Although it sounds like an action film, this heroic name refers to the additional teeth being formed to the 20 primary and 32 permanent teeth that we naturally have.

One supernumerary is a somewhat special process, as it occurs in less than 15% of the population, and usually does not cause symptoms, so the diagnosis is often a chance finding on examination.

Its form pIt can be similar to that of normal teeth. or quite different, cone-shaped, tuberculate or simply an unshaped tooth structure, called odontoma. They may also appear as single or multiple teeth and may erupt as milk teeth from birth (neonatal teeth), at very early ages or at tooth replacement between 6 and 12 years of age.

The most common supernumerary has its own name: mesiodens. They represent 50% of the cases, appear between the two central incisors, and are characterised by their smaller size and conical shape.

The cause of supernumerary teeth is multifactorialAlthough genetics plays an important role in its occurrence, it is more common in boys than in girls.

The best way to see their location and possible risks is by means of a 3D radiography called CBCT. They can be straight, inclined, inverted or horizontal.

If they have a good position and sufficient space will erupt into the oral cavity, but if they are tilted, inverted or lying down they will not.

Generally, supernumerary teeth are extracted, whether they appear in the mouth or are retained in the bone, although there is no consensus as to when this is indicated, as it depends on the shape and position.

It is clear that the following circumstances require immediate removal of supernumerary teeth: 

1. Inhibition or delay of eruption of permanent teethbecause the supernumerary tooth does not allow the permanent tooth to erupt. 

2. If the supernumerary is displacing the adjacent tooth to another position.

3. If it interferes with the orthodontic movements.

4. Presence of a pathological condition. If this tooth is creating dental resorptions or follicular cysts.

5. If they favour the emergence of caries in neighbouring teeth for hindering hygiene.

 Early diagnosis can help to avoid complications. The management of such cases depends on the stage of development of the teeth, the position of the teeth and the availability of space. 

If the supernumerary appears in the mouth, it will be extracted in the conventional way, but if it is inside the jaws, the treatment can combine orthodontics with surgical intervention. This intervention can be carried out with conscious sedation techniques so that this process is as precise and light as possible, and the children or adolescents are calmer and have the best possible memory.