|Year : 2012 | Volume
| Issue : 3 | Page : 197-199
Occurrence of fourth mandibular molars bilaterally and a supernumerary tooth in premolar region: A rare case
Vinay Kumar Bhardwaj1, Sanjeev Vaid2, Nishant Negi2, Anil Chug3, Pravesh Jhingta4, Atul Chauhan5
1 Department of Public Health Dentistry, H.P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
2 Department of Orthodontics and Dentofacial Orthopaedics, H.P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
3 Department of Oral and Maxillofacial Surgery, H.P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
4 Department of Periodontology, H.P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
5 Department of Oral Medicine and Radiology, H.P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
|Date of Web Publication||26-Dec-2012|
Vinay Kumar Bhardwaj
Department of Public Health Dentistry, H.P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
To present a rare case of fourth molar bilaterally and a supernumerary tooth in #35 region in the mandible. Brief review of the literature; presentation of the clinical data of the patient and images of the case. Supernumerary fourth molars are rare anomalies of the maxillofacial complex that are more common in the maxilla than in the mandible. Panoramic radio graphs of a female patient aged 38 years revealed the presence of two impacted bilateral mandibular fourth molars and unilateral supernumerary tooth. The supernumerary teeth had normal tooth morphology with regard to their crowns and roots and were similar to the existing third molars and premolars.
Keywords: Fourth molar, mandibular, supernumerary teeth
|How to cite this article:|
Bhardwaj VK, Vaid S, Negi N, Chug A, Jhingta P, Chauhan A. Occurrence of fourth mandibular molars bilaterally and a supernumerary tooth in premolar region: A rare case. Int J Health Allied Sci 2012;1:197-9
|How to cite this URL:|
Bhardwaj VK, Vaid S, Negi N, Chug A, Jhingta P, Chauhan A. Occurrence of fourth mandibular molars bilaterally and a supernumerary tooth in premolar region: A rare case. Int J Health Allied Sci [serial online] 2012 [cited 2019 Oct 14];1:197-9. Available from: http://www.ijhas.in/text.asp?2012/1/3/197/105088
| Introduction|| |
Supernumerary teeth are present in addition to the normal complement of teeth in permanent/deciduous dentitions.  Their incidence is high in permanent dentition, affects both the gender, but is more common in males, with the male to female ratio of 2:1.  These occur in 0.3-3.8% of the population, out of which 90-98% are seen in the maxilla. These may be present singly or in multiples, unilaterally or bilaterally in the maxilla, the mandible or both and are commonly seen in the incisor region of the maxillary arch.  Supernumerary premolars occur three times more in males than in females, indicating a sex-linked inheritance, with the highest frequency of occurrence in the mandibular premolar region (74%).  Removal of unerupted supernumeraries involves the risk of damage to the adjacent structures, and a decision should be made whether to remove or monitor them. Early surgical intervention is recommended when the supernumerary is causing problems such as extensive resorption of adjacent teeth, hindering the eruption or malposition of permanent teeth.
| Case Report|| |
A 38-years-old female patient reported to the comprehensive oral care clinic, department of public health dentistry with a chief complaint of continuous intense pain in the right and left mandibular angle, radiating to the ear and neck since one and half month. Family, medical and dental histories were non-contributory. On intraoral and extraoral examination, no abnormality was detected. As a part of routine examination, Orthopentomogram radiograph was taken. Radiographic view revealed the presence of additional fourth molars bilaterally in the mandible and impacted supernumerary tooth in relation to #35 [Figure 1],[Figure 2] and [Figure 3].
|Figure 1: Orthopentomogram showing fourth molars and supernumerary tooth|
Click here to view
| Discussion|| |
Bilateral fourth molars and a supernumerary tooth unilaterally in the mandible have been reported very rarely in the literature. Gay, et al. (1999)  have reported a low prevalence between 0.13% and 0.6% for fourth molars. Scheiner, et al. (1997)  revealed that fourth molars generally are radiographic findings and that 93.2% of patients come spontaneously and without associated pathology. Among the complementary tests that are needed to identify a fourth molar, the panoramic radiograph is the first choice for diagnosis. However, this test does not give details and high definition and could be distorted (Hopcraft, 1998; Cortes, et al., 2009). , Orhan, et al. mentioned that supernumerary teeth can be observed as isolated or multiple cases, unilateral or bilateral and in mandible or maxilla. In this report, both the fourth molars were identified isolated and bilaterally in the mandible and supplemental tooth in the left premolar region. Supernumerary teeth reported were more often found in males than in females. Timocin, et al. (1994)  reported a case where it was found in a female patient, contrary to the present report. The reason could be racial, genetic, geographical and environmental factors.
Cortes, et al., (2009)  mentioned that the 95% of cases of supernumerary teeth are impacted similar to the present case. In the case, the crown-root ratio was 1:2 higher than the cases reported by Kokten, et al., (2009)  where it was 1:1.
Qaradaghi, et al., (2009)  states that supernumerary teeth can have normal morphology or may be rudimentary in shape and smaller in size. In present case also, both the fourth molar presented normal morphology, fused roots, and supernumerary tooth in # 35 region was with normal shape and size.
The etiology of supernumerary teeth is ambiguous, with different factors giving rise to different types of supernumeraries and combined etiological factors responsible for same. Various theories have been suggested to explain this phenomenon,  they are:
(1) Atavism or reversion; (2) Heredity; (3) Aberrations during embryologic formation; (4) Progress zone;
(5) Unified etiologic explanation.
- Atavism or reversion: This hypothesis proposes a reversion to an ancestral human dentition, which contained a larger number of teeth.  It has been proposed that a supernumerary premolar may be an atavistic reappearance of the extra premolar of the primitive dentition.
- Heredity: Supernumerary teeth are theorized to result from mutant genes. This is supported by the observation of a greater frequency of supernumerary teeth in patients with maxillofacial anomalies such as:  cleidocranial dysostosis, cleft lip or cleft palate and Gardner's syndrome. It has also been proposed that autosomal inheritance with lack of penetration might also give rise to supernumerary teeth. 
- Aberrations: There are several theories, which are based on aberrations during embryologic formation. They include theory of epithelial remnants, theory of supernumerary dental germs and theory of duplication by dichotomy of tooth germs, theory of additional proliferation of the dental lamina, theory of histochemical disruption. 
- Progress zone: This theory proposed that supernumerary teeth result from the progress zone of the dental lamina in the end of every tooth series. 
- Unified etiologic explanation: This theory suggests a unified etiology for anomalies of tooth number and size. It is based on a multifactorial model that has a continuous scale with thresholds related to a spectrum of tooth number and size. Oehlers suggested that supplemental premolars were formed from an extension of the dental lamina in the region.  He cited that the accessory buds may possibly represent members of post-permanent dentition. Supernumerary teeth usually cause dental abnormalities, except in cases of deeply buried asymptomatic teeth. These teeth should be reviewed periodically.
Supernumeraries generally cause problems of malocclusion of local nature like tipping of adjacent teeth, rotation, bodily displacement, delayed eruption or prevent eruption of tooth of normal series and resorption also. Also, they may lead to esthetic disharmony and functional distortion. 
In this case, the supernumerary premolar has resorbed the roots of #35 and left fourth molar had resorbed the distal root of #38, hence they were extracted, whereas right fourth molar was maintained in situ with regular follow-up.
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[Figure 1], [Figure 2], [Figure 3]