3D-imaging is essential in determing when to remove supernumerary teeth

Geist, Shin-Mey Rose, Salwa Atwan, and James Geist

In March 2015 a six-year-old boy in California died during a supernumerary tooth removal. This tragedy raised concerns regarding risk/benefit assessment for determing the timing and procedural setting of removal of supernumerary teeth. The decision should be reached not only by the provider but also the patient or the authorized guardian(s). Among the many factors influencing the decision making process, the paramount ones are the exact location of the supernumerary tooth, its relation with vital organs or structures, and whether it is associated with any pathoses.

Two-dimensional panoramic radiographs are the most frequently used images in detecting supernumerary teeth. However, the value in providing adequate diagnosis for any supernumerary tooth may be low.

Three dimensional imaging produced by cone beam computed tomography is a convenient and economic diagnostic tool that provides comprehensive information that is crucial for both the informed consent for the patient's part and treatment planning by the provider.

Once the diagnosis is established, both provider and the patient can follow an algorithm with all factors considered to reach the decision.