A 10-year-old Caucasian girl was referred to the paediatric dentistry clinic with the chief complaint of delayed eruption of the permanent maxillary anterior teeth. There was no significant medical history and no family history of dental anomalies. The patient was a healthy child with no mental retardation, normal facial appearance, and no skeletal or other abnormalities suggestive of a systemic syndrome. She was the first child of a nonconsanguineous marriage, and her parents had no hereditary peculiarities.\nIntraoral examination revealed the presence of over-retained primary maxillary anterior teeth. The patient was in the mixed dentition stage and had a Class I molar relationship (Figures –). Oral hygiene was fair, resulting in multiple carious lesions.\nRadiographic examination showed 9 retained supernumerary teeth: 2 mesiodens, 4 in the mandibular left and right premolar regions, 2 in the maxillary right premolar region, and 1 in the maxillary right canine region (Figures -). Panoramic radiographs of the patient's parents showed no pathology or supernumerary teeth; however, her 2-year-old brother was not evaluated due to his young age.\nThe proposed treatment plan consisted of extraction of the retained supernumerary teeth and associated primary anterior and molar teeth in order to allow the permanent teeth to erupt. The treatment plan was explained to the patient and her family. With their permission, 20 teeth were extracted under general anesthesia (11 primary teeth and 9 impacted supernumerary teeth) (Figures -).\nFigures – shows an intraoral view and panoramic radiograph of the patient 1 month after the extractions. The patient was also provided with removable space maintainers and routine clinical and radiographic follow-up was performed at 6, 12, and 24 months in order to detect any possible delayed appearance of new supernumerary teeth. shows the panoramic radiographs of 6th and 12th months.\nAfter 2 years of follow-up, 2 additional supernumerary teeth were observed, 1 in the maxillary left premolar region and 1 in the maxillary anterior region (). In all other regions, eruption of the permanent premolars was normal. Extraction of the new supernumerary teeth was performed (Figures -), and orthodontic treatment was initiated.\nAt the end of a 3-year follow-up, orthodontic treatment using fixed mechanics was shown to have achieved good esthetics with an ideal overjet and overbite relation (Figures – and ). An Essix appliance was constructed for retention.\nPanoramic radiograph of the younger brother of the patients' at age 5 showed an impacted supernumerary tooth in the mandibular left canine region (). His follow-up visits are also continuing; however the extraction the supernumerary tooth was delayed until the eruption time of premolars.
Case 1. A female, leucoderma, Brazilian patient, aged 7 years and 3 months, presenting mouth breathing and skeletal Class II, division 2 malocclusion, sought a private clinic for orthodontic treatment. The initial panoramic radiograph revealed no abnormalities in the dentition ().\nOrthodontic treatment started two years later, when the patient was aged 9 years and 4 months. The corrective phase of the treatment occurred after the interceptive phase. For the treatment of the Class II malocclusion, an orthopedic expansion device across the upper and lower arches was placed over a period of 12 months. After this period, a lingual bar was adapted, and a follow-up radiograph was required because tooth 84 exhibited no physiological mobility and was the last deciduous teeth to remain in the oral cavity. Control radiographs obtained at 31 and 38 months after the first initial radiographic assessment revealed the early formation of a supernumerary tooth in the right mandibular premolar region (Figures and ). There were no reports of supernumerary teeth in the family. Due to its location, surgical removal was indicated.\nBefore beginning the second phase of the treatment, additional tests and a new panoramic radiograph were requested, which revealed the formation of a supplemental supernumerary tooth, this time in the left mandibular premolar region (), which was also surgically removed.\nControl panoramic radiographs taken at two different moments along the orthodontic treatment demonstrated no evidence of further supernumerary teeth ().