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PEDIATRIC DENTAL JOURNAL 22(2): 198201, 2012

Case Report

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 Matsudo
2-870-1 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 a
7-year-old patient. An erupted supernumerary molar was found palatal to the
permanent upper right first molar. On computed tomogram examination, four
unerupted molars were clearly identified distal to the permanent upper right
first molar. This dental anomaly is rarely encountered and this may be the first
case in which four supernumerary molars were observed in a quadrant with
no identifiable pathology.

Introduction
Of the anomalies affecting number of teeth, supernumerary central maxillary incisors or mesiodens
are most frequently encountered, followed by supernumerary molars14). The reported frequency of
supernumerary molars is 0.45%4). Supernumerary
molars occur more frequently unilaterally in the
maxilla and are often impacted. There are no
gender differences in presence of supernumerary
molars5) and they can also be seen fused to the third
molar68).
Supernumerary teeth in the molar region are
either paramolars or fourth molars (distomolars)
and are usually rudimentary small teeth. Paramolars
are situated distal to the first molar outside of the
dental arch, and fourth molars, or distomolars, are
found distal to the third molar and generally in line
with the dental arch1). They are not completely
developed with a rudimentary conical shape and
are more often smaller in the maxilla than in the
mandible, in which they are equal to the normal
molars5).
The etiology of supernumerary teeth has yet
* Correspondence to: Takehiko Shimizu

E-mail: shimizu.takehiko@nihon-u.ac.jp

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

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Key words
Supernumerary molar,
Supernumerary tooth,
Tooth anomaly

to be clearly elucidated but genetic factors play


an important role in the occurrence of multiple
supernumerary teeth. Multiple supernumerary teeth
are a feature of certain genetic syndromes like
Cleidocranial dysplasia and Gardners syndrome3)
and are rarely found in patients without such
pathologies.
Here, we describe the clinical and radiological
characteristics of a patient with six molars in one
maxillary quadrant.

Case Report
A 7-year-old Japanese female patient was referred
by her general dental practitioner for removal of
a supernumerary tooth. The patient complained of
food impaction in the permanent upper right first
molar region, probably due to the supernumerary
molar. The patient was healthy and showed none
of the features of syndromes commonly associated
with the presence of supernumerary teeth. There
was no family history of supernumerary teeth.
On oral examination, a supernumerary molar
was found palatal to the permanent upper right first
molar, which was displaced buccally (Fig. 1). The
supernumerary molar had a retrogressive crown with
a mesiodistal diameter of 10mm.

Four supernumerary molarsina maxillary quadrant

199

Fig. 1 Intraoral view of the right side of the maxilla showing the supernumerary molar
located palatal to the first molar

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

On radiographic examination, the orthopantomogram revealed unerupted developing multiple


supernumerary molars in the upper right quadrant
(Fig. 2). The three-dimensional reconstruction of
a computed tomogram (CT) clearly revealed the
presence of four unerupted molars (Fig. 3). Two
of these had small rudimentary crowns and were
located palatal to the permanent upper right second
molar, which was displaced and rotated. Another
molar was observed distal to the permanent upper
right second molar. This tooth was identified as
a supernumerary molar, and not the third molar

because of the young age of the patient. Super


numerary molars appeared clearly separate from
each other and the permanent upper right second
molar on the CT images.
The erupted supernumerary molar was extracted
immediately to solve the problem of dislocation of
the permanent upper right first molar. The extracted
supernumerary molar had three roots with normal
shape (Fig. 4). The permanent upper right first molar
moved in line with the dental arch automatically
three months later. Surgical removal of the unerupted
supernumerary molars is planned after a short

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Shimizu, T., Shimizu, Y., Miyamoto, M. et al.

Fig. 3 Computed tomogram and the three-dimensional (3D) reconstructions showing


supernumerary molars on the right side of the maxilla
A: sagittal section, B: sagittal 3D, C: coronal section, D: coronal 3D,
1: the first molar, 2: the second molar, S: supernumerary molars

follow-up to monitor development of the permanent


upper right second molar and the remaining supernumerary molars.

Discussion

Fig. 4 The extracted supernumerary molar located


palatal to the upper right first molar

A review of the literature revealed that supernu


merary molars are fairly common. Many cases of
non-syndromic fifth molars have been reported1,915).
Among the 53 cases of supernumerary molars presented, 8.3% were maxillary fifth molars1). However
sixth molars, i.e. three supernumerary molars in a
quadrant, are extremely rare. To date, only two such
cases have been reported3,16).
In the present case, six molars in the upper
right quadrant were clearly revealed by CT. These
supernumerary teeth did not include the third molar,
because the crowns of the unerupted supernumerary

Four supernumerary molarsina maxillary quadrant

molars were of the same developmental stage of


calcification as the permanent upper second molar.
Thus, to the best of our knowledge, the present report
is the first case showing four supernumerary molars
in a quadrant with no identifiable pathology.
Supernumerary teeth may cause various complications including delay in eruption of permanent
teeth, crowding, diastema, rotation, resorption of
adjacent teeth or dentigerous cysts17). A supernumerary tooth should be extracted immediately if any of
the above complications are present. In the present
case, extraction of the erupted supernumerary tooth
was reasonable because the permanent upper right
first molar was dislocated. Since normal eruption of
the permanent upper right second molar was clearly
blocked, we plan to surgically remove the unerupted
supernumerary teeth in the near future to enable
normal development of the permanent upper right
second molar.
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