Impaction Predictors and Diagnosis of Supernumerary Teeth: A Romanian Study

Background: Supernumerary teeth (ST) are developmental anomalies that may interfere with eruption, alignment, and occlusal balance. Their etiopathogenesis and management remain controversial. This multicentric study aimed to evaluate the epidemiological, morphological, and radiographic features of ST in a Romanian population and identify impact predictors. Methods: Between 2020 and 2025, 153 patients (91 males, 62 females; mean age 14.8 ± 6.2 years) with clinically and radiographically confirmed ST were examined in three academic centers. Diagnostic assessment included orthopantomography and cone-beam computed tomography (CBCT). Teeth were classified by morphology, topography, and eruption status. Statistical analyses and binary logistic regression identified significant predictors (p < 0.05). Results: A total of 185 ST were recorded, most frequently conical (48.6%) and mesiodens (56.2%). Complications were observed in 40.5% of patients. Predictors of impaction included younger age (< 13 years) (OR = 3.12; p = 0.003), male gender (OR = 1.78; p = 0.046), tuberculate morphology (OR = 2.93; p = 0.021), and Class III malocclusion (OR = 1.89; p = 0.039). CBCT demonstrated superior diagnostic accuracy (κ = 0.89). Conclusions: Supernumerary teeth show morphology- and age-dependent impaction risk. CBCT provides enhanced diagnostic precision, supporting personalized, evidence-based management and future genetic investigations.