Supernumerary teeth in patients with cleft lip and palate: the tooth germs do not separate

Abstract

Introduction: Supernumerary teeth in cases of cleft lip and palate do not result from the division of normal germs before the formation of hard tissue. Deciduous and permanent teeth odontogenesis begins after the face has formed, either with or without the cleft. Discussion: The most acceptable hypothesis to enable understanding of the presence of supernumerary teeth on one or both sides of the cleft palate is hyperactivity of the dental lamina in its walls. This hyperactivity, with the formation of more tooth germs, must be attributed to mediators and genes related to tooth formation, under strong influence of local epigenetic factors, whose developmental environment was affected by the presence of the cleft. Conclusion: The current concepts of embryology no longer support the fusion of embryonic processes for the formation of the face, but rather the leveling of the grooves between them. All human teeth have a dual embryonic origin, as they are composed of ectoderm and mesenchyme/ectomesenchyme, but this does not make it easy for them to be duplicated to form supernumerary teeth.

Effect of maxillary anterior supernumerary tooth extraction on the underlying malocclusion

“…The ‘supplemental’ tooth can be found in every part of the dental arch, most commonly in the premaxilla (called mesiodens when located between the two central incisors). A couple of theories aim to explain the appearance of supernumerary teeth, ranging from hyperactivity of dental lamina and atavism to sectioning of the tooth germ and heredity (Consolaro et al, 2021). While most authors (Rotberg and Kopel, 1984; Scanlan and Hodges, 1997) advocate the early removal of ST, others claim that this approach can be hazardous, if performed too early, to the germs or roots of the developing adjacent teeth (Koch et al, 1986; Scanlan and Hodges, 1997).…”