Supernumerary tooth Notation System

[Downloaded free from http://www.ijdr.in on Tuesday, September 17, 2013, IP: 14.96.119.94] || Click here to download free Android application for this journal

Original Research Sarjeev’s supernumerary tooth notation system: A universally compatible add‑on to the Two‑Digit system Sarjeev Singh Yadav, Sapna Sonkurla1 Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Afzalgunj, Hyderabad, Andhra Pradesh, 1Department of Conservative Dentistry and Endodontics, YMT Dental Collage and Hospital Khargahar, Navi Mumbai, India

ABSTRACT

Received : 05-07-11 Review completed : 14-12-12 Accepted : 30-01-13

Aim: To give notation for quadrants, tooth position, and the type of supernumerary teeth for both permanent and deciduous dentition. Tooth numbering provides dentists with an essential shortcut in clinical record keeping. Materials and Methods: Three systems are favored worldwide: the Zsigmondy/Palmer system, the Universal system, and the Federation Dentaire Internationale (FDI) Two‑Digit system. Histories of all tooth‑numbering methods were traced and the strengths and deficiencies of each system were reviewed. The FDI Two‑Digit system is widely used throughout the world, except USA, and is the only method that makes the visual sense, cognitive sense, and computer sense. Conclusion: On review it was noticed that all tooth notation systems in vogue have a drawback as they do not provide any information or notations for supernumerary teeth such as paramolar, distomolar, mesiodens, and fused teeth. Key words: Army system, Bosworth system, distomolar, fused teeth, Haderup’s system, Navy system, Sarjeev’s supernumerary tooth notation system, Two‑Digit notation, Universal notation, Zsigmondy/Palmer notation

Dentists, in writing or speech, use several different dental notation systems for associating information to a specific tooth. The various common systems are the Federation Dentaire Internationale (FDI) World Dental Federation notation,[1] the Universal numbering system (dental),[2] Haderup’s system, the Army system, the Navy system, the Zsigmondy/Palmer notation method,[3] and Bosworth system.[4] The FDI system is in vogue worldwide and the Universal notation system is more popular in USA. The FDI World Dental Federation notation is widely used by dentists internationally to associate information to a specific tooth. Developed by Dr. J. Viohal and accepted by FDI in 1971, the World Dental Federation notation is also known as ISO 3950 notation.[5] It allows everyone in an oral health team to efficiently share information among him or Address for correspondence: Dr. Sarjeev Singh Yadav E‑mail: [email protected] Access this article online Quick Response Code:

Website: www.ijdr.in PMID: *** DOI: 10.4103/0970-9290.118009

her and further provides those outside the team with clear and precise information about their work. In addition, the FDI Two‑Digit notation system is widely used to record information on a patient’s situation. All notation systems introduced so far have been used as per local needs and convenience, but all the notation systems have one drawback in common, which is they does not provide any information and/or notation for supernumerary or fused teeth, etc. The majority of supernumerary teeth are considered to develop as a result of horizontal proliferation or hyperactivity of the permanent or deciduous dental lamina.[6] Supernumerary teeth are classified according to location and morphology.[7] Multiple supernumerary teeth are rare in individuals with no other associated diseases or syndromes.[8] According to studies performed so far, 3.1% of males and 2.6% of females[9] have supernumerary and fused teeth, and the incidence of these abnormal or extra teeth is increasing due genetic mutations, and environmental and local conditions. The incidence of supernumerary teeth varies between 0.45 and 3%, depending on the literature source, and is more common in females than in males (proportion 2:1).[10,11] Although such teeth may be found in any region of the dental arch, they are more commonly located on the maxillary midline Indian Journal of Dental Research, 24(3), 2013


Sarjeev’s supernumerary tooth notation system

Yadav and Sonkurla

where they are referred to as mesiodens, representing 80% of all supernumerary teeth.[12,13] This location is followed in decreasing order of frequency by four molars or upper distomolars; upper paramolars; and – proportionately far behind – by lower premolars, upper lateral incisors, lower fourth molars, and lower central incisors. Upper premolars are exceptional, as are upper and lower canines and lower lateral incisors.[14] The incidence of supernumerary teeth in different locations is increasing worldwide and there are no notation systems to address these increasing incidences.

8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 R ___________________________________________ L 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8

Thus, to overcome the drawback and to have notations for these extra components of the human dentition, Sarjeev’s supernumerary notation system was devised to satisfy the increasing need and requirement of a notation system for other than normal supernumerary teeth in the human dentition.

E D C B A ABCDE R ___________________________________________ L E D C B A ABCDE

The orientation of the chart is traditionally “dentist’s view”, that is, patient’s right corresponds to notation chart’s left. The designations “left” and “right” on the chart, however, nonetheless correspond to the patient’s left and right, respectively.

CHART OF CODES 1. FDI World Dental Federation notation Permanent

Upper right – 1

Upper left – 2

18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 R ___________________________________________ L 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 Lower right – 4 Lower left – 3

Upper right – 5

Upper left – 6

55 54 53 52 51 61 62 63 64 65 R ___________________________________________ L 85 84 83 82 81 71 72 73 74 75 Lower right – 8 Lower left – 7

Different variations for temporary teeth: R V IV III II I | I II III IV V L e d c b a abcde R ___________________________________________ L e d c b a abcde

5D 4D 3D 2D 1D 1D 2D 3D 4D 5D R ___________________________________________ L 5D 4D 3D 2D 1D 1D 2D 3D 4D 5D d5 d4 d3 d2 d1 d1 d2 d3 d4 d5 R ___________________________________________ L d5 d4 d3 d2 d1 d1 d2 d3 d4 d5 5m 4m 3m 2m 1m 1m 2m 3m 4m 5m R ___________________________________________ L 5m 4m 3m 2m 1m 1m 2m 3m 4m 5m • Deciduous teeth are indicated as follows: 1. a to e 2. A to E 3. I to V 4. 1D to 5D 5. d1 to d5 6. 1m to 5m 3. Haderup’s system Dane invented this system. Permanent

Deciduous

Deciduous

I – Incisor C – Canine P – Premolar M – Molar

8 + 7 + 6 + 5 + 4 + 3 + 2 + 1+ +1 + 2 + 3 + 4 + 5 + 6 + 7 + 8 R ___________________________________________ L 8‑7‑6‑5‑4‑3‑2‑1‑ −1‑2‑3‑4‑5‑6‑7‑8 Different variations for temporary teeth: 05 + 04 + 03 + 02 + 01+ +01 + 02 + 03 + 04 + 05 R ___________________________________________ L 05‑04‑03‑02‑01‑ −01‑02‑03‑04‑05 V + IV + III + II + I+ +I + II + III + IV + V R ___________________________________________ L V‑ IV‑ III‑ II‑ I‑ ‑I ‑II ‑III ‑IV − V

2. Zsigmondy/Palmer notation method

4. Universal system

This is the oldest method, introduced in 1861. Also called Palmer’s notation. Permanent

This notation system is approved by ADA, widely used in USA. Even though it includes all permanent and deciduous teeth, it does not have notation system for supernumerary teeth.

Indian Journal of Dental Research, 24(3), 2013



Yadav and Sonkurla

Permanent

of the distal‑most permanent tooth of the arch.

1 2 3 4 5 6 7 8 9 10 11 12 1 3 14 15 16 R ___________________________________________ L 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17

Fused teeth [Figure 3] – Two teeth united during development by union of their tooth germs; the teeth may

Deciduous A B C D E FGHIJ R ___________________________________________ L T S R Q P ONMLK 5. Army system Permanent 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 R ___________________________________________ L 16 15 14 13 12 11 10 9 9 10 11 12 13 14 15 16 Deciduous E D C B A ABCDE R ___________________________________________ L J I H G F FGHIJ

Figure 1: A paramolar on maxillary left second molar, that is, β6p

6. Navy system Permanent 1 2 3 4 5 6 7 8 9 10 11 12 1 3 14 15 16 R ___________________________________________ L 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Different variations for temporary teeth: A B C D E FGHIJ R ___________________________________________ L K L M N O PQRST I II III IV V VI VII VIII IX X R ___________________________________________ L XI XII XIII XIV XV XVI XVII XVIII XIX XX

Figure 2: (a) A distomolar distal to the lower right third molar, that is, δ8dm. (b) A supernumerary tooth between first and second right premolars, that is, δ4S

7. Bosworth system 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 R ___________________________________________ L H G F E D C B A ABCDEFGH

Supernumerary teeth

Paramolar [Figure 1] – It is a supernumerary molar usually small and rudimentary, situated buccally or palatally to one of the maxillary molars, or in the inter‑proximal space buccal to the second and third molars.[15] Distomolar [Figure 2a and b] – A supernumerary tooth located behind the third molar,[16] and if third molar is missing, there is evidence of a distomolar to the distal aspect

Figure 3: Fused teeth in the lower right second molar, that is, δ7f Indian Journal of Dental Research, 24(3), 2013



be joined by the enamel of their crowns, by their root dentin, or by both.[17,18] Gemination: It is the formation of two teeth from the same follicle, and there is one common pulp chamber, which results in the embryological persistence of dental lamina. In gemination, the normal number of teeth is usually present for a given dental age, but one is geminated.[19] Mesiodens [Figure 4] – A mesiodens is the most common supernumerary (extra) tooth. It is located in the maxilla in the midline (hence the special name, which means “middle tooth”). They can be well‑formed or maybe just little clumps of tooth‑like stuff.[20,21]

MODIFIED CHART OF CODES Permanent Upper right (α) Upper left (β) α8 α7 α6 α5 α4 α3 α2 α1 β1 β2 β3 β4 β5 β6p β7 β8 R ___________________________________________ L δ8dm δ7f δ6 δ5 δ4S δ3 δ2 δ1 γ1 γ2 γ3 γ4 γ5 γ6 γ7 γ8 Lower right (δ) Lower left (γ) Deciduous Upper right (π) Upper left (ε) π5 π4 π3 π2 π1 ε1 ε2 ε3 ε4 ε5 R ___________________________________________ L η5 η4 η3 η2 η1 λ1 λ2 λ3 λ4 λ5 Lower right (η) Lower left (λ)

How the codes are constructed Quadrant codes α Upper right permanent arch β Upper left permanent arch γ Lower left permanent arch δ Lower right permanent arch π Upper right deciduous arch ε Upper left deciduous arch λ Lower left deciduous arch η Lower right deciduous arch Tooth codes 1 Central incisors (permanent teeth)/(deciduous teeth) 2 Lateral incisors (permanent teeth)/(deciduous teeth) 3 Canines (permanent teeth)/(deciduous teeth) 4 1st Premolars (permanent teeth)/1st molar (deciduous teeth) 5 2nd Premolars (permanent teeth)/2nd molar (deciduous teeth) 6 1st Molars (permanent teeth) 7 2nd Molars (permanent teeth) 8 3rd Molars (permanent teeth) Indian Journal of Dental Research, 24(3), 2013

Yadav and Sonkurla Permanent

Deciduous

α-Alpha β-Beta γ-Gamma δ-Delta

π-Pi ε-Epsilon λ-Lambda η-Eta

Note: When the supernumerary tooth is in between two adjacent teeth in that arch, the position of the supernumerary tooth shall be coordinated with the tooth, which is medial to the tooth and not the distal tooth. This rule is not applicable to mesiodens or the supernumerary tooth in the midline of the arch wherein both teeth at the midline have to be recorded for notations. To further clarify, in notating a fused tooth, the normal tooth to which there is a fusion will be taken into consideration. p – Para molar dm – Distomolar f – Fused teeth g – Gemination M – Mesiodens.

ADVANTAGES • • • • • • • • • •

It fulfills the following basic requirements: Provides a cognitive, visual sense, and computer sense. Easy to record on a computer. Convenience of use in the present days of instant distant communication such as medical transcription. Identification, interaction, and communication regarding the dentition other than the normal dentition in the oral cavity. Simple to teach and understand. Adaptation and modification to the Universal system, FDI, and other two digit systems in use at present for better patient management and dental care. Easily adaptable to standard charts used in general practice. Readily communicable in print and by telephone. Easy to describe in conversation and dictation.

Figure 4: A mesiodens between upper two central incisors, that is, α1mβ1



DISCUSSION AND CONCLUSION This system has been devised to overcome the drawbacks and shortcomings of previous notation systems. This article reports the design of a supernumerary tooth notation system and fulfills the vacuum, but is definitely not an attempt to replace the well‑established and popular notation systems. Sarjeev’s supernumerary notation system allows us to designate teeth in both permanent and deciduous dentition that are not normal components of human dentition. The notations for quadrant codes are (α), (β), (γ), and (δ) for permanent dentition, and (π), (ε), (λ), and (η) for deciduous dentition. Greek mathematical symbols have been used since numbers and alphabets (alphanumeric) codes have been used in the FDI notation and the Universal numbering system. Roman numerals followed by capital alphabets were formerly used in the Palmer notation. To classify and to have notations that are universally acceptable, useful, time saving, and effective for all tooth hard tissue components, other than the normal, has been the main aim of this original review article. The concept of Sarjeev’s supernumerary tooth notations is novel and fulfills the need of the present day scenario of having a dental tooth notation system to notify supernumerary teeth of human dentition. Concluding with a personal favorite quote, “Today is yesterday’s result and tomorrow’s cause”.

REFERENCES 1. 2.

FDI Two Digit Notation. Available from: http://www.fdiworldental.org/ two‑digit‑notation. [Last accessed on 2012 Dec 21]. American Dental Association. Council on Dental Practice: Dental Abbreviation, Symbols and Acronyms. Designation for teeth, 2nd ed. 2008. p. 35. Available from: http://www.ada.org/sections/

Yadav and Sonkurla professionalResources/pdfs/dentalpractice_abbreviations.pdf [Last accessed on 2008 Dec 14]. 3. Ferguson JW. The Palmer notation system and its use with personal computer applications. Br Dent J 2005;198:551‑3. 4. Bosworth System. Available from: www.dentalassistant.org. [Last Accessed on 2012 April 18]. 5. ISO 3950:2009 Dentistry – Designation system for teeth and areas of the oral cavity. 6. Kokten G, Balcioglu H, Buyukertan M. Supernumerary fourth and fifth molars: A report of two cases. J Contemp Dent Pract 2003;4:67‑76. 7. Brook AH. Dental anomalies on number, form and size: Their prevalence in British school children. J Int Assoc Dent Child 1974;5:37‑42. 8. Scheiner MA, Sampson WJ. Supernumerary teeth: A review of literature and four case reports. Aust Dent J 1997;42:160‑5. 9. Kinirons MJ. Unerupted premaxillary supernumerary teeth: A study of their occurrence in males and females. Br Dent J 1982;153:110. 10. Salem G. Prevalence of selected dental anomalies in Saudi children from Gizan region. Community Dent Oral Epidemiol 1989;17:162‑3. 11. Thongudomporn U, Freer TJ. Prevalence of dental anomalies in orthodontic patients. Aust Dent 1998;43:395‑8. 12. Alaejos C, Contreras MA, Buenechea R, Berini L, Gay C. Mesiodens: A retrospective study of 44 patients. Med Oral 2000;5:81‑8. 13. Danalli DN, Buzzato JF, Braum TW, Murphy SM. Long‑term interdisciplinary management of multiple mesiodens and delayed eruption: Report of a case. J Dent Child 1988;55:376‑80. 14. Gay C, Mateos M, Spain A, Gargallo J. Other impacted teeth: Mesiodens and other supernumerary teeth. Teeth included. In: Gay C, Berini L, Editors. Oral Surgery. Madrid: Editorial Ergon, Madrid, 1999. p. 511-50. 15. Dubuk AN, Selvig KA, Tellefsen G, Wikesjö UM. Atypically located paramolar. Report of a rare case. Eur J Oral Sci 1996;104:138‑40. 16. Kakolewska‑Maczyńska J, Zyszko A. Paramolar and distomolar teeth. Czas Stomatol 1990;43:232‑7. 17. Schulze C. Developmental anomalies of the teeth and the jaws. In: Gorlin RJ, Goldman HM, editors. Thoma’s Oral Pathology. 6th ed. St. Louis; 1970. p. 96‑183. 18. Braham RL. Developmental anomalies of dentition – A scientific review. Pediatr Dent J 1995;5:105‑16. 19. Nirmala S, Velpula L, Nuvvula S, Mallineni SK. An unusual occurrence of geminated primary tooth with talon’s cusp. J Dr NTR Univ Health Sci 2012;1:187‑91. 20. Gallas MM, Garcia A. Retention of permanent incisors by mesiodens: A family affair. Br Dent J 2000;188:63‑4. 21. Seddon RP, Johnstone SC, Smith PB. Mesiodentes in twins: A case report and review of literature. Int J Paediatr Dent 1997;7:177‑84. How to cite this article: Yadav SS, Sonkurla S. Sarjeev's supernumerary tooth notation system: A universally compatible add-on to the Two-Digit system. Indian J Dent Res 2013;24:395-6. Source of Support: Nil, Conflict of Interest: None declared.

Indian Journal of Dental Research, 24(3), 2013