|Year : 2017 | Volume
| Issue : 1 | Page : 63-66
Bilateral multirooted first primary molar: A rare case report
Satyapal Yadav1, Pooja Mishra2, Nikhil Marwah2, Puneet Goenka2
1 Department of Oral Medicine, Diagnosis and Radiology, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan, India
2 Department of Pedodontics and Preventive Dentistry, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan, India
|Date of Submission||06-Jan-2017|
|Date of Acceptance||14-Jul-2017|
|Date of Web Publication||04-Aug-2017|
Room no 203, Type IV-B, P.G. Hostel, Mahatma Gandhi College of Medical Sciences, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Morphologic root variation is a rare finding in primary molars with reported prevalence of <0.1%. In depth understanding about such disparity of tooth structure is of high significance in pediatric endodontics. The present case presents deciduous first molar with three roots bilaterally.
Keywords: Bilateral, first molar, multirooted, primary first molar
|How to cite this article:|
Yadav S, Mishra P, Marwah N, Goenka P. Bilateral multirooted first primary molar: A rare case report. J Indian Acad Oral Med Radiol 2017;29:63-6
|How to cite this URL:|
Yadav S, Mishra P, Marwah N, Goenka P. Bilateral multirooted first primary molar: A rare case report. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2022 Jan 27];29:63-6. Available from: https://www.jiaomr.in/text.asp?2017/29/1/63/212086
| Introduction|| |
A complete knowledge regarding the anatomy and morphology of tooth structure, importantly the roots of teeth is of high significance to the clinician for performing any dental procedure, especially endodontics. Root anomalies in teeth may be represented in form of accessory roots, radix entomolaris, or radix paramolaris. The incidence of root anomaly is far commonly observed in permanent dentition than in primary dentition as roots of the deciduous teeth tend towards simplification by fusion or by disappearance of the longitudinal grove. Most frequently found root anomalies in primary teeth are concrescence, dilacerations, and hypercementosis. The presence of an additional or supernumerary root was first described by Carabelli when he found a permanent mandibular molar with three roots. Since then, many cases of three rooted molars have been reported in permanent dentition. However, the presence of such cases in primary molars is very rare with Tratman reporting the frequency of less than <1% in primary first molars. Yang et al. studied root variation in primary mandibular second molar in Chinese population, in which he found 72.28% and 27.52% had 2 and 3 roots, respectively. Earlier cases that have been reviewed in literature regarding presence of three roots in primary mandibular first molar have mostly observed it as a unilateral finding, however, this report presents a rare case of bilateral occurrence of deciduous mandibular first molar with three roots.
| Case Report|| |
A 14-year-old adolescent reported to the Department of Pediatric and Preventive Dentistry with the chief complaint of pain and swelling in the mandibular anterior region. On detailed recording of pain history, it was explained by the patient to be of sharp, continuous, and radiating in nature which aggravated on chewing food and relieved by medication. Family of the patient reported that all blood examinations were done under physician’s consultation and it was found that the patient was anemic. No history of systemic conditions was given. Height and weight of the patient was 151 cm and 47 kg, respectively, which was normal according to his age. The mental age of the patient was also found to be normal. Medical and previous dental history were noncontributory. Extraoral examination of patient revealed swelling [Figure 1] in mandibular anterior jaw involving the submental region extending backward to middle of the body of the mandible with reduced mouth opening. Submandibular lymph nodes were palpable bilaterally, however, no abnormality was detected in the temporomandibular joint.
Intraoral soft tissue examination revealed gingival enlargement in the mandibular anterior region extending up to the position of mandibular first molars. The swelling was diffuse, firm, and tender on touch with no tendency to bleed. Patient practiced routine oral hygiene habits. All the other soft tissues of oral cavity were normal in appearance. Hard tissue examination presented 12 retained deciduous teeth; four in the maxillary arch and eight in the mandibular arch (53, 55, 63, 65, 72, 73, 74, 75, 82, 83, 84, and 85) which exhibited no preshedding mobility [Figure 2]. Maxillary molars in relation to 55, 16, 64, and 26 were decayed.
|Figure 2: Intraoral examination showing over retained primary teeth with respect to 72, 73, 74, 75, 82, 83, 84, and 85|
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Orthopantomograph (OPG) was done to evaluate the cause of the swelling and to examine the status of the retained primary teeth in relation to the nonerupting permanent teeth. OPG revealed retained deciduous teeth with unresorbed roots in accordance with intraoral examination [Figure 3]. It also exhibited that tooth buds of all the successive permanent teeth were also present with presence of more than 2/3 roots except for permanent second molar wherein tooth crypts were present in all quadrants. Although there was no other collaborative finding to support the cause of swelling in the region, the OPG made serendipitous revelation of the presence of three roots in mandibular deciduous first molar bilaterally. OPG was considered to be better in reviewing the underlying reason behind the noneruption of permanent teeth. To avoid multiple radiographic exposures, OPG was chosen. And after extraction it was found that the primary mandibular first molar comprised three roots.
|Figure 3: Orthopantomograph showing retained deciduous teeth with nonresorbed roots and multirooted primary first molar present bilaterally|
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Following differential diagnosis was made viz. mucosal barrier, supernumerary teeth, ankylosis of deciduous teeth, odontogenic tumor, nutritional deficiency, endocrine disorders, and fibromatosis gingivae. Provisional diagnosis was gingival hyperplasia due to nutritional deficiency. The clinical and radiographic findings helped in reaching a diagnosis that the swelling was due to retained deciduous teeth. This could have been the cause of gingival hyperplasia or vice-versa that gingival overgrowth lead to noneruption of permanent teeth. It was decided to extract all the retained deciduous teeth in a phased manner and the treatment protocol was explained to the patient and parents, and a written informed consent was obtained. During teeth extraction, it was confirmed that deciduous first molars had three roots viz. mesial, distal, and lingual [Figure 4] and [Figure 5]. A biopsy from the site of the extraction was also performed to determine the underlying pathology causing delay in the eruption of permanent teeth. Regression in swelling was observed clinically after extraction of mandibular anterior teeth. The patient reported routinely for extraction of all retained teeth and the gingival hyperplasia (which was also confirmed in biopsy) in the mandibular region showed visible reduction. Extraction sockets were healed and the patient was kept on regular follow up. Permanent teeth did not erupt till 7 months of follow-up [Figure 6].
|Figure 4: Mandibular deciduous first molar with three roots with respect to 84 (left) and 74 (right)|
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| Discussion|| |
Knowledge of teeth and its morphological variation is important for clinical practice, anthropological data, and for forensic record. Three rooted permanent mandibular first molar and deciduous mandibular second molar have been reported widely in literature, however, the presence of three rooted deciduous mandibular first molar is relatively rare with only a few cases being reported.,, According to a review of literature, a high incidence of 15.2% is seen in people of Mongolian origin (Japanese, Malaysian, Chinese, Thai, Eskimo, Aleutian, and American Indian), and the incidence in Indian population is estimated to be very low i.e., 0.2%. The presence of bilateral three-rooted deciduous first molar, as in our case, is a very rare phenomenon and has been reported very sparingly in literature. According to the study conducted by Song et al. in Korea, 4050 children were examined for multiple roots in mandibular posterior teeth, out of which only 9.7% reported with additional roots. Winkler and Ahmad reported a case initially, and two more cases have been reported by Gupta et al. and Ramamurthy et al. in the Indian population.
Although the etiology of supernumerary roots is relatively unknown, it is proposed that if during the development of root, epithelial sheath of Hertwig is folded or disrupted, it can result in the formation of accessory or supernumerary root canals. This can be the most probable explanation of the presence of three roots in our case. The pattern of shedding of deciduous teeth and eruption of permanent teeth should follow a normal sequence with delay of not more than 2 years, beyond which an intervention is required to diagnose and treat the underlying cause. The presence of gingival hyperplasia which causes an abundance of dense connective tissue or acellular collagen can be a hindrance to tooth eruption. Another factor which could have affected the eruption status was the presence of anemia in the child, which has also been considered to be a factor in delayed teeth eruption. However, the verdict of gingival hyperplasia upon the extraction of retained deciduous teeth points out that gingival hyperplasia does prevent eruption of teeth but it can also be the result of retained teeth or vice versa.
| Conclusion|| |
The rare presence of bilateral three rooted deciduous first molar, which was evident both clinically and radiographically in our case, does present a clinical challenge to the dentist and should always be evaluated critically, especially due to endodontic or exodontic consideration.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]