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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 2  |  Page : 125-127

Fusion of multiple impacted supernumerary teeth with maxillary third molar - A rare case report


Department of Dentistry, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Date of Submission24-Dec-2020
Date of Acceptance16-Jan-2021
Date of Web Publication22-Mar-2021

Correspondence Address:
Rita Rai
Department of Dentistry, Dayanand Medical College and Hospital, Ludhiana - 141 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_224_20

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  Abstract 


Fused supernumerary teeth are an uncommon finding. Fusion is an abnormality of tooth development. It is common in the lower anterior but rare in maxilla. Supernumerary teeth are additional teeth in normal series, occurring with a frequency of 0.3%–3.8% in population. The frequency of fusion of a permanent tooth with a supernumerary is <1% of cases and usually involves maxillary anterior teeth. Panoramic radiograph revealed a radiopaque mass in periapical region associated with maxillary third molar. The findings were suggestive of impacted supernumerary teeth. This case is an example of a rare phenomenon of fused multiple impacted supernumerary teeth in maxillary third molar area.

Keywords: Fusion, impacted teeth, maxillary third molar, supernumerary teeth


How to cite this article:
Rai R, Kaura S, Bhardwaj S, Satia G, Budhiraja N. Fusion of multiple impacted supernumerary teeth with maxillary third molar - A rare case report. Indian J Dent Sci 2021;13:125-7

How to cite this URL:
Rai R, Kaura S, Bhardwaj S, Satia G, Budhiraja N. Fusion of multiple impacted supernumerary teeth with maxillary third molar - A rare case report. Indian J Dent Sci [serial online] 2021 [cited 2021 Apr 20];13:125-7. Available from: http://www.ijds.in/text.asp?2021/13/2/125/311686




  Introduction Top


Fused supernumerary teeth are an uncommon finding. Fusion is an abnormality of tooth development, defined as the union at the enamel, dentin and cementum or pulp level during different stages of odontogenesis of two or more separately developing contiguous tooth germs.[1] It is common in the lower anterior, but rare in maxilla and found in both sexes.[2] They are more commonly found in the deciduous (0.5%) than in permanent dentition (0.1%).[3] However, the etiology of fusion is still unknown.

Supernumerary teeth are additional teeth in normal series, more commonly seen in the maxillary anterior region.[4] They are considered uncommon, occurring with a frequency of 0.3%–3.8% in a population. Supernumerary molars when present occur more commonly in the maxilla, i.e., 79.7% and frequently are impacted (88.7%) and found bilaterally present (23.9%).[5] Single supernumeraries occur in 76-86% of cases, double supernumeraries in 12%–23% of cases, and multiple supernumeraries in <1% of cases.[6] The conditions commonly associated with an increased prevalence of supernumerary teeth include cleft lip and palate, cleidocranial dysplasia, and Gardner syndrome.[4],[5],[6] Supernumerary tooth can be fused to either a normal erupted or an impacted tooth.[5] The frequency of fusion of a permanent tooth with a supernumerary is <0.1% of cases and usually involves maxillary anterior teeth.[7] These fused teeth tend to cause spacing and alignment problems. Herein, we present a rare case of unilateral fusion of maxillary third molar with impacted three supernumeraries.


  Case Report Top


A 40-year-old male patient reported to the Dental Department, DMC and H, Ludhiana, with the chief complaint of atypical pain in temporomandibular join (TMJ) on left side. On history taking, he had a dull aching pain on left side of maxilla in the area of TMJ for the past 1 year. He developed radiating pain since 1 week and had been taking antibiotics and analgesics. He was advised an orthopantogram by his dentist and referred to a tertiary care center. On radiographic examination, a radiopaque mass in periapical region associated with left maxillary third molar was noted, with characteristics suggestive of a supernumerary tooth or a cementoblastoma. [Figure 1] He complained of discomfort on opening his mouth. On clinical examination, all molars were fully erupted and well aligned. The patient had no swelling and redness of the gingiva. There was no history of systemic disease. Palpation revealed painful vestibulum oris in the area of roots of maxillary left third molar. However, it was not possible to determine the boundary between tooth and the incidental finding. Therefore, in order to arrive at a differential diagnosis, a Cone beam computed tomography (CT) maxilla was performed (Carestream cs3d9000 machine with a field of view of 5 cm × 5 cm). [Figure 2] Cone beam CT image showed 3 impacted teeth lying apical to 28 tooth and all teeth appeared to be fused to each other.[Figure 3] One tooth coronal part was seen positioned mesially, other palatally and third buccally. [Figure 4] Floor of maxillary sinus appeared to be intact. The findings were suggestive of impacted supernumerary teeth. The patient was informed of the existing condition and surgical extraction of left maxillary third molar along with fused supernumerary teeth was advised.
Figure 1: Orthopantomogram of the patient

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Figure 2: Cone beam computed tomography maxilla left side

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Figure 3: Cone beam computed tomography maxilla right side

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Figure 4: Cone beam computed tomography maxilla

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Figure 5: Mesio-distal dimension

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Figure 6: Bucco-lingual width

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Figure 7: Incisal-apical distance

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Under local anesthesia, standard surgical procedure for the extraction of upper left third molar was performed. After surgical extraction, the patient was advised antibiotics (Amoxicillin and Clavulanic acid 625 mg twice daily) and analgesics (Aceclofenac [100 mg], Paracetamol [500 mg] thrice daily) for 5 days. The patient was explained postextraction instructions and asked to report for follow-up after 1 week. On clinical examination, wound healing was normal. The postoperative healing course was successful without any swelling.


  Discussion Top


Dental anomalies occur during the embryological and developmental life of the tooth.[8] Fusion of molar teeth with supernumerary teeth is particularly unique. Etiology of fusion is not fully known. Shafer, Hine and Levy indicate that some physical force or pressure produce contact of the developing teeth and their subsequent fusion.[4] Hou states the occurrence of tooth fusion mainly in primary dentition and considers the occurrence of their anomaly in permanent dentition to be rare. He has reported of fusion of third upper molar with a supernumerary fourth molar.[9] Kim et al. reported an incidence of about 0.1% in the permanent and 0.5% in primary dentition.[10] Fused teeth have predilection for mandible over maxilla, unilateral (0.05%), over bilateral (0.02%), and deciduous (0.5%), over permanent dentition (0.1%).[8]

Supernumerary teeth may erupt normally, remain impacted, appear inverted, or assume an abnormal path of eruption. Only 13%–34% of all permanent supernumerary teeth erupt normally as compared with 73% of primary supernumerary teeth. The rest remain unerupted and may produce complications.[11] Fusion of permanent and supernumerary teeth usually occurs in anterior region of the maxilla. However, fusion involving molars are rarely reported. Gunduz et al. describe the rare anomaly of the fusion of the third mandibular molar with the supernumerary molar.[12]

Fused teeth are majorly asymptomatic. However, fusion may cause clinical problems related to aesthetics, spacing, periodontal complications, and complicated extractions as reported by Mader.[13] In the case reported, patient had atypical pain in the affected area which increased more on opening his mouth. After his radiographic and clinical assessment, surgical extraction was advised.

The differentiation between fusion and gemination in the permanent dentition when supernumerary teeth may be involved is difficult. Anomalies of dentition pose diagnostic and treatment challenges to the practitioners. A thorough clinical, radiographic evaluation is required before any treatment strategy is planned. The case reported herein, also cites the occurrence of rare anomaly of fusion of maxillary third molar with three impacted supernumeraries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.



 
  References Top

1.
Kumar A, Wadhwani P, Ali IT. Fused mandibular third molar with supernumerary tooth: A rare case report. Indian J Oral Sci 2015;6:26-9.  Back to cited text no. 1
  [Full text]  
2.
Mitate E, Kawano S, Mikami Y, Kiyoshima T, Ikebe T, Nakamura S. A case of inversely fused tooth of impacted maxillary third molar and supernumerary tooth. Int J Case Rep Images 2017;8:129-32.  Back to cited text no. 2
    
3.
Babaji P, Prasanth MA, Gowda AR, Ajith S, D'Souza H, Ashok KP. Triple teeth: report of an unusual case. Case Rep Dent 2012;2012:735925.  Back to cited text no. 3
    
4.
Shafer WG, Hine MK, Levy BM. A textbook of oral pathology. 7th ed. New Delhi: Elsevier; 2012. p. 41-8.  Back to cited text no. 4
    
5.
Faqeeh MA, Absi FS, Alrefai MA, Ali FM. A case report of bilateral impacted mandibular fourth molars. Int J Contemporary Med Res 2017;4:2306-7.  Back to cited text no. 5
    
6.
Nayak G, Shetty S, Singh I, Pitalia D. Paramolar-A supernumerary molar: A case report and an overview. Dent Res J (Isfahan) 2012;9:797-803.  Back to cited text no. 6
    
7.
Moreira DD, Vaz SL, Melo SL, Freitas DQ. Unusual Fusion Of A Distomolar With A Third Molar Assessed By Cone Beam Computed Tomography. Stomatos 2014;20:12-17.  Back to cited text no. 7
    
8.
Sultan N. Incidental finding of two rare developmental anomalies: Fusion and dilaceration: A case report and literature review. J Nat Sci Biol Med 2015;6:S163-6.  Back to cited text no. 8
    
9.
Hou GL, Tsai CC. Fusion of maxillary third and supernumerary fourth molars. Case report. Aust Dent J 1989;34:219-22.  Back to cited text no. 9
    
10.
Kim SY, Choi SC, Chung YJ. Management of the fused permanent upper lateral incisor: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:649-52.  Back to cited text no. 10
    
11.
Rajab LD, Hamdan MA. Supernumerary teeth: Review of the literature and a survey of 152 cases. Int J Paediatr Dent 2002;12:244-54.  Back to cited text no. 11
    
12.
Gunduz K, Sumer M, Sumer AP, Gunhan O. Concrescence of a mandibular third molar and a supernumerary fourth molar: Report of a rare case. Br Dent J 2006;200:141-2.  Back to cited text no. 12
    
13.
Mader CL. Fusion of teeth. J Am Dent Assoc 1979;98:62-4.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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