Multiple Supplemental Supernumerary Premolars: Unusual Presentation in a Nonsyndrome Patient

Supplementary teeth in the dental arch are a rare occurrence. Though they are mostly reported in association with syndromes they can also present in the absence of systemic pathology. This paper reports a case with multiple supernumerary teeth along with discussion of the frequency, types, complications, and management of such occurrence. 1. Introduction Extra set of teeth in the dental arch are designated as supernumerary which is a well-known dental phenomenon. This dental anomaly is common to primary and permanent dentitions in which the jaw has more teeth than normal. The term supernumerary frequently encompasses the supplementary teeth which are extra teeth that resemble those of the normal series. This developmental anomaly can occur either in the maxilla or in the mandible and is frequently seen in association with syndromes such as Gardner’s syndrome, Cleidocranial dysplasia, Trichorhinophalangeal syndrome, and cleft of the lip and palate. They can also be present in the absence of systemic pathology [1]. Prevalence rate of supernumerary teeth for permanent and primary dentitions is said to be between 0.5%–5.3%, and 0.2%–0.8% respectively [2]. However, the prevalence range depends on the methodology for detection and variation in the population. Supernumerary teeth can be unilateral, bilateral, single, or multiple presenting in either of the jaws. There is an apparent predilection of certain sites for supernumeraries and the most common ones are the maxillary mesiodens, followed by supernumeraries of maxillary molar region and those in mandibular premolar region [3]. The supernumerary premolars are mostly seen in the permanent dentition, the prevalence of which is in between 0.075% and 0.26% and they account for only 10% of all the supernumerary cases [2]. Studies on nonsyndrome multiple supernumerary teeth have found 60.9% of the total sample to occur in the mandible and 44.8% in the mandibular premolar region [4]. Morphologically supernumerary teeth are classified into three types, Tuberculate, Supplemental and Conoid forms. Supplemental, tooth is defined as tooth that may resemble a tooth of the normal series [5]. The presence of multiple supernumerary premolars in the absence of any associated syndromes or systemic conditions is relatively rare. This paper describes multiple unilaterally distributed supplemental type of supernumerary premolars of the mandibular arch. 2. Case Report A 26-year-old male came to the dental clinic with the chief complaint of pain in the lower left back tooth region. His familial, medical, and dental histories