Case

report

Bilateral macrodontia of mandibular second premolars:

a case report

Fuentes, R.* and Borie, E.

Dentistry Department, Universidad de la Frontera, Temuco, Chile

*E-mail: [email protected]

Abstract
Macrodontia is a rare dental anomaly characterized by an excessive enlargement of all tooth structures that
generally could be related with some syndromes. Until today, there is a low prevalence of bilateral macrodontia.
The present report shows a patient with bilateral macrodontia in mandibular second premolars and with a
clear medical history of him and his parents without any syndromes or other dental anomalies. It is important
to know macrodontia because the crown shape of teeth is more predisposed to caries and may cause some
problems in the occlusion of the patient. By the above, is important to acquire a deeper knowledge about this
anatomical variation, as well as must be prepared to perform a carefully treatment of the compromised teeth.
The aim of this study was to describe this case with a bilateral rare condition of interest to dentists.
Keywords: dental anomalies, premolars, crown shape, macrodontia, megadontia.

1 Introduction
The aetiology of dental anomalies remains largely unclear (ALMANDEY, ANTHONAPPA, KING  et  al.,  2010;
(KÜCHLER, RISSO, COSTA  et  al.,  2008), but some KUMAR, PRABHU and CAMERON, 2009; BRANCATI,
anomalies in tooth structure, shape and size results by many D´AVANZO, DIGILIO et al., 2004; MAEGAWA, LEITE,
factors from disorders during the morphodifferentiation stage FÉLIX et al., 2004). Macrodontia of a single tooth is a relatively
of development. (USLU, AKCAM, EVIRGEN et al., 2009; uncommon condition, and frequently have been reported
ALTUG-ATAC and ERDEM,  2007; BASDRA, in mandibular molars or premolars (KUMAR, PRABHU
KIOKPASOGLU, STELLZIG,  2000). Identification of and CAMERON,  2009; NEMES and ALBERTH,  2006).
specific patterns of associated dental anomalies could be related It may affect incisors, third molars and second mandibular
with certain genetic and environmental factors contributing premolars. It last, is characterized by excessive enlargement
to differents dental anomaly subphenotypes (KÜCHLER, of mesiodistal and faciolingual tooth dimensions with an
RISSO, COSTA et al., 2008; DUGMORE, 2001). occlusal crown area increased (GARIB and PECK,  2006).
Some authors have postulated that it is really important Macrodontia can also be seen in pairs (DUGMORE, 2001).
to take care with these anomalies because they could create Some authors have described that macrodontia is most
disturbances in maxillary and mandibular arch lengths and frequently found in incisors and canines (ALMANDEY,
occlusions (ALTUG-ATAC and ERDEM, 2007).
ANTHONAPPA, KING et al., 2010; DUGMORE, 2001);
Macrodontia (or Megadontia) is a rare dental
others reported that are more observed in mandibular
anomaly (DUGMORE,  2001; ROOTKIN-GRAY and
second premolars (ROOTKIN-GRAY and SHEEHY, 2001;
SHEEHY, 2001) characterized by an excessive enlargement
PEKER and KAYAOGLU,  2009). The prevalence of
of all tooth structures and, in few cases, may be associated
macrodontia is  1-2% in males (O´SULLIVAN.,  2000)
with morphological anomalies (GARIB and PECK,  2006;
and 0,9% in females, but macrodontia of mandibular second
DUGMORE,  2001; O´SULLIVAN,  2000). Such anomaly
can be categorized as follows: true generalized (large premolars affect both sexes equally. In the most of cases
percentage of dentition), relative generalized (entire macrodontia in mandibular second premolars have been
dentition), and isolated macrodontia of single tooth reported in children (DUGMORE, 2001). Altug-Atac and
(NEMES and ALBERTH,  2006; DUGMORE,  2001). Erdem (2007) reported in their study that macrodontia of
Multiple macrodontia is strange, but it may be associated maxillary incisor was noted in only 1 female patient and the
with some diseases like insulin-resistant diabetes, otodental prevalence of this abnormality in all patients was calculated
syndrome, or facial hemihyperplasia (PEKER and as 0,03%.
KAYAOGLU, 2009; NEMES and ALBERTH, 2006). Also, It is important to know Macrodontia because it may cause
generalized macrodontia may be produced by hormonal problems with aesthetics and also with crowding if there is a
imbalance, as has been described in pituitary gigantism. discrepancy between the dimensions of the teeth and the size
(NEMES and ALBERTH,  2006; DUGMORE,  2001). of the dental bases (O´SULLIVAN, 2000). Also, these teeth
For example, generalized macrodontia is highly related are more predisposed to caries and related with disruption
with KBG syndrome (when the syndrome was first of the developing occlusion by occlusal morphology
described by Herrmann  et  al. in  1974, they named (DUGMORE, 2001). The aim of this study was to describe
KBG because the initials of affected families’ surnames) this case with a bilateral rare condition of interest to dentists.

212 J. Morphol. Sci., 2011, vol. 28, no. 3, p. 212-215

 Bilateral macrodontia of mandibular second premolars: a case report

2 Case report Clinically, left mandibular second premolar (tooth  3.5)

presented a measure of 8,37 mm bucco-lingually, 9,14 mm
A  22-year-old Chilean man (with  1,65  m of height mesio-distally and a coronal height of 8,27 mm. The right
and 56 kg of weight) was attended for a routine dental check second premolar (tooth 4.5) was bigger than tooth 3.5 and
up. Extra-oral examination revealed no abnormalities. In the presented a measure of 10,6 mm bucco-lingually, 10,89 mm
intraoral examination no caries or periodontal disease was mesio-distally and a coronal height of  5,06  mm (no
noted and the patient presented an Angle class I. However, presented complete eruption until the neck). The crown
it was noticed that both mandibular second premolars was shape of tooth  4.5 had ovoid molariform crown with
enlarged with an abnormal occlusal shape. The patient had multiple cusps and an irregular crater with some great
no history of pain, gingivitis, trauma, pituitary gigantism or fissures (that were sealed) (Figures 1a,b). The crown shape
any other syndrome that could be related with this condition. of tooth  3.5 was very similar with the first left deciduous
The man and his parents had a clear medical history and the mandibular molar (tooth  7.4) with two pits (that were
parents had no similar dental anomalies. A full permanent sealed too) (Figures  2a,b). The patient related too that he
dentition was erupted or developing, including third molars. left naturally the tooth 7.4 and was sure that the tooth 3.5

Figure 1. Lateral and occlusal view of tooth 4.5 with macrodontia. a) Note the ovoid molariform crown with multiple cusps, and
b) an irregular crater with some great fissures (sealed).

Figure 2. Frontal and occlusal view of tooth 3.5 with macrodontia. a) Note the similar shape like tooth 7.4, b) with an enlargement
on mesio-distal way.

J. Morphol. Sci., 2011, vol. 28, no. 3, p. 212-215 213

 Fuentes, R. and Borie, E.

Figure 3. Periapical radiographs showing tooth 4.5 (a) and 3.5 (b). Note the crown with an irregular shape and size of tooth 4.5 (a)
if is compared with tooth 3.5 with a normal size and shape but with a reduced root length (b).

was a permanent tooth. To determine the diagnostic of these must be prepared to perform a carefully treatment planning
anomalies a panoramic and two periapicals radiographs were previously to intervene a tooth with macrodontia, to avoid
taken. unexpected problems during dental treatments procedures
Radiographically, both mandibular second premolars generated by ignorance of morphology of this anatomical
presented single roots. In the periapical radiograph the variation.
tooth 4.5 presented an abnormal size and shape (Figure 3a).
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Received December 20, 2010

Accepted August 22, 2011

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