Supernumerary lateral incisor

Is that a supernumerary in your pocket, or are you just happy to see me? 😏

CC: “There is a gap between my teeth.”

Dx: supernumerary lateral incisor #10’

Tx: extraction of #10’, orthodontic referral for diastema closure

🔑: Treatment of mesiodens and anterior supernumerary teeth may seem straightforward; just extract and pat yourself on your back. However, timing of the treatment remains controversial. 

Some studies support delaying intervention until adjacent teeth’s root development is almost complete (around age 8-10). Other studies support earlier intervention as soon as discovery of the supernumerary teeth (age 6 or earlier). Which side are you on? Let me know below!

Some studies support delaying intervention until adjacent teeth’s root development is almost complete (around age 8-10). The logic behind this is reduced risk of  iatrogenic damage to adjacent developing tooth buds/roots during extraction. An additional benefit is easier behavior management due to increased patient age. However, this approach has its drawbacks, including disruption of adjacent teeth development (e.g. dilaceration, root resorption) and eruption (e.g. prevention of eruption, delayed eruption, displacement leading to malocclusion/diastema). 

Other studies support earlier intervention as soon as discovery of the supernumerary teeth (age 6 or earlier). The logic behind this is that by removing the mesiodens earlier, you minimize disruption to the adjacent teeth development and eruption (as mentioned above). The drawback is increased difficulty with patient management; surgical extraction of supernumerary teeth in children age 6 or younger may require sedation or general anesthesia. In addition, iatrogenic damage to vulnerable developing tooth buds during extraction is possible with side effects including retarded root development, root resorption, loss of tooth vitality, and enamel defects. 

Factors to consider before determining timing of extraction includes: position of supernumerary, direction of eruption, and patient behavior and management needs. 

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