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PEDIATRIC DENTAL JOURNAL 22(2): 198–201, 2012

Four supernumerary molars in one maxillary quadrant:A case report

Takehiko Shimizu *, Yoko Shimizu, Momoe Miyamoto and Takahide Maeda

Department of Pediatric Dentistry, Nihon University School of Dentistry at Matsudo2-870-1 Sakaecho-Nishi, Matsudo, Chiba 271-8587, JAPAN

Abstract Multiple supernumerary molars are an uncommon occurrence.In this case report, six molars were observed unilaterally in the maxilla of a7-year-old patient. An erupted supernumerary molar was found palatal to thepermanent upper right rst molar. On computed tomogram examination, fourunerupted molars were clearly identied distal to the permanent upper rightrst molar. This dental anomaly is rarely encountered and this may be the rstcase in which four supernumerary molars were observed in a quadrant withno identiable pathology.

to be clearly elucidated but genetic factors playan important role in the occurrence of multiplesupernumerary teeth. Multiple supernumerary teethare a feature of certain genetic syndromes likeCleidocranial dysplasia and Gardner’s syndrome 3) and are rarely found in patients without suchpathologies.

Here, we describe the clinical and radiologicalcharacteristics of a patient with six molars in onemaxillary quadrant.

Case Report

A 7-year-old Japanese female patient was referredby her general dental practitioner for removal ofa supernumerary tooth. The patient complained of

food impaction in the permanent upper right rstmolar region, probably due to the supernumerarymolar. The patient was healthy and showed noneof the features of syndromes commonly associatedwith the presence of supernumerary teeth. Therewas no family history of supernumerary teeth.

On oral examination, a supernumerary molarwas found palatal to the permanent upper right rstmolar, which was displaced buccally (Fig. 1). Thesupernumerary molar had a retrogressive crown witha mesiodistal diameter of 10 mm.

Introduction

Of the anomalies affecting number of teeth, super-numerary central maxillary incisors or mesiodensare most frequently encountered, followed by super-numerary molars 1–4) . The reported frequency ofsupernumerary molars is 0.45% 4). Supernumerarymolars occur more frequently unilaterally in themaxilla and are often impacted. There are nogender differences in presence of supernumerarymolars 5) and they can also be seen fused to the thirdmolar 6–8) .

Supernumerary teeth in the molar region areeither paramolars or fourth molars (distomolars)and are usually rudimentary small teeth. Paramolarsare situated distal to the rst molar outside of the

dental arch, and fourth molars, or distomolars, arefound distal to the third molar and generally in linewith the dental arch 1). They are not completelydeveloped with a rudimentary conical shape andare more often smaller in the maxilla than in themandible, in which they are equal to the normalmolars 5).

The etiology of supernumerary teeth has yet

Key wordsSupernumerary molar,Supernumerary tooth,Tooth anomaly

* Correspondence to: Takehiko ShimizuE-mail: [email protected]

Received on February 9, 2012; Accepted on March 26, 2012

Case Report



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On radiographic examination, the orthopanto-

mogram revealed unerupted developing multiplesupernumerary molars in the upper right quadrant(Fig. 2). The three-dimensional reconstruction ofa computed tomogram (CT) clearly revealed thepresence of four unerupted molars (Fig. 3). Twoof these had small rudimentary crowns and werelocated palatal to the permanent upper right secondmolar, which was displaced and rotated. Anothermolar was observed distal to the permanent upperright second molar. This tooth was identied asa supernumerary molar, and not the third molar

because of the young age of the patient. Super-

numerary molars appeared clearly separate fromeach other and the permanent upper right secondmolar on the CT images.

The erupted supernumerary molar was extractedimmediately to solve the problem of dislocation ofthe permanent upper right rst molar. The extractedsupernumerary molar had three roots with normalshape (Fig. 4). The permanent upper right rst molarmoved in line with the dental arch automaticallythree months later. Surgical removal of the uneruptedsupernumerary molars is planned after a short

Fig. 1 Intraoral view of the right side of the maxilla showing the supernumerary molarlocated palatal to the rst molar

Fig. 2 Orthopantomogram showing the maxillary supernumerary molar on the right side

FOUR SUPERNUMERARY MOLARS IN A MAXILLARY QUADRANT



201FOUR SUPERNUMERARY MOLARS IN A MAXILLARY QUADRANT

molars were of the same developmental stage ofcalcication as the permanent upper second molar.Thus, to the best of our knowledge, the present reportis the rst case showing four supernumerary molarsin a quadrant with no identiable pathology.

Supernumerary teeth may cause various compli-cations including delay in eruption of permanentteeth, crowding, diastema, rotation, resorption ofadjacent teeth or dentigerous cysts 17). A supernumer-ary tooth should be extracted immediately if any ofthe above complications are present. In the presentcase, extraction of the erupted supernumerary toothwas reasonable because the permanent upper rightrst molar was dislocated. Since normal eruption ofthe permanent upper right second molar was clearlyblocked, we plan to surgically remove the uneruptedsupernumerary teeth in the near future to enable

normal development of the permanent upper rightsecond molar.

References

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