PMC4306249_01
Preoperative intraoral photographs.
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The patient was in the mixed dentition stage and had a Class I molar relationship (Figures 1(a)-1(e)).
PMC4306249_02
Preoperative radiographs showing multiple supernumerary teeth. (a) The arrows show 9 supernumerary teeth in both jaws. (b) The arrows show 2 supernumerary teeth in the upper anterior region.
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Radiographic 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 2(a)-2(b)).
Postsurgical photographs showing extracted teeth. (a) Maxillary extracted primary molars and supernumerary teeth. (b) Mandibular extracted primary molars and supernumerary teeth.
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With their permission, 20 teeth were extracted under general anesthesia (11 primary teeth and 9 impacted supernumerary teeth) (Figures 3(a)-3(b)).
Intraoral and panoramic views 1 month after the extractions. (a) Postoperative panoramic radiograph. (b, c) Postoperative intraoral views of the patient. (d, e) Space maintainers were prepared for maxillary and mandibular regions.
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Figures 4(a)-4(e) shows an intraoral view and panoramic radiograph of the patient 1 month after the extractions.
(a, b) Six-month and 12-month follow-up radiographs.
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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.  Figure 5 shows the panoramic radiographs of 6th and 12th months.
Two-year follow-up radiograph showing 2 additional supernumerary teeth, 1 in the maxillary left premolar region and 1 in the maxillary anterior region.
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After 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 (Figure 6).
(a, b) Postsurgical photographs of the extracted supernumerary teeth and panoramic view.
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Extraction of the new supernumerary teeth was performed (Figures 7(a)-7(b)), and orthodontic treatment was initiated.
(a-e) Intraoral views of the patient after completion of orthodontic treatment.
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At 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 8(a)-8(e) and Figure 9).
Panoramic view of the patient at the end of 3-year follow-up.
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At 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 8(a)-8(e) and Figure 9).
Panoramic radiograph of the patient's brother showing impacted supernumerary tooth.
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Panoramic radiograph of the younger brother of the patients' at age 5 showed an impacted supernumerary tooth in the mandibular left canine region (Figure 10).