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Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 55-57

A unique case of nonsyndromic concomitant hypodontia and multiple supernumerary teeth with talon cusps

1 Department of Dentistry, SHKM Government Medical College, Mewat, India
2 Department of Pathology, Kalpana Chawla Government Medical College, Karnal, Haryana, India

Date of Web Publication1-Mar-2018

Correspondence Address:
Dr. Sonam Sharma
B-5, Varun CGHS Ltd., Plot No. GH-03, Sector - 52, Gurgaon - 122 003, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijhas.IJHAS_35_17

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The simultaneous presence of hypodontia and hyperdontia is a rare condition in general population posing a diagnostic dilemma to dental practitioners. Its etiology is still not exactly known. It can result in several clinical problems which may require a multidisciplinary approach and long-term dental care. The growing knowledge about this condition emphasizes that concomitant anomalies should be excluded when hypodontia or hyperdontia is diagnosed. Presented here is an unusual case of bimaxillary concomitant hypodontia and multiple supernumerary teeth with Talon cusps as an associated dental anomaly.

Keywords: Hyperdontia, hypodontia, supernumerary teeth, talon cusps

How to cite this article:
Sharma A, Sharma S. A unique case of nonsyndromic concomitant hypodontia and multiple supernumerary teeth with talon cusps. Int J Health Allied Sci 2018;7:55-7

How to cite this URL:
Sharma A, Sharma S. A unique case of nonsyndromic concomitant hypodontia and multiple supernumerary teeth with talon cusps. Int J Health Allied Sci [serial online] 2018 [cited 2022 Jun 28];7:55-7. Available from: https://www.ijhas.in/text.asp?2018/7/1/55/226261

  Introduction Top

Hypodontia or congenital absence of a tooth/teeth may be considered as an opposite dental developmental anomaly to hyperdontia or supernumerary tooth/teeth. Moreover, their simultaneous occurrence in the same individual is a rare condition. It has been found more often in the permanent dentition rather than in primary or mixed dentition. The etiology of coexisting hypodontia and hyperdontia is unknown. Disturbances in migration, proliferation, and differentiation of the neural crest cells and interactions between the epithelial and mesenchymal cells during the initiation of odontogenesis have been suggested.[1]

Concomitant hypo-hyperdontia (CHH) has been reported in cleft lip palate patients and with syndromes such as Down, Marfan, and Ellis-van Creveld.[2],[3] The incidence of nonsyndromic CHH is likely to be very rare in general population, given the incidence in an orthodontic population to be as low as 0.3%.[4]

  Case Report Top

A 25-year-old male working as a daily wages laborer reported to do his assigned job of putting up signboards in the Department of Dentistry. While talking to him, it was noticed that he had odd looking front teeth. After due consent, when asked, he said that he had never been to a dentist. The family, medical, and dental histories were noncontributory. Extraoral examination did not reveal any abnormality. On intraoral examination, a full complement of permanent dentition was present except for the left mandibular first premolar. Poor oral hygiene and carious teeth were also noted. Two bilaterally erupted supplemental supernumerary teeth were seen palatal to the right and left maxillary central incisors. Labially, an erupted supplemental supernumerary canine was seen between right maxillary central and lateral incisor, while on the left side, it was found between maxillary central incisor and canine [Figure 1], [Figure 2], [Figure 3]. Both right and left maxillary supernumerary canines exhibited talon cusps.
Figure 1: Anterior occlusal photograph of dentition

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Figure 2: Upper occlusal photograph showing erupted multiple anterior supernumeraries

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Figure 3: Lower occlusal photograph of dentition showing clinically absent lower left first premolar

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Radiographic investigation of the case [Figure 4] revealed four well-developed erupted supplemental supernumerary teeth in relation to maxillary right and left central incisors and canines. A V-shaped radioopaque structure overlapping the coronal aspect of the supernumerary canines was also observed. It confirmed the clinical diagnosis of Talon cusp. The left mandibular first premolar was confirmed to be missing [Figure 5].
Figure 4: Maxillary occlusal radiograph

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Figure 5: Radiograph showing missing first premolar

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The patient was educated about oral hygiene maintenance and complete oral prophylaxis was done. He was also made aware of dental caries and other dental anomalies. Due to poverty and lack of time, the patient refused to undergo any further treatment like the restoration of carious teeth. Despite extensive counseling, the extraction of supernumeraries and orthodontic correction, later on, was refused by the patient. He further admitted that, on the pretext of superstitious belief system, at times, he showed his dentition to scare others and got his works done.

  Discussion Top

Despite advances in the knowledge of tooth morphogenesis and differentiation, relatively little is known about the etiology and molecular mechanisms underlying supernumerary tooth formation. A small number of supernumerary teeth may be a common developmental dental anomaly, while multiple supernumerary teeth usually have a genetic component and they are sometimes thought to represent a partial third dentition in humans.[5] The supernumerary teeth may be single or multiple, unilateral or bilateral, erupted, or impacted. Approximately 75% of anterior supernumerary teeth remain unerupted, while 25% are partially or fully erupted. Supernumeraries may be classified into two types according to their shape as follows: supplemental and rudimentary.

Talon cusps are morphologically well delineated, accessory talon-cusps, projecting from the lingual or facial surface of the crown of incisors and extending at least half the distance from the cementoenamel junction to the incisal edge. Talon cusp can occur in maxillary or mandibular anterior teeth in both the primary and permanent dentition. This accessory cusp can occur as an isolated entity or in association with other dental anomalies.[6] The occurrence of talon cusp on supernumerary teeth is extremely rare. The exact etiology of this condition remains unknown. It is thought to occur during morphodifferentiation stage as a result of outward folding of inner enamel epithelial cells (precursors of ameloblasts) and transient focal hyperplasia of mesenchymal dental papilla (precursors of odontoblasts) or a combination of genetic and environmental factors (multifactorial). Small talon cusps are usually asymptomatic and need no treatment. On the other hand, large prominent cusps may cause clinical problems, including poor esthetics, occlusal interference, displacement of the affected tooth, carious lesions in the developmental grooves and pulpal exposure due to cuspal attrition, accidental cuspal fracture, pulpal necrosis, periapical pathoses, periodontal pockets, tongue irritation, and possibility of temporomandibular joint pain.[7]

Concomitant hypo-hyperdontia is an extremely rare numerical mixed condition that exhibits both extra teeth and missing teeth relative to the normal compliment. The present nonsyndrome case of hypodontia along with bilaterally erupted supplemental multiple supernumerary teeth, especially the maxillary canines makes it a very rare condition in itself. Talon cusps on the supernumerary canines further add to the rarity of this case.[8],[9]

It is essential to enumerate and identify the teeth present clinically and radiographically before a definitive diagnosis and treatment plan can be formulated. The management of this condition is challenging and warrants a multidisciplinary approach because no standard treatment protocols have been documented in the literature. Most erupted supernumerary teeth of abnormal size and shape are removed for esthetic reasons. Supplementary teeth may be extracted or preserved if necessary if hypodontia is evident at the same site or in the adjacent region. Early diagnosis is essential for proper management, allowing the clinician to implement the most appropriative treatment to minimize future complications.[10]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Ranta R. Numeric anomalies of teeth in concomitant hypodontia and hyperdontia. J Craniofac Genet Dev Biol 1988;8:245-51.  Back to cited text no. 1
Hattab FN, Yassin OM, Sasa IS. Oral manifestations of Ellis-van Creveld syndrome: Report of two siblings with unusual dental anomalies. J Clin Pediatr Dent 1998;22:159-65.  Back to cited text no. 2
Acerbi AG, de Freitas C, de Magalhães MH. Prevalence of numeric anomalies in the permanent dentition of patients with Down syndrome. Spec Care Dentist 2001;21:75-8.  Back to cited text no. 3
Varela M, Arrieta P, Ventureira C. Non-syndromic concomitant hypodontia and supernumerary teeth in an orthodontic population. Eur J Orthod 2009;31:632-7.  Back to cited text no. 4
Wang XP, Fan J. Molecular genetics of supernumerary tooth formation. Genesis 2011;49:261-77.  Back to cited text no. 5
Sharma A, Sharma S, Singh VP. Concomitant hypodontia and unusual dental anomalies in families. J Health Spec 2014;2:82-5.  Back to cited text no. 6
  [Full text]  
Babaji P, Sanadi F, Melkundi M. Unusual case of a talon cusp on a supernumerary tooth in association with a mesiodens. J Dent Res Dent Clin Dent Prospects 2010;4:60-3.  Back to cited text no. 7
Sharma A. A rare non-syndrome case of concomitant multiple supernumerary teeth and partial anodontia. J Clin Pediatr Dent 2001;25:167-9.  Back to cited text no. 8
Sharma A. A rare case of bilaterally erupted supernumerary canines. J Indian Acad Oral Med Radiol 2000;11:116-7.  Back to cited text no. 9
Mallineni SK, Nuvvula S, Cheung A, Kunduru R. A comprehensive review of the literature and data analysis on hypo-hyperdontia. J Oral Sci 2014;56:295-302.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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