Healing without Surgery: A Case of Supernumerary Tooth, : Lack of a Permanent Element, and Gingival Hypertrophy in an Orthodontic Patient

Giovanna Mosaico1, Luca Viganò2, Germano Orrù3, 4, *, Cinzia Casu5
1 Freelancer, Brindisi, Italy
2 Departement of Oral Radiology, San Paolo Dental Building, University of Milano, Milano, Italy
3 Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
4 National Research Council of Italy, ISPA-CNR, Sassari, Italy
5 Private Dental Practice, Cagliari, Italy.

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© 2019 Mosaico et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Oral Biotechnology Laboratory (OBL), University of Cagliari, Via Ospedale 54, 09121 Cagliari, Italy;
Tel:+39 070 537413; Fax: +39 070 537437; E-mail:



Supernumerary teeth are present in 0,2-3% of the population. Multiple supernumeraries are often associated with syndromes such as cleidocranial dysplasia and Gardner's syndrome. They often hinder the permanent eruption’s teeth, causing cavities, periodontal lesions, pulp necrosis, and in some cases follicular cysts. Reactive lesions such as fibroma, local fibrous hyperplasia, pyogenic granuloma, and peripheral ossifying fibroma are frequent gingival lesions.

Materials and Methods:

We reported a case of a 9 years old patient with the missed eruption of a permanent element caused by a supernumerary tooth, associated with an exophytic palatine lesion. The deciduous incisor was still present and the supernumerary included. It was decided to proceed with the extraction of the deciduous and to wait for scheduling checks every two months. After a few months, the conoid shape supernumerary tooth erupted in the maxillary arch, so a fixed orthodontic therapy was performed to create the space for the central incisor’s eruption.


After a few months, the tooth began to erupt in the arch thanks to orthodontic traction. The patient was instructed to correct and specific oral hygiene maneuvers to lower the plaque index and try to reduce gingival hypertrophy.


Supernumerary teeth often hinder the eruption and development of the related permanent tooth causing localized periodontal problems. Corrective fixed orthodontics requires more strict oral hygiene to avoid periodontal complications.

Keywords: Orthodontic therapy, Gingival hypertrophy, Supernumerary tooth, Soft tissue lesion,, Orthodontic mucosal lesion, Pulp necrosis.