Scholars Journal of Medical Case Reports ISSN 2347-6559 (Online)

Sch J Med Case Rep 2016; 4(11):879-882 ISSN 2347-9507 (Print)

©Scholars Academic and Scientific Publishers (SAS Publishers)
(An International Publisher for Academic and Scientific Resources) DOI: 10.36347/sjmcr.2016.v04i11.020

A case series of rare variations in impacted permanent molars

Fareedi Mukram Ali1*, Abdul Modysh Bajawi2, Ibrahim Mohammed Gadhan2, Mohammed Ali Kariri2
1
Asst professor, Dept of Oral & Maxillofacial Surgery, College of Dentistry, Jazan University, Jazan, Saudi Arabia
2
Dental Intern, College of Dentistry, Jazan University, Jazan, Saudi Arabia

*Corresponding author
Fareedi Mukram Ali
Email: [email protected]

Abstract: Axial movement of the tooth from the developmental position within the jaw to its functional position in the
occlusal plane is called as eruption of tooth. Failure of the eruption of tooth may be caused by any interference in the
sequential events of eruption or by the pathology of the surrounding bone. This can lead to the aberrant eruption pattern
or ectopic eruption of the tooth. Impacted tooth therefore can be abnormal, non-functional or pathological. However,
some teeth are rarely impacted or some patterns of impaction are rarely seen. The present case series reports ectopic
eruption of the permanent molars with rare presentations.
Keywords: Ectopic eruption, Impaction, Permanent molars.

INTRODUCTION mandibular second molar. There is supraeruption of the

Impacted tooth is defined as the tooth which maxillary first permanent molar of the left side. Also,
cannot erupt into its normal functioning occlusal both sided maxillary third molars were found to be
position and is pathologic and therefore require impacted below the cervical levels of the second
treatment. The impaction of permanent teeth commonly molars.
occurs in the descending order of third molars, followed
by maxillary canines, mandibular premolars, CASE 2
mandibular canine, maxillary premolars, maxillary A 21 year old male patient came with a
central incisors, and mandibular second molars. First complaint of pain at the maxillary right posterior of jaw
permanent mandibular molars and permanent maxillary since 2 to 3 months. On clinical examination deep
second molars are rarely impacted [1-3]. pocket was present between permanent second premolar
and first permanent molar. Also, missing third molar
Interference in the natural process of eruption was found on both right and left side. In radiographical
can lead to impaction of tooth and can lead also lead to examination, both the right and left side permanent
arch length deficiency or other consequences in future maxillary third molars were impacted deeply in
[1, 4]. maxillary bone with uncommon angulations. (Fig. 4)

Here we report a case series of permanent CASE 3

molars with rare impaction patterns. Ectopic eruptions A 22 year old male patient came with a
of the third molar are rare and impactions of first and complaint of pain at the right side mandibular posterior
second molars are infrequent. However, we report a region since 1 to 2 months. On clinical examination,
case of first molars impacted, deep maxillary third only small portion of the crown of permanent
molar impaction, horizontal impaction, distoangular mandibular third molar was visible. On radiological
impaction and impacted distomolar and paramolars. examination, both sided mandibular third molars were
horizontally impacted. Also, in the maxillary arch, on
CASE REPORT left side, 2 supernumerary teeth were present. One was
CASE 1 paramolar visible in the oral cavity behind the
A 19 year old male patient came with a permanent first molar and the second was distomolar
complaint of minimally visible tooth in the left impacted between second and third molar. (Fig.5)
mandibular posterior region. On examination impacted
permanent mandibular first molar was seen. (Fig.1) In CASE 4
radiological examination, distoangular impacted A 24 year old male patient came with a
mandibular first permanent molar was visible with complaint of pain at the maxillary left posterior region
typical curvature of root in 180 degree. (Fig. 2 and 3) since 2 months. On radiographical examination, it was
The occlusal surface of the first molar was slopping found that both sided maxillary third molars were
distally and was below the cervical margin of the impacted distoangularly. Also, supernumerary molar

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Fareedi Mukram Ali et al.; Sch J Med Case Rep, Nov 2016; 4(11):879-882

was found on the distal of the left permanent maxillary third molar. (Fig.6)

Fig-1: Clinical photograph of the patient showing impacted permanent mandibular first molar of left side.
(Case 1)

Fig-2: OPG showing impacted permanent mandibular first molar of left side with typical 180 degree curvature of
the root. Impacted maxillary third molars were also seen. (Case1)

Fig-3: IOPA showing impacted permanent mandibular first molar with 180 degree angulation of the root.
(Case 1)

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Fareedi Mukram Ali et al.; Sch J Med Case Rep, Nov 2016; 4(11):879-882

Fig-4: OPG showing deep maxillary impaction of the permanent maxillary third molars of the right and left side.
(Case 2)

Fig-5: OPG showing horizontally impacted permanent mandibular third molars and presence of supernumerary
teeth, paramolar (impacted) and distomolar in the maxillary left side. (Case 3)

Fig-6: OPG showing presence of distoangularly impacted all permanent third molars with presence of impacted
distomolar in the maxillary left side.(case 4)

DISCUSSION Permanent first molars are key teeth in the

Permanent first and second molars are less occlusion and it is essential that their delayed eruption
commonly impacted, with the prevalence of 0.08% for be guided to the correct position in the dental arch [5].
the permanent maxillary second molar, 0.02% for the
permanent maxillary first molar and 0.01% for Reasons for the impaction of the permanent
permanent mandibular first molar [1, 9]. molars other than third molars are ectopic eruption and
it may cause resorption of distal root of deciduous
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Fareedi Mukram Ali et al.; Sch J Med Case Rep, Nov 2016; 4(11):879-882

molars or even premature exfoliation of the same. The identification of the ectopically erupted teeth is highly
causes for impaction can be systemic and local [1, 6]. important in view of the pathology associated.

 Systemic causes includes [1, 6, 7]: REFERENCES

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In choosing a treatment plan for multiple

impacted molars the decision-making process must be
handled very cautiously as a result of the uncertain
etiology, the lack of standard therapy, and the paucity
of cases reported [1, 9].

Due to the low prevalence of impaction of the

first and second permanent molars, there is a lack of
uniformity in the management of these impacted teeth,
and published reports are mostly based on case reports
and mesially inclined molars [9].

CONCLUSION
Clinical and radiological investigations of
patients revealed some interesting findings. The

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