A female patient aged around 25 visited our Clinic (Wisdom Super speciality Dental Clinic) with a complain of additional teeth on the inner side of the Lower Jaw obstructing with the Tongue and Speech. On Clinical Examination we have observed that the patient had a supernumerary Premolar or Para Premolar in the 3rd and 4th quadrants. The Para Premolar in the 4th quadrant was a normal shaped supernumerary premolar while the one in the 3rd Quadrant was a very Rarely seen – Para Premolar + Gemination where the Root is fused while the there are two separate crowns. Refer to the below image showing clinical picture of the 3rd quadrant.
Para Premolar (Supernumerary tooth in the Premolar region) are very Rare and reported to be in the range of 0.01 and 1 percent. The supernumerary premolars come under the post permanent series of teeth developing from the extensions of the dental lamina. Gemination comes under the Developmental anomaly where it occurs during the initiation of tooth development.
On Radiographic examination it was observed that the Root of the Geminated Para Premolar was placed in between the 1st and 2nd Premolar Roots. The Para Premolar has been positioned Lingual to Bucally with the Crown placed Lingually while the Root is positioned inter dentally between the Roots of the 2 premolars closed to the apical part of the 1st Premolar. This can be seen in the Radiograph uploaded below.
As the patient was facing difficulty in day to day activity it was decided to Extract the Supernumerary Para Premolars on both quadrants, the 4th Quadrant one was a simple extraction as it was not diagonally placed in between other teeth but parallel to the Pre Molars which made it easy to luxate.
The Para Premolar in the 3rd Quadrant with the Gemination was a little tricky with the Root located in between the Premolars. The tooth was luxated and in the process due to the close proximity with the 1st Pre molar it had become mobile (Grade 1). After the Extraction of the Para Premolar Bone Graft was used to close the Socket and Sutures given. Patient was recalled after 5 days for follow up.
It is advisable to extract the Supernumerary Premolars in the Mandible region as they can lead to Caries due to the difficulty in Cleaning and also cause increased food impaction due to its proximity to the tongue.
Image and Case Credit:
- Wisdom Super speciality Dental Clinic – Hyderabad
This case highlights the importance of addressing supernumerary teeth, especially in the mandible, to prevent complications like caries and speech issues. Timely extraction and proper follow-up care can significantly improve the patient’s quality of life. Great work!