Hyper-hypodontia, gemination, ankyloglossia and multiple high-attached frena: a case report

BACKGROUND: The concomitant occurrence of hypodontia and hyperdontia is a rare clinical phenomenon. This report describes the multidisciplinary management of a non-syndromic 8-year-old patient presenting with a complex combination of gemination, bilateral missing mandibular lateral incisors, supplemental maxillary canines, ankyloglossia, and multiple hyperplastic frena. CASE PRESENTATION: An 8-year-old female was referred for the management of ankyloglossia. Clinical and radiographic assessments, utilizing panoramic imaging and cone beam computed tomography (CBCT), identified bilateral supernumerary maxillary canines and agenesis of mandibular lateral incisors. Under general anesthesia, the supernumerary teeth were surgically extracted, and frenectomies were performed to restore tongue mobility and enhance periodontal health through improved plaque control. Furthermore, a geminated tooth (73) received prophylactic resin restoration to preserve arch integrity. Maxillary expansion was initiated using a Hyrax appliance for orthodontic interception. The patient remains under longitudinal observation for definitive interdisciplinary orthodontic treatment. CONCLUSION: Managing concurrent numerical and structural dental anomalies requires early detection via advanced imaging and a coordinated, multi-specialty approach. Clinical intervention should prioritize the restoration of physiological function and the prevention of secondary complications, such as periodontal instability or severe malocclusion, rather than isolated phenotypic corrections.