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24 Dental Tribune Middle East & Africa Edition | July-August 2015paediatric tribune < Page 21 Dr. Ghada Hussain, UAE BDS (Dublin), BA (Dublin) Postgraduate Resident in Paediat- ric Dentistry Hamdan Bin Mohammed College of Dental Medicine Mohammed Bin Rashid Universi- ty of Medical and Health Sciences E: ghada.hussain@hbmcdm.ac.ae Dr. Iyad Hussein , UAE DDS (Dam), MDentSci (Leeds), GDC Stat. Exam (London), MFD- SRCPS (Glasg) Asst. Clinical Professor in Paedi- atric Dentistry & UK Specialist in Paediatric Dentistry Hamdan Bin Mohammed College of Dental Medicine Mohammed Bin Rashid Universi- ty of Medical and Health Sciences E: iyad.hussein@hbmcdm.ac.ae About the Authors sion appliance (with an anterior expanding screw) and posterior bite blocks to correct the ante- rior cross bite (Fig. 13). The appliance was activated us- ing the key (seen in Fig. 13) and the patient was asked to wear the appliance for 24 hours a day (except at meal times) (Fig.14). Whenshewasreviewedamonth later, tooth 11 was corrected and over the bite but tooth 21 was still in cross bite. LT subsequent- ly lost the appliance, so an al- ternative method to correct the cross bite without subjecting the patient to new impressions (due to her gag reflex) was used. We placed glass ionomer cement (GIC) on the occlusal surface of 55, 65, 75, and 85 to open the bite (Fig.15 a & b). This would allow for spontane- ous correction of the anterior cross bite of 21 due to the posi- tive pressure of the patient’s tongue. At two-month follow up, tooth 21 had moved but was still in cross bite. We placed a com- posite ramp/restoration on 31 incisally, to finalise the correc- tion of the cross bite. One month later, tooth 21 was over the bite and in the correct anterior-pos- terior position (Fig. 16 a & b). Discussion Supernumerary teeth occur in 1.5-3.5% of cases in the perma- nent dentition8 . Supernumerar- ies may present as tuberculate, conical, supplemental, inverted, pegged shaped or odontome shaped teeth. There is a male to female ratio approximately 2:1.8 They are more frequent in max- illa to mandible ratio around 5:1 and are called mesiodens in the maxillary anterior region. The effect of supernumeraries causing the failure or delayed eruption of permanent incisors was reported to be in 28% to 38% of the cases. Tuberculate supernumerary teeth are more likely to cause obstruction.9 In 54-78% of the cases removal of the supernumerary will result in the permanent incisor erupt- ing spontaneously within an average of 16 months10 . In this case, the inverted conical super- numerary was obstructing the eruption of 21, and its removal facilitated the eruption of 21 al- most immediately. Correction of anterior crossbites is essential because they (if left untreated) may cause attrition to the labial surface of the upper incisors, fractures or mobility of incisor teeth or gingival recession. The treatment modalities adopted here fit with the best current practice UK guidelines.1,11 Conclusion Monitoring the developing den- tition may reveal anomalies that require multifaceted interven- tion by the paediatric dentist. The paediatric dentist skills should cover the range of restor- ative, interceptive orthodontic and oral surgical procedures as demonstrated in this case. GDPs must always check for delayed eruption of permanent central incisors specially if one had erupted more than 6 months prior. If detected, an appropri- ate referral should be made to a paediatric dentist for overall management. We recommend following the Royal College of Surgeons of England (RCSEng) Guidelines (2010)1 on manage- ment of unerupted maxillary incisors. References 1. Management of unerupted maxillary incisors. Yaqoob O, Fig. 12. One week post surgery. Tooth 21 had begun to erupt into a crossbite after the removal of the $. Note that 11 is al- ready in cross bite. Fig.13. Upperremovableorthodonticappliancewithananteriorexpanding palatal screw; to correct the cross bite of 11 & 21. The expansion key is on the right Fig. 14. The URA in place. Notice the posterior biteblocks opening the bite to facilitate the correction of the ante- rior crossbite. Fig. 16 (a & b). Final result. The anterior crossbite of teeth 11 and 21 had been corrected 4 months following surgery. There is a midline diastema, which is a normal phenomena at this stage and will subsequently close. The patient may later benefit by a 2X4 fixed orthodontic appliance to straighten both 11 & 21, but we will wait for the eruption of 22. Fig. 15 (a & b). GIC build ups on LT’s upper primary molars to open the bite O’Neill J, Gregg T, Noar J, Co- bourne M, Morris, D. Guidelines of the Royal College of Surgeons of England, 2010 2. Cons N C, J, Kohout F J. DAI: The dental aesthetic index. Iowa: College of Dentistry, Uni- versity of Iowa; 1986. 3. Snow K, Articulatory Profi- ciency in Relation to Certain Dental Abnormalities. Journal of Speech and Hearing Disorders 1961; 26: 209-12 4. Show W C, O’Brien KD, Rich- mond S, Brook P. Quality con- trol in orthodontics: risk/benefit considerations. Br Dent J 1991; 170:33-37. 5. Hitchen A D. The impacted maxillary incisor. Dent Pract Dent Rec 1970; 20:423-33 6. Mac Phee CG. The incidence of erupted supernumerary teeth in consecutive series of 4000 school children. Br Dent J 1935;58:59-60 7. Di Biase DD. Midline su- pernumeraries and eruption of maxillary central incisors. Transactions of the BSSO 1968- 1969;83-88. 8. Welbury R, Duggal M, Hosey M. Paediatric Dentistry Fourth Edition 2012. 9. Foster T D, Taylor G S. Char- acteristics of supernumerary teeth in the upper central inci- sor region. Dent Pract Dent Rec 1969;20:8-12. 10. Mitchell L, Bennett T G. Su- pernumerary teeth causing de- layed eruption - a retrospective study. Br J Orthod 1992;19:41-46. 11. Borrie, F & Bearn D. Inter- ceptive orthodontics. Intercep- tive Orthodontics-Current Evi- dence- Based Best Practice. Dent Update 2013; 40: 442–450