supernumerary maxillary paramolar on the right buccal side.
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Figure-5B OPG: buccally placed peridens supernumerary maxillary paramolar in the right side.
Figure-6B OPG: impacted peridens right supernumerary maxillary distomolar. Figure-6A Intraoral: bony hard swelling in the right side of maxilla
Source of Support : Nil, Conflict of Interest: None Declared
