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      Fourth molar: A retrospective study and literature review of a rare clinical entity

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          Abstract

          Purpose

          The prevalence of supernumerary teeth has been reported to be between 0.1% and 3.8%. The aim of this study was to determine the prevalence, clinical significance, and associated pathologies of fourth molars based on a retrospective study and a literature review.

          Materials and Methods

          A 5-year retrospective prevalence study was conducted at the Department of Oral Diagnosis and Dentomaxillofacial Radiology of Okayama University Hospital, Okayama, Japan. The study involved extracting data from the digital records of patients from January 1, 2013 through December 31, 2017. The sampling frame included all patients who had panoramic radiographs, cone-beam computed tomography (CT), and multislice CT images during the period under review.

          Results

          A total of 26,721 cases were reviewed and 87 fourth molars were identified. The prevalence of fourth molars in the 5-year study at Okayama was calculated as 0.32%. The mean age of patients with a fourth molar was 30.43 years, and the male-to-female ratio was 1:0.98. The vast majority of cases were in the maxilla (92%) and had normal shapes (89.7%); furthermore, 82.8% of cases were unerupted.

          Conclusion

          The prevalence of fourth molars in the study population was found to be 0.32%, and fourth molars occurred with approximately equal frequency in males and females. Fourth molars were more common in the maxilla and were predominantly unerupted and small.

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          Most cited references18

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          Clinical applications of cone-beam computed tomography in dental practice.

          Cone-beam computed tomography (CBCT) systems have been designed for imaging hard tissues of the maxillofacial region. CBCT is capable of providing sub-millimetre resolution in images of high diagnostic quality, with short scanning times (10-70 seconds) and radiation dosages reportedly up to 15 times lower than those of conventional CT scans. Increasing availability of this technology provides the dental clinician with an imaging modality capable of providing a 3-dimensional representation of the maxillofacial skeleton with minimal distortion. This article provides an overview of currently available maxillofacial CBCT systems and reviews the specific application of various CBCT display modes to clinical dental practice.
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            Supernumerary teeth: review of the literature and a survey of 152 cases.

            A review of the literature relating to supernumerary teeth is presented along with a survey of 152 cases. The study population consisted of 152 children who visited the department of Paediatric Dentistry at the Jordan University Hospital. Patients ranged in age from 5 to 15 years. Supernumeraries were detected by clinical examination and radiographs. Males were affected more than females with a sex ratio of 2.2 : 1. Seventy-seven percent of the patients had one supernumerary tooth, 18.4% had double teeth, and 4.6% had three or more supernumeraries. Ninety percent of the supernumerary teeth occurred in the premaxilla, of which 92.8% were in the central incisor region and of these latter 25% were located in the midline. The other 10.4% of the supernumeraries were located in the premolar, canine, molar, and lower central incisor regions. Two cases were of non-syndrome supernumerary teeth. Seventy-five percent of the supernumeraries were conical, 83.1% were in the normal vertical position and 26.5% were erupted. Conical-shaped supernumerary teeth had a significantly higher rate of eruption compared to the tuberculate type.
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              Retrospective study of 145 supernumerary teeth.

              The goal of the present retrospective study is to describe the distribution of the supernumerary teeth in a population of patients that have been attended at the Public Clinic of the Department of Oral Surgery. Supernumerary teeth and multiple hyperdontia are usually associated with different syndromes, such as Gardner syndrome, or with facial fissures; however, they can appear in patients without any pathology. Their prevalence oscillates to 0.5-3.8% in patients with permanent teeth and to 0.35-0.6% in patients with primary teeth. A total of 36,057 clinical histories of patients that were admitted at the clinic between September of 1991 and March of 2003 were revised. The following data were extrapolated: age, sex, number of extracted supernumerary teeth, localization, morphology and type of supernumerary teeth. Consequently, 102 patients were included into the present study. Of the 147 supernumerary teeth identified in the oral cavities of patients 145 were extracted. The most frequent supernumerary teeth identified were mesiodens (46.9%), followed by premolars (24.1%) and fourth molars or distal molars (18%). As for location, 74.5% of the supernumerary teeth were found in the superior maxillary bone and 46.9% of the supernumerary teeth were present in the palatine/lingual area. Heteromorphology was found in two thirds of the supernumerary teeth, with conical shape being the most frequent. Finally, 29.7% of the supernumerary teeth had occlusion with permanent teeth, and mesiodens were the predominating type of supernumerary teeth that showed this feature. Mesiodens very frequently cause retention of permanent incisors, which erupt spontaneously after the extraction of supernumerary teeth, if there is sufficient space in the dental arch and if they conserve the eruptive force. Generally, supernumerary premolars are eumorphic and are casually discovered during radiological exam, if not producing any symptomology.
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                Author and article information

                Journal
                Imaging Sci Dent
                Imaging Sci Dent
                ISD
                Imaging Science in Dentistry
                Korean Academy of Oral and Maxillofacial Radiology
                2233-7822
                2233-7830
                March 2019
                25 March 2019
                : 49
                : 1
                : 27-34
                Affiliations
                [1 ]Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
                [2 ]Department of Oral Diagnostic Sciences, Faculty of Dentistry, Bayero University Kano, Kano, Nigeria.
                [3 ]Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama, Japan.
                [4 ]Department of Dental Informatics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
                [5 ]Oral Inspection and Diagnostic Center, Okayama University Hospital, Okayama, Japan.
                [6 ]Department of Chemistry and Forensic Sciences, Savannah State University, Georgia, USA.
                Author notes
                Correspondence to: Dr. Babatunde O. Bamgbose. Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 5-1, Shikata-Cho, 2-Chome, Kita-Ku, Okayama, Japan 700-8558. Tel) 81-86-235-6705, drtundebamgbose@ 123456yahoo.com
                Author information
                https://orcid.org/0000-0002-1287-8406
                https://orcid.org/0000-0001-8056-4305
                https://orcid.org/0000-0002-9112-5145
                https://orcid.org/0000-0001-7129-5115
                https://orcid.org/0000-0002-7750-793X
                https://orcid.org/0000-0002-7282-8750
                https://orcid.org/0000-0002-9765-3125
                https://orcid.org/0000-0002-1380-5639
                Article
                10.5624/isd.2019.49.1.27
                6444009
                30941285
                dab1817a-adca-4db0-97d5-01299d20ade4
                Copyright © 2019 by Korean Academy of Oral and Maxillofacial Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 October 2018
                : 28 November 2018
                : 15 December 2018
                Categories
                Original Article

                Dentistry
                tooth, supernumerary,odontoma,odontogenic cyst
                Dentistry
                tooth, supernumerary, odontoma, odontogenic cyst

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