CASE REPORT |
https://doi.org/IJCPD863_test |
Pediatric Molar Hyperdontia: A Descriptive Case Report
Corresponding Author: Sangeetha P Venkatesh, Department of Dentistry, Royal Oman Police Hospital, Muscat, Oman, Phone: +96892405713, e-mail: sangeevenu@gmail.com
ABSTRACT
Background: Hypergenetic molars are uncommon in children and adolescents. Furthermore, the presence of multiple eumorphic supernumerary molars (SNMs) in children is sporadic. The author, therefore, reports a nonsyndromic case of multiple supplemental SNMs in a child.Case description: A ten year old boy primarily complaining of cheek biting was found to have six molars on the maxillary left quadrant. Following investigations and case discussion, four molars and fibroma were surgically removed under general anesthesia.Discussion: This paper discusses the prevalence and management of SNMs in the pediatric population while documenting the first case of multiple eumorphic SNMs in the mixed dentition.
How to cite this article: Venkatesh SP. Pediatric Molar Hyperdontia: A Descriptive Case Report. Int J Clin Pediatr Dent 2023;16(5):763–768.
Source of support: Nil
Conflict of interest: None
Keywords: Case report, Distomolar, Fibroma, Paramolar, Primary molars, Supernumerary molars
INTRODUCTION
Supernumeraries (SPNs) in the molar region are called supernumerary molars (SNMs). SNMs are uncommon, solitary, unilateral, and rudimentary structures. The SNM may appear as a tooth fused with the wisdom tooth or its additional cusp in its residual form. However, eumorphic SNMs are rare. Furthermore, multiple SNMs in the supplemental form are extremely rare.1
Supernumerary molars (SNMs) are of two types—paramolars and distomolars. Paramolars are usually located buccal or palatal or in the interproximal space of the molars.2 While the distomolar (fourth molar/retromolar) is distal or distolingual to the third molar.3 Nevertheless, reports of the fifth, sixth, and seventh SNMs are published.4–7
Supernumerary molars (SNMs) are uncommon in the pediatric population. Trenouth and Bedi,8 Park et al.,9 and Shimizu et al. 10 have documented SNMs in the primary dentition, and El-Bahannasawy11 reported a case of concomitant hypo-hyperdontia (CHH) with SNM in the mixed dentition. However, the permanent dentition of adolescents exhibits more SNMs than the primary and mixed dentition12 (Tables 1 and 2).
| Author | Year | Age/sex | Arch | Number | Morphology | Location |
|---|---|---|---|---|---|---|
| Trenouth and Bedi8 | 1963 | 9/M | Mx | Solitary unilateral | Supplemental with successional unerupted supernumerary | Erupted |
| Scheiner and Sampson49 |
1996 | 16/M | Mx | Bilateral | Conical | Erupting |
| Shimizu et al.10 | 2007 | 4.1/F | Mx | Solitary unilateral | Supplemental first primary molar with the permanent supernumerary successor | Primary second molar region |
| Harris and Clark72 | 2008 | 12–18 years; 11 M/seven F | Mx/Md | 20/8 | Distomolars | – |
| Ferrés-Padró et al.74 | 2009 | 5–19 years; 51 M/28 F | Mx/Md | 5/2 | Distomolars/paramolars | – |
| Park et al.9 | 2010 | 4.3 years/F | Mx | Solitary unilateral | Supplemental primary molar | |
| Nagaveni et al.12 | 2010 | 11/F | Mx | Solitary unilateral | Rudimentary paramolar |
Erupted buccally between first and second molar |
| Arikan et al.71 | 2013 | 3–16 years; 48 M | Md | Two unilateral | One conical; four tuberculate paramolar |
Unerupted |
| 3–16 years; 26 F | Three bilateral | |||||
| Kariya et al.70 | 2014 | 15/M | Mx/Md | Bilateral | Paramolars and distomolars | Two erupted-Mx/two partially erupted-md |
| Vlaykov et al.69 | 2015 | 12/F | Md | Unilateral | Distomolar | Impacted |
| Nirmala and Tirupathi42 | 2016 | 13/F | Mx | Bilateral | Rudimentary paramolar (right) Distomolar (left) |
Impacted |
| Singhal et al.7 | 2017 | 12/F | Md | Unilateral multiple | Fourth, fifth, sixth, and seventh supplemental molars | Impacted |
| Ribeiro75 | 2017 | 13/F | Mx/Md | Bilateral multiple | Supplemental molar (one in each quadrant) | Impacted |
| Chandna et al.73 | 2017 | 15/F | Mx | Bilateral | Rudimentary paramolar |
Erupted |
| Jaiyeoba and Ifesanya65 | 2018 | 15/M | Mx/Md | Four bilateral | Tuberculate distomolar | Unerupted |
| 14/M | Md | Bilateral | Supplemental distomolar | Unerupted | ||
| Mx | Solitary | |||||
| 12/F | Mx | Bilateral | Supplemental distomolar |
Unerupted |
| SNMs | Paramolars | Distomolars | ||
|---|---|---|---|---|
| Prevalence | 0.036–0.13%10,12,46–49 0.09–0.29%50 Females > males23,54 |
0.03–2.1%17,24,57,61 Males > females17,57,59 Males = females17,57 |
||
| Morphology | Heteromorphic > eumorphic19 Conical > tuberculate > supplemental23,46 Tuberculate > supplemental54,56 |
Heteromorphic > eumorphic17,24,58 Peg, conical, tuberculate, molariform57,59 |
||
| Location Maxilla/mandible |
Mandible > maxilla48,49,52 Maxilla > mandible23,53,54 Maxilla = mandible56 |
Maxilla > mandible17,57 | ||
| Right/left | Right < left23,54 | Right > left59; left < right; right = left17,58,59,61 | ||
| Unilateral/bilateral | Unilateral > bilateral23,55 | Unilateral > bilateral17,57,58 | ||
| Solitary/multiple | Solitary > multiple23,55 | Solitary > multiple64,65 | ||
| Position in the arch | Between FPM and SPM < between SPM and TPM12,47,49 | Distal or distolingual to TPM64–68 | ||
| Eruption status | Erupted > partial/completely impacted23 | Erupted < partial/completely impacted17,43,57,58,62 Erupted > partial/completely impacted24,63 |
||
*FPM, first permanent molar; SPM, second permanent molar; TPM, third permanent molar
Only one case of nonsyndromic sporadic multiple eumorphic SNMs in the mandibular left quadrant is documented in the pediatric age group.7 Hence, the authors report a sporadic case of multiple supplemental SNMs in the maxillary left quadrant of a 10-year-old male child, who primarily reported cheek biting of a left buccal swelling. This article tabulates the prevalence of pediatric molar hyperdontia.
CASE DESCRIPTION
Case Presentation
A 10-year-old boy and his father sought treatment at the Department of Dentistry for extra growth on the left cheek inside the mouth. The child complained that the growth was interfering with his bite. Medical, family, and social histories were noncontributory.
Clinical Assessment
An intraoral, nonpainful, and moderate solitary pedunculated growth was observed at the occlusal level of the left cheek. The left maxillary posterior sextant was crowded with three molars morphologically similar to the permanent first molar—a molar in buccoversion, a molar palatal, and a molar distal to them. Extraoral findings were not relevant (Figs 1A and B).
Fig. 1A and B: (A) Preoperative (pre-op)—buccal fibroma; (B) Pre-op—occlusal view of maxillary right quadrant
Radiographic Assessment
An orthopantamogram (OPG) (Fig. 2A) revealed six permanent molars in the left maxillary sextant; three erupted and three unerupted. The dental development in all other quadrants was appropriate for the child’s chronologic and dental age. A cone-beam CT was ordered to evaluate the accurate locations of supernumerary teeth and their spatial relationships with neighboring structures and adjacent teeth (Figs 2A and B).
Figs. 2A and B: (A) Orthopantomogram (2 years post-op OPG); (B) CBCT (pre-op)
Treatment Plan
Extraction of all three erupted molars and one unerupted (most accessible and displaced) molar was planned under general anesthesia. Parental consent was obtained for the treatment.
Treatment and Follow-up
All three erupted molars and one unerupted molar distal to the last erupted molar were extracted, and the fibroma was excised under general anesthesia. Postoperative recovery was uneventful. After 2 years, OPG was repeated (Fig. 3).
Fig. 3 Pre-op OPG
DISCUSSION
Supernumeraries (SPNs), also known as hyperdontia, are developmental aberrations during odontogenesis. An excessive number of teeth, which may be normal or associated with coronary or radicular problems, characterizes it.13 They might appear before birth or as late as 10 years of age.14 In various groups, the prevalence of supernumerary teeth in permanent dentition ranges between 0.5 and 5.3%, and deciduous teeth range between 0.2 and 0.8%.15–17 The occurrence of supernumerary teeth was greater (approximately 1.28–2.4%) in studies that mainly included youngsters, primarily in the premaxillary region. However, a smaller percentage (1%) was reported in research that looked at older age groups (adults), which was mainly in the maxilla and posterior parts of the dental arch.18
Single or multiple SPNs are possible. A single SPN is found in 76–86% of instances and two SPNs in 12–23%. Despite this, only 1% of cases (that is, more than three) had multiple SPNs.19–21 Multiple hyperdontia is uncommon in people who have no other disorders or syndromes. The mandibular and premolar areas have the most nonsyndromic multiple SPNs, followed by the anterior and molar regions.4,22
The prevalence of SNMs ranges from 0.18 to 0.33%.23,24 SNMs are of two types—paramolars and distomolars. They can be eumorphic or rudimentary. The eumorphic SNMs arise from the lingual extension of an additional tooth bud, while the rudimentary form occurs due to the proliferation of epithelial remnants of the dental lamina that are, in turn, induced by the pressure of the complete dentition.25–27 The permanent supernumerary teeth developing as supplemental teeth after the permanent teeth are thought to represent a third dentition. Reduplication of SNPs yields their respective successors. SNMs can develop before the primary dentition (predeciduous), contemporary to the deciduous/mixed/permanent teeth, or after the permanent dentition (postpermanent dentition, also called late-developing SPNs)14 (Table 2).
Ooe27 reported a case of a tooth germ between the first and second primary molars of a 5-month-old fetus, but at this stage, it appeared only as a thickening of the dental lamina. Leche28 reported a tooth germ in the cap stage in a 3-month-old infant located between the upper primary canine and the first primary molar. Whether this tooth would have developed into a primary canine or a first molar is unknown. To date, only two cases of primary SNM in the primary dentition. One case of primary SNM with reduplication in the mixed dentition has been reported.8–11 Only one case of nonsyndromic multiple eumorphic SNMs in the mandibular left quadrant in an adolescent is documented.7 Likewise, the current case has multiple SPN supplemental molars in the left maxillary quadrant.
Panoramic radiography has long been used to detect and diagnose extra teeth. These radiographic images do not assess the precise location of a supernumerary tooth and its spatial interactions with nearby structures and adjacent teeth, which is crucial for treatment planning. For determining, analyzing, and planning SPN treatment based on precise three-dimensional information about the type, shape, and position of the SPN and local aberrations and root resorption of adjacent permanent teeth, cone-beam computed tomography (CBCT) is recommended.12 The radiation dose used in CBCT is frequently higher than that used in conventional radiography. This is a cause for concern among children, so ALADAIP principles should be prioritized in optimization (as low as diagnostically acceptable, indication-oriented, and patient-specific). This has prompted more efforts to adjust doses and justify using CBCT in pediatric dentistry. Hence, rational use of low-dose CBCT is being advocated in the pediatric population.29,30
Supernumerary molars (SNMs)—like structures such as the paramolar tubercle/bolk cusp, formation supradentalis, formation paradentalis, and the fused supernumerary tooth should be ruled out in the differential diagnosis.12,31
Supernumeraries (SPNs) with a normal orientation will usually erupt. Compared to 73% of primary SPNs, only 13–34% of all permanent SPNs erupt.20 The position of impacted or erupted SPNs may remain unchanged for many years without causing any clinically discernible problems. SNMs may erupt normally, remain impacted, appear inverted, or assume an abnormal eruption path. However, they may cause carious and/or periodontal breakdown, impaction of permanent teeth, the delayed or ectopic eruption of adjacent teeth, dilaceration, delayed or abnormal root development of associated permanent teeth, and root resorption of adjacent teeth, pulp necrosis20,32–35 cyst formation with bone loss.20,36 The prevalence of dentigerous cysts with SPNs is 1–9.9%. Adenomatoid odontogenic tumor with multiple impacted SPNs is also reported. However, ameloblastoma with dental follicles of SPN is rare. To date, only four cases of dentigerous cysts associated with SNM are documented.37
Supernumerary molars (SNMs) can migrate to the maxillary sinus or hard palate, may impinge on nerves, leading to paresthesia and/or pain, or reduplicate (late-forming SPNs).34,38,39 It can cause malocclusions like crowding or be an impediment in treatment like incomplete space closure during orthodontic treatment,40,41 jeopardizing the implant sites and complicating alveolar bone grafting. Buccally positioned SNMs cause traumatic bite with laceration of the buccal mucosa.42 Similarly, in the present case, the crowded left maxillary posterior quadrant had caused cheek biting on the left side, resulting in traumatic/irritation fibroma at the line of occlusion.
The presence of SNMs in the developing occlusion of a child patient may make it difficult to intervene or call for aggressive treatment later. Surgical removal of impacted SPNs may not be required unless there is a risk of developing complications or is associated with a pathological condition. Proponents have advocated delayed surgical removal of SPNs within the proximity of permanent teeth as they can interfere with root development. However, if early removal is necessary, it must be accompanied by an adequate clinical and radiographic diagnosis and sound surgical intervention with effective behavior management. SPN management decision-making systems assist practitioners in making treatment decisions, such as removing the supernumerary tooth and, in some cases, the retention of impacted or erupted SPNs with no functional or esthetic complications.43,44
When a supplemental tooth emerges, it may not be easy to distinguish which tooth is extra and which is of the regular dental series.45 It is reasonable to remove the most displaced tooth from the line of the arch to alleviate crowding.41 In this case, all three erupted molars and one unerupted distomolar were extracted to avoid a future surgical procedure due to the potential reduplication of SNM. The fibroma was excised under general anesthesia with histopathological confirmation.
CONCLUSION
-
Supernumerary molars (SNMs) are relatively uncommon clinical entities in the pediatric population.
-
Majority of SNMs can cause clinical complications.
-
A prompt diagnosis and rationally tailored treatment minimize complications.
-
It is vital to reduce their impact as soon as possible and establish proper occlusion of adjacent permanent teeth.
ACKNOWLEDGMENT
For constant support and encouragement, author would like to thank Brigadier Dr Abdul Malik Al Kharusi-Director General-DGMS; Senior Consultant in Cardiology, Colonel Dr Nasser Al Mantheri-Assistant Director-DGMS; Senior Consultant in Orthodontics, Dr Lamees Al Lawatiya; Consultant in Prosthodontics, HOD-Department of Dentistry, (Retd) Dr Arvind Dogra-Senior Consultant in Oral and Maxillofacial Surgery and Dr Sriram Krishanan-Specialist in Oral and Maxillofacial Surgery @Royal Oman Police Hospital, Muscat, Oman.
REFERENCES
1. Rahnama M, Szyszkowska AM, Puławska M, et al. A rare case of retained fourth molar teeth in maxilla and mandible. Case report. Curr Issues Pharm Med Sci 2014;27(2):118–120. DOI: 10.2478/cipms-2014-0028
2. Dubuk AN, Selvig KA, Tellefsen G, et al. Atypically located paramolar. Report of a rare case. Eur J Oral Sci 1996;104:138–140. DOI: 10.1111/j.1600-0722.1996.tb00058.x
3. Kakolewska-Maczyñska J, Zyszko A. Paramolar and distomolar teeth. Czas Stomatol 1990;43(4):232–237.
4. Yusof WZ. Non-syndrome multiple supernumerary teeth: literature review. J Can Dent Assoc 1990;56(2):147–149.
5. Anemone RL, Watts ES. Dental development in apes and humans: a comment on Simpson, Lovejoy and Meindl (1990). J Hum Evol 1992;22(2):149–153.
6. Nordenram A. Fourth and fifth molar in ramus mandibulae: case report. Odontol Tidskr 1968;76(1):23–25.
7. Singhal P, Sah VK, Kumar A, et al. Unilateral fourth, fifth, sixth, and seventh molar in a nonsyndromic patient: a rare and unusual case report. J Indian Soc Pedod Prev Dent 2017;35(4):374–377. DOI: 10.4103/JISPPD.JISPPD_186_16
8. Trenouth MJ, Bedi R. Supernumerary primary first molar and first premolar: clinical report. Pediatr Dent 1983;5(3):214–216.
9. Park MS, Park HW, Lee JH, et al. Supernumerary tooth in the primary molar region: case report. Korean Acad Pediatr Dent 2011;38(1):51–55.
10. Shimizu T, Miyamoto M, Arai Y, et al. Supernumerary tooth in the primary molar region: a case report. J Dent Child (Chic) 2007;74(2):151–153.
11. El-Bahannasawy E, Fung DE. Missing C, supplemental D and supplemental premolar all in one quadrant: a case report. Int J Paediatr Dent 2004;14(6):461–464. DOI: 10.1111/j.1365-263X.2004.00580.x
12. NB N, Umashankara KV, Radhika NB, et al. Maxillary paramolar: report of a case and literature review. Arch Orofac Sci 2010;5:24–28.
13. Arandi N. Distomolars: an overview and 3 case reports. Dent Oral Craniofac Res 2017;4:1–3.
14. Khalaf K, Al Shehadat S, Murray CA. A review of supernumerary teeth in the premolar region. Int J Dent. 2018;2018:1–5.
15. De Oliveira Gomes C, Drummond SN, Jham BC, et al. A survey of 460 supernumerary teeth in Brazilian children and adolescents. Int J Paediatr Dent 2008;18(2):98–106. DOI: 10.1111/j.1365-263X.2007.00862.x
16. Díaz A, Orozco J, Fonseca M. Multiple hyperodontia: report of a case with 17 supernumerary teeth with non syndromic association. Med Oral Patol Oral Cir Bucal 2009;14(5):E229–E231.
17. Kaya E, Güngör K, Demirel O, et al. Prevalence and characteristics of nonsyndromic distomolars: a retrospective study. J Investig Clin Dent 2015;6(4):282–286. DOI: 10.1111/jicd.12108
18. Peñarrocha MA, Peñarrocha M, Larrazábal C, et al. Dientes supernumerarios consideraciones quirúrgicas y ortodóncicas. Archivos de Odonto Estomatología 2003;19:263–272.
19. Fernández Montenegro P, Valmaseda Castellón E, Berini Aytés L, et al. Retrospective study of 145 supernumerary teeth. Med Oral Patol Oral Cir Bucal 2006;11(4):E339–E344.
20. Rajab LD, Hamdan MA. Supernumerary teeth: review of the literature and a survey of 152 cases. Int J Paediatr Dent 2002;12(4):244–254. DOI: 10.1046/j.1365-263x.2002.00366.x
21. Yassin OM, Hamori E. Characteristics, clinical features and treatment of supernumerary teeth. J Clin Pediatr Dent 2009;33(3):247–250. DOI: 10.17796/jcpd.33.3.0j1227k74883531
22. Pasha Z, Choudhari S, Rathod A, et al. Bilaterally impacted mandibular supernumerary premolars associated with unusual clinical complications. J Pharm Bioallied Sci 2013;5(2):166–169. DOI: 10.4103/0975-7406.111826
23. Kara Mİ, Aktan AM, Ay S, et al. Characteristics of 351 supernumerary molar teeth in Turkish population. Med Oral Patol Oral Cir Bucal 2012;17(3):e395–e400. DOI: 10.4317/medoral.17605
24. Cassetta M, Altieri F, Giansanti M, et al. Morphological and topographical characteristics of posterior supernumerary molar teeth: an epidemiological study on 25,186 subjects. Med Oral Patol Oral Cir Bucal 2014;19(6):e545–e549. DOI:10.4317/medoral.19775
25. Sykaras SN. Mesiodens in primary and permanent dentitions. Report of a case. Oral Surg Oral Med Oral Pathol 1975;39(6):870–874. DOI: 10.1016/0030-4220(75)90107-3
26. Primosch RE. Anterior supernumerary teeth—assessment and surgical intervention in children. Pediatr Dent 1981;3(2):204–215.
27. Ooe T. Three instances of supernumerary tooth germs observed with serial sections of human foetal jaws. Z Anat Entwicklungsgesch 1971;135(2):202–209. DOI:10.1007/BF00521110
28. Leche W. Zur entwicklungsgeschichte des zahnsystems der saugetiere. Ontogenie Bibliotheca Zoologica. Stuttgart: Nagele 1895
29. Oenning AC, Pauwels R, Stratis A, et al. Halve the dose while maintaining image quality in paediatric cone beam CT. Sci Rep 2019;9(1):5521.
30. Van Acker JW, Martens LC, Aps JK. Cone-beam computed tomography in pediatric dentistry, a retrospective observational study. Clin Oral Investig 2016;20(5):1003–1010. DOI: 10.1007/s00784-015-1592-3
31. Sharma S, Tyagi S, Kumar V. Paramolar tubercle- Bolk cusp: a case report. J Oral Res Rev 2018;10(2):76–79. DOI: 10.4103/jorr.jorr_20_18
32. Hattab FN, Yassin OM, Rawashdeh MA. Supernumerary teeth: report of three cases and review of the literature. ASDC J Dent Child 1994;61:382–393.
33. Sian JS. Root resorption of first permanent molar by a supernumerary premolar. Dent Update 1999;26:210–211. DOI: 10.12968/denu.1999.26.5.210
34. Lu X, Yu F, Liu J, et al. The epidemiology of supernumerary teeth and the associated molecular mechanism. Organogenesis 2017;13(3):71–82. DOI: 10.1080/15476278.2017.1332554
35. Kalra N, Chaudhary S, Sanghi S. Non-syndrome multiple supplemental supernumerary teeth. J Indian Soc Pedod Prev Dent 2005;23(1):46–48. DOI: 10.4103/0970-4388.16029
36. Liu JF. Characteristics of premaxillary supernumerary teeth: a survey of 112 cases. ASDC J Dent Child 1995;62(4):262–265.
37. Di Donna E, Keller LM, Neri A, et al. Maxillary distomolar associated with dentigerous cyst: an unusual entity. Oral 2022;2(1):1–6. DOI:10.3390/oral2010001
38. Parry RR, Iyer VS. Supernumerary teeth amongst orthodontic patients in India. Br Dent J 1961;111:257–258.
39. Garvey MT, Barry HJ, Blake M. Supernumerary teeth—an overview of classification, diagnosis, and management. J Can Dent Assoc 1999;65(11):612–616.
40. Shah A, Hirani S. A late-forming mandibular supernumerary: a complication of space closure. J Orthod 2007;34(3):168–172. DOI: 10.1179/146531207225022149
41. Shah A, Gill DS, Tredwin C, et al. Diagnosis and management of supernumerary teeth. Dent Update 2008;35(8):510–520. DOI: 10.12968/denu.2008.35.8.510
42. Nirmala SVSG, Tirupathi SP. Rare combination of developing unerupted paramolar and distomolar in maxilla: a case report and review of literature. J Interdiscipl Med Dent Sci 2016;4(4):1–6. DOI: 10.4172/2376-032X.1000201
43. Clementini M, Ottria L, Pandolfi C, et al. Four impacted fourth molars in a young patient: a case report. Oral Implantol 2013;5(4):100–103.
44. Amarlal D, Muthu M S. Supernumerary teeth: review of literature and decision support system. Indian J Dent Res 2013;24(1):117–122. DOI: 10.4103/0970-9290.114911
45. Oh MH, Lee KH, Kim DE, et al. Case report: supernumerary teeth on maxillary premolar and mandibular incisal area. J Korean Acad Pediatr Dent 2006;3:529–533.
46. Khandelwal V, Nayak AU, Naveen RB, et al. Prevalence of mesiodens among six- to seventeen-year-old school going children of Indore. J Indian Soc Pedod Prev Dent 2011;29(4):288–293. DOI: 10.4103/0970-4388.86369
47. Kim HS, Song YH, Lee YS, et al. A case of bilateral paramolar teeth. Taehan Chikkwa Uisa Hyophoe Chi 1973;11(2):131–133.
48. Parolia A, Kundabala M, Mohan M. Bilateral maxillary paramolars and endodontic therapy: a rare case report. Front Dent 2010;7(2):107–111.
49. Scheiner MA, Sampson WJ. Supernumerary teeth: a review of the literature and four case reports. Aust Dent J 1997;42(3):160–165. DOI: 10.1111/j.1834-7819.1997.tb00114.x
50. Nayak G, Shetty S, Singh I, et al. Paramolar - a supernumerary molar: a case report and an overview. Dent Res J (Isfahan) 2012;9(6):797–803.
51. Timocin N, Yalcin S, Ozgen M, et al. Supernumerary molars and paramolars, a case report. J Nihon Univ Sch Dent 1994;36:145–150.
52. Hou GL, Lin CC, Tsai CC. Ectopic supernumerary teeth as a predisposing cause in localized periodontitis. Case report. Aust Dent J 1995;40(4):226–228. DOI: 10.1111/j.1834-7819.1995.tb04799.x
53. Mossaz J, Kloukos D, Pandis N, et al. Morphologic characteristics, location, and associated complications of maxillary and mandibular supernumerary teeth as evaluated using cone beam computed tomography. Eur J Orthod 2014;36(6):708–718. DOI: 10.1093/ejo/cjt101
54. Bereket C, Çakır-Özkan N, Şener İ, et al. Analyses of 1100 supernumerary teeth in a nonsyndromic Turkish population: a retrospective multicenter study. Niger J Clin Pract 2015;18(6):731–738. DOI: 10.4103/1119-3077.154213
55. Cholakova R. Clinical and epidemiological study of supernumerary teeth in patients from plovdiv region. Acta Medica Bulgarica 2020;47(2):22–26. DOI: 10.2478/AMB-2020-0018
56. Jain A, Karuna YM, Suprabha Bhat, et al. An unusual case of bilateral supernumerary teeth in the primary dentition stage. J Oral Maxillofacial Surg Med Pathol 2016;29(3):281–283. DOI: 10.1016/j.ajoms.2016.10.007
57. Kurt H, Suer BT, Senel B, et al. A retrospective observational study of the frequency of distomolar teeth in a population. Cumhur Dent J 2015;18(4):335–342. DOI: 10.7126/cdj.58140.5000108165
58. Arslan A, Altundal H, Ozel E. The frequency of distomolar teeth in a population of urban Turkish adults: a retrospective study. Oral Radiol 2009;25:118–122. DOI: 10.1007/s11282-009-0020-2
59. Thomas SA, Sherubin E, Pillai KS. A study on the prevalence and characteristics of distomolars among 1000 panoramic radiographs. J Indian Acad Ora Med Radiol 2013;25(3):169–172.
60. Gopakumar D, Thomas J, Ranimol P, et al. Prevalence of supernumerary teeth in permanent dentition among patients attending a dental college in South Kerala: a pilot study. J Indian Acad Ora Med Radiol 2014;26(1):42–45. DOI: 10.4103/0972-1363.141854
61. Mitsea A, Vardas E, Papachatzopoulou A, et al. The frequency of nonsyndromic distomolar teeth in a Greek population sample? J Clin Exp Dent 2015;7(5):e589–e594. DOI: 10.4317/jced.52411
62. Szkaradkiewicz AK, Karpinski TM. Maxillary bilateral distomolars–a case report. Int J Dent Clinics 2012;4:50–51.
63. Reddy GS, Reddy GV, Krishna IV, et al. Nonsyndromic bilateral multiple impacted supernumerary mandibular third molars: a rare and unusual case report. Case Rep Dent 2013;2013:857147. DOI: 10.1155/2013/857147
64. Patidar DC, Patidar D. Distomolars—exploring the known entity. Indian J Dent Sci 2020;12(2):103–108. DOI: 10.4103/IJDS.IJDS_10_20
65. Jaiyeoba OO, Ifesanya JU. Mandibular and maxillary distomolars in the orthodontic child patient: a report of 3 cases. Ann Ib Postgrad Med 2018;16(2):177–180.
66. Gupta K, Singh S. A rare incidence of bilateral paramolars and unilateral impacted distomolar in the maxilla of a non-syndrome patient: a case report. Case Rep Odontol 2019;6(1):01–04.
67. Moreira DD, de-Azevedo-Vaz SL, Melo SL, et al. Unusual fusion of a distomolar with a third molar assessed by cone-beam computed tomography. Stomatos 2014;20(38):12–17.
68. Bamgbose BO, Okada S, Hisatomi M, et al. Fourth molar: a retrospective study and literature review of a rare clinical entity. Imaging Sci Dent 2019;49(1):27–34. DOI:10.5624/isd.2019.49.1.27
69. Vlaykov A, Sharlanov D, Vicheva D. Fourth mandibular molar in a pediatric patient—case report. Rom J Rhinol 2015;5(20):229–231. DOI: 10.1515/rjr-2015-0027
70. Kariya PB, Mallikarjuna R, Singh S, et al. Rare combination of paramolar and distomolar supernumerary teeth in a 15-year-old male adolescent. BMJ Case Rep 2014;2014:bcr2014205000. DOI: 10.1136/bcr-2014-205000
71. Arikan V, Ozgul BM, Firdevs TO. Prevalence and characterıstıcs of supernumerary teeth in a child population from Central Anatolıa—Turkey. Oral Health Dent Manag 2013;12(4):269–272.
72. Harris EF, Clark LL. An epidemiological study of hyperdontia in American blacks and whites. Angle Orthod 2008;78(3):460–465. DOI: 10.2319/022807-104.1
73. Chandna P, Srivastava N, Adlakha VK, et al. Bilateral maxillary paramolars in an adolescent. Compend Contin Educ Dent 2017;38(7):e5–e8.
74. Ferrés-Padró E, Prats-Armengol J, Ferrés-Amat E. A descriptive study of 113 unerupted supernumerary teeth in 79 pediatric patients in Barcelona. Med Oral Patol Oral Cir Bucal 2009;14(3):E146–E152.
75. Ribeiro MC, Kato RB, Amaral MBF, et al. Nonsyndromic multiple supernumerary teeth in a child: a rare case report. J Dent App 2017;4(1):370–371.
________________________
© The Author(s). 2023 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.