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A CASE REPORT OF NON-SYNDROMIC PATIENT ASSOCIATED WITH MULTIPLE IMPACTED
SUPERNUMERARY AND PERMANENT DENTITION
NMRR-17-1999-35814

Lim XJ, Yusoff UA

Introduction: An impacted tooth is defined as a tooth which fails to erupt into the dental
arch within the expected time whereas a supernumerary tooth is a tooth that is additional
to that of the normal series. Multiple supernumeraries are usually associated with
syndromes such as Gardner’s syndrome and cleft lip and palate, but occasionally it may
also present in the absence of any syndromes. Case report: A non-syndromic 17-year-old
female patient presented with Class III malocclusion on Class III skeletal pattern
complicated with multiple impacted permanent teeth and associated with 9 impacted
supernumeraries, mainly in the premolar region. Upon a discussion with the oral surgeon
of Oral Surgery Department at Hospital Pakar Sultanah Fatimah, Muar, the exposure and
bonding of impacted teeth 13, 23, 25 and surgical removal of all the impacted
supernumerary teeth under general anaesthesia was decided. A fixed orthodontic
appliance of the maxillary arch with 3M Gemini brackets was commenced to align upper
teeth and create space for orthodontic traction for teeth 13, 23 and 25. Removable
appliance with posterior bite plane and labial bow was fitted on the mandibular arch to
disclude the occlusion. The 13, 23 and 25 teeth had fully erupted within 22 months of
treatment period. Tooth 34, which was noted short and blunt-rooted was extracted to
allow full eruption of tooth 35 which was distally angulated at 16 months of treatment
period. At thirty months of treatment period, fixed appliance of the mandibular arch using
the same 3M Gemini brackets was fixed. Within 52 months, all teeth had fully erupted and
aligned. Overjet achieved was edge to edge. After five and a half years of treatment, upper
and lower arches was well-aligned and all spaces had been closed. Right buccal segment
was in buccal crossbite with no displacement noted while left buccal segment showed
normal overjet and overbite. Debonding of upper and lower arches were perfomed with
bonded fixed retainer from 13 to 24. Patient was prescribed with upper Hawley and lower
Essix retainers. Conclusion: The treatment for this patient involved a combination of
surgical procedures and orthodontic treatment. Through a collaborative effort from
multidisciplinary team, all impacted teeth were successfully brought into alignment.

th
Poster presentation at the National Oral Health Research Conference 2019 on 23-24 April 2019 at Eastin Hotel, Kuala
Lumpur and Johor Scientific Research Day 2018.
Dr Lim Xin Jie
Dr Ummu Aiman Yusoff
Orthodontic Specialist Clinic
Muar Johor

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