Maxillary Distomolar Associated with Dentigerous Cyst: An Unusual Entity

Edouard Di Donna,Alexandre Perez,Loïc Mahé Keller,Tommaso Lombardi,Annika Neri

doi:10.3390/oral2010001

Abstract

Supernumerary teeth may be encountered as an incidental finding on a radiograph. When impacted, they may be associated with clinical signs related to different problems such as failure of eruption, teeth displacement, root resorption or cystic lesions. They may occur in primary and permanent dentition, in both the maxilla and mandible and can be single or multiple in patients with syndromes. Mesiodens is the most commonly impacted tooth and appears between the central maxillary incisors in pediatric ages. Supernumerary teeth distal to the third molar are rare, usually impacted and referred to as a distomolar. A 46-year-old male consulted with the main complaint of pain on the left side of the maxilla. A panoramic radiograph revealed a right impacted maxillary fourth molar located posterior to the third molar associated with a pericoronal radiolucency. The supernumerary tooth was removed surgically under local anesthesia and the pericoronal lesion enucleated. Histopathological examination was consistent with the diagnosis of a dentigerous cyst associated with an impacted distomolar. Healing was uneventful, and the patients remained asymptomatic. The occurrence of an impacted maxillary distomolar is rare and even rarer the association with a dentigerous cyst.

Highlights

A supernumerary tooth, called hyperdontia, is a medical condition defined by an excess number of teeth, which can be normal or with coronary or radicular malformations [1]
Distomolar teeth may partially or completely erupt, but in 92.7% of cases, they are impacted [2]. They are considered rare, according to the literature, and the prevalence presents geographic variations: Kurt et al [2] reported a prevalence of 0.32% in Turkish populations; Thomas et al found [3] a prevalence of 2.1% in Indian populations among 1000 panoramic radiograph; in Greek populations, Mitsea et al [4] found distomolars’ frequency ranged from 0.84% to 0.95% in the maxilla and from 0.11 to 0.22% in the mandible
The development of a dentigerous cyst associated with an impacted supernumerary tooth is rare, but when it appears, in 90% of cases, it is associated with a mesiodens [6]

Summary

Introduction

A supernumerary tooth, called hyperdontia, is a medical condition defined by an excess number of teeth, which can be normal or with coronary or radicular malformations [1]. According to their locations, supernumerary teeth are categorized differently: mesiodens if located in the middle suture of the upper maxilla, paramalor if situated buccally or palatally to one of the molars and distomolar, known as the fourth molar, if located behind the third molar. The development of a dentigerous cyst associated with an impacted supernumerary tooth is rare, but when it appears, in 90% of cases, it is associated with a mesiodens [6]

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