18 Orthodontics January 2019 Multiple Recurrent Supernumerary Teeth: A Case Report Abstract: Supernumerary teeth affect approximately 1−3% of the population, however, recurrent supernumerary teeth are extremely rare (prevalence = 0.0001%) and may be associated with undiagnosed syndromes. The syndromes associated with recurrent supernumerary teeth vary widely and a diagnosis often necessitates involvement of a spectrum of medical disciplines. This case report describes a patient with recurrent supernumerary teeth and a history of sebaceous cysts that indicated the potential presence of Gardner’s syndrome. It highlights the importance of multidisciplinary communication and investigation for effective patient management. CPD/Clinical Relevance: Supernumerary teeth can be a feature of several syndromes. Dental health professionals should be aware of this association and of the signs that indicate that further investigation may be warranted. Ortho Update 2019; 12: 18–20 Mohammad Owaise Sharif Mohammad Owaise Sharif, BDS(Hons), MJDF RCS(Eng), MOrth RCS(Ed), FDS(Ortho) RCS(Eng), FHEA, Clinical Lecturer and Honorary Consultant in Orthodontics, UCL Eastman Dental Institute, 256 Gray’s Inn Road, London, WC1X 8LD, Farooq Ahmed, BDS(Hons), MSc, MDPH, MFDS, MOrth, FDS RCS(Orth), AFEA, Consultant Orthodontist, Guy’s and St Thomas’ NHS Foundation Trust and Mariyah Nazir, BDS(Hons), MPhil, MFDS RCS(Eng), MOrth RCS(Ed), FDS(Orth) RCS(Eng), Consultant in Orthodontics, University of Manchester Dental Hospital, Higher Cambridge Street, Manchester M15 6FH, UK. Enhanced CPD DO C Supernumerary teeth are those teeth occurring in excess of the normal series. The prevalence of such teeth has been reported to be as high as 3% in the permanent dentition. 1 Most commonly, they present as single units, however, multiple supernumerary teeth account for 8−27% of all cases. 2,3,4 They can present in isolation, but systemic or genetic factors may be implicated, for example:  Gardner’s syndrome;  Cleido-Cranial Dysostosis;  Cleft Lip and Palate. 5,6,7 Supernumerary teeth are classified according to location (mesiodens, paramolar, distomolar or parapremolar) or morphology (conical, tuberculate, supplemental or odontome) (Table 1 and Figures 1−4). In contrast to hypodontia, males are affected more commonly than females (ratio − 2:1). 8 Other factors associated with supernumerary teeth include:  Delayed eruption;  Pathology (cysts, root resorption);  Spacing (eg a midline diastema);  Malposition of erupting teeth;  Dilaceration of developing teeth;  Crowding (in the case of erupted supernumeraries);  Over-retention of primary teeth (in the case of Cleido-Cranial Dysostosis). This case reports describes the management of a patient with recurrent multiple supernumerary teeth in the premolar region. Case report A 13-year-old female was referred by her General Dental Practitioner (GDP) to the Orthodontic Department at The University of Manchester. Medically, the patient was fit and well, the reason for referral being dental crowding. An orthodontic assessment revealed that the patient had Class I incisors on a Class I skeletal base with mild upper and lower arch crowding; this was complicated by retained lower deciduous first molars (LRD and LLD) and unerupted lower first premolar teeth (LR4 and LL4). As part of the assessment, an Orthopantomogram (OPG) was taken to inform diagnosis and treatment planning. The OPG revealed the presence of all permanent teeth, including developing third molars. In addition, four supernumerary teeth were identified, one in each of the upper right, lower right quadrants, and two in the lower left quadrant (Figure 5). The supernumerary teeth in the lower right and left quadrants were impeding the eruption of LR4 and LL4, resulting in an IOTN score of 5i on dental health grounds. After discussion with the patient and her parents, arrangements were made for the extraction of the retained LRD, LLD and surgical removal of all four supernumerary teeth. This was carried out under general anaesthesia 7 months later. Whilst performing the surgical removal of the supernumeraries in the LLQ the oral surgeon noted that the LL4 was in Farooq Ahmed and Mariyah Nazir Downloaded from magonlinelibrary.com by 146.198.175.032 on March 26, 2019.