K. G. Verma et al. / Open Journal of Stomatology 3 (2013) 37-41
40
hyperdontia [12] from various studies has been calcu-
lated to range from 0.002% to 3.1%. Hypo-hyperdontia
does not usually manifest in the same arch and very
rarely in the same area of an arch [6,12]. Patients with
hypo-hyperdontia usually do not present any symptoms
and are usually detected during examination for other
causes or on radiographic examination of the jaws [10,
17,18]. The current case was only recognised when the
patient came for oral prophylaxis. When any numeric
anomaly of the dentition is noted, a thorough clinical
intra-oral examination is warranted, combined with a
judicious use of radiographs. Panoramic radiographs are
the best screening modality available by virtue of dem-
onstrating the entire teeth-bearing segment of the jaws
and supporting structures in a single image [19]. Addi-
tional information about the root morphology and root
development can be obtained using periapical views. In
the present case, the age of the patient (9 years) pre-
cluded any possibility o f late development of at least the
mandibular central incisors, as some radiographic evi-
dence would have been noted. Having stated this it will
still have to be emphasised that in most cases supernu-
merary as well as unerupted teeth go undetected and cli-
nicians have to make the effort to determine these condi-
tions by a thorough clinical as well as radiographic ex-
amination. Such rare situations can at times significantly
alter the treatment plan and enough latitude should be
considered in managing such clinical circumstances.
6. CONCLUSION
Due to the rarity of combined hypodontia of the man-
dibular incisors and the presence of the mandibular me-
siodens, treatment of affected children is generally un-
dertaken. Multidisciplinary treatment planning, which tak e s
account of established and emerging techniques, needs to
be practiced [8]. Different treatment options that take
account of growth and development of the dentition and
of the compliance of child can lead to a treatment plan
that can produce desirable interim results, which do not
compromise any future treatment. Careful treatment plan-
ning is importan t, becaus e th ere is a ne ed to deal with not
only the immediate but also the long-term adverse im-
plications.
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