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To evaluate the etiopathogenesis, clinical features and surgical approaches for removal of ectopic third molars in the mandible.
We report a case of an impacted mandibular third molar dislocated on mandibular sigmoid notch. 20 cases of ectopic mandibular third molars reported in the English-language literature, identified from Pubmed and Medline da...
Context in source publication
Context 1
... performed a literature search using the PubMed da- tabase. We used ectopic third molar and mandible as key words. Of the 45 articles found, we only considered the English literature and well-documented cases of ectopic third molars in the mandible. Our inclusion criteria were as follows: English-language articles generated by the Pubmed database search containing at least one case of an ectopic third molar in the mandible; and articles con- taining cases of patients with ectopic third molars loca- ted in the mandibular condyle, coronoid, and sigmoid regions (Table 1). We compared the results of our search with the following case study. A 45-year-old man was referred to the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry Hospital (Isparta, Turkey), in August 2011 for the eva- luation and assessment of an impacted lower right third molar in the mandibular sigmoid notch associated with a radiolucent lesion and multiple cysts located in the jaws. His medical history also did not give any signifi- cant information that could associated with the presen- ting symptoms. On intra oral examination, there were no signs of any significant pathology in relation to any tooth or tissue. Panoramic radiograph examination re- vealed a radiolucent area surrounding the crown of the fully formed, ectopic mandibular third molar in right mandibular sigmoid notch region ( Fig. 1). Cystic lesions were also seen in the left maxillary and right mandibular area. Cone beam CT scans showed the impacted tooth with the proximity to the lingual cortical bone and there was also cortical bone exposure in the coronal images (Fig. 2). The surgical staff carried out the surgical procedure with the patient under general anesthesia. They obtained in- traoral access via an incision on the anterior edge of the mandibular ramus and along the external oblique rid- ge. They performed the periosteal dissection was done lingually to expose the sigmoid notch of the mandible. They used a round burr was used to make cuts on the cortical bone of the mandible where they had estimated the crown of the ectopic tooth from the CT scans and the panoramic radiograph. They elevated the tooth was then elevated out of the bony socket by an elevator via the bony window. Then they enucleated the other cystic lesions located in the maxilla and mandible, were enucleated without any complica- tions. They sent the enucleated soft tissues were sent to pathology and sutured the wound after irrigation. The pathology report revealed tissue compatible with a den- tigerous cyst around the ectopic tooth; radicular cysts in the maxilla; residual csyt in the mandible. The postoperative phase was uneventful (Fig. 3). The patient was under antibiotic coverage along with anti- inflammatory analgesics for 7 days. The patient was under regular follow-up care for 18 months. There was no deviation of the mandible and preoperative occlusion was maintained without any functional ...
Citations
... The majority of cases reported in the literature involve mandibular third molars associated with pathologies such as cysts or tumors. 6 Fındık and Baykul, 10 in their review of 23 articles, found that in their study of 23 articles, all ectopic teeth in the condyle were mandibular third molars associated with radiolucent pathologies. Tooth bud displacement can occur due to pressure from progressive cystic lesions, such as dentigerous cysts, resulting in tooth dislocation. ...
Purpose
Ectopic eruption can be defined as the emergence of a tooth in an abnormal location, where the tooth does not follow its typical eruption pathway. While ectopic eruption within the dentate region is well-documented in the literature, ectopic eruption in non-dentate regions is relatively rare. This study aimed to report 6 cases of ectopic teeth and present a systematic review of the English-language literature on ectopic teeth, emphasizing demographic characteristics, radiographic features, potential complications, and treatment options.
Materials and Methods
A literature search was conducted using the PubMed, Medline, Web of Science, and Cochrane databases. The demographic data and radiographic findings of patients presenting with ectopic teeth were recorded.
Results
The literature review yielded 61 cases of ectopic teeth, with patients ranging in age from 3 to 74 years. The findings from these previously reported cases demonstrated that the most common location for ectopic teeth was the maxillary sinus, which is consistent with this case series. The Pearson chi-square test was performed to evaluate the correlation between age and location of ectopic teeth, and the results were found to be statistically significant (P<0.05). However, no statistically significant relationship was observed between sex and the location of ectopic teeth.
Conclusion
The distinct features of these cases warrant reporting. This study presents the first case of supernumerary teeth in the condyle without any associated pathosis. Another notable characteristic is the pre-eruptive resorption of 2 inverted supernumerary teeth ectopically located in the palate, which predisposes to sinus opacification.
... Ectopic teeth are rare; however, the molar is the most commonly reported ectopic tooth in the antrum 4,7 and the man-dible [8][9][10] . Veerabhadrappa et al. 10 noted that more than twothirds of patients with ectopic mandibular molars were >40 years of age, and more were female, at a sex ratio of 2.5:1. ...
... Veerabhadrappa et al. 10 noted that more than twothirds of patients with ectopic mandibular molars were >40 years of age, and more were female, at a sex ratio of 2.5:1. Ectopic tooth eruption, though not completely understood, may result from abnormal tissue interaction during tooth development 9 . ...
... Ectopic teeth have been reported in various locations, including the antrum, floor of the orbit, lower border of the mandible, nasal cavity, ramus, coronoid, condyle and sigmoid notch [3][4][5][6]9,10 . The ectopic tooth is a rare entity; only a few have been reported 10 . ...
Objectives:
An ectopic tooth is a rare eruption of a tooth out of the normal dental apparatus and occurs commonly with the third molar. Thus, in this study, we reported a case series of ectopic teeth in rare jaw locations and highlight the associated pathology and our experience in the surgical management. Patients and.
Methods:
All cases of ectopic tooth managed at the Department of Oral and Maxillofacial Surgery, University of Maiduguri Teaching Hospital from January 2011 to December 2020 were reviewed. The information retrieved includes biodata, location of the ectopic tooth, signs, symptoms, type of tooth and associated pathology, surgical approach and complications.
Results:
Ten cases of ectopic teeth were identified over the study period. This comprised 80.0% males with a mean age was 23.3 years. The antrum and lower border of the mandible accounted for 50.0% and 40.0% of the ectopic locations, respectively. Dentigerous cyst was the most associated pathology (70%) and usually presented with pain and swelling. Surgical intervention predominantly via the intraoral route was performed if indicated.
Conclusion:
Ectopic teeth are rare and not always associated with pathology. A high index of suspicion and radiological investigation are necessary for diagnosis. A more extensive multi-center study is however recommended to determine the prevalence of ectopic teeth other than the third molar.
... The ectopic eruption in the maxillary sinus can induce sinonasal symptoms, most commonly due to recurrent or chronic sinusitis, or it can cause ocular problems [7]. A headache, face discomfort, edema, nasal blockage, nasal discharge, epiphora, rhinorrhea, hyposmia, and orbital proptosis are among the symptoms. ...
Ectopic tooth in the maxillary sinus is a rare occurrence. There are multiple etiologies of this condition, including developmental disruption, pathological process, iatrogenic, and in rare cases no recognized reason. Ectopic teeth in the maxillary sinus are noticed by accident during routine radiological examinations. A 38-year-old married female reported to the Department of oral medicine and oral surgery at the University Dental Clinic of Monastir-Tunisia. She has been experiencing pain in the left side of the face and a chronic headache for two months. Orthopantography and computed tomography are used to identify the existence of an ectopic tooth within the left maxillary sinus. The Modified Caldwell-Luc Technique was executed to remove the tooth. The patient remained free of the presenting symptoms three months later. Although the existence of an ectopic tooth in the maxillary sinus is rare, it should be evaluated and detected as soon as possible. An ectopic tooth in the maxillary sinus needs to be extracted since it might cause cyst development if left untreated. The modified Caldwell-Luc method, which offers a clear view into the maxillary sinus, is the standard approach. Case Report Jihed et al.; Int.
... Entretanto, nota-se uma maior prevalência desta condição em mulheres, e localização condilar, seguido pelo processo coronoide, incisura e ramo mandibulares 20 . Com relação à sintomatologia, é possível identificar casos assintomáticos, porém, comumente são descritos casos com presença dor, aumento volumétrico, febre, sinusite, trismo, dificuldade mastigatória e disfunção na articulação temporomandibular 4,8,15,18,[23][24][25] . ...
Dentes ectópicos são frequentemente encontrados, entretanto, terceiros molares inferiores ectópicos são incomuns, com etiologia obscura e pouco descritos na literatura pertinente. Sua localização já foi relatada nas regiões condilar, subcondilar, incisura mandibular, ângulo e borda inferior da mandíbula. Devido à importância do planejamento terapêutico, manejo adequado e variedade das manifestações clínicas desta condição, este trabalho teve como objetivo relatar um caso clínico de terceiro molar inferior ectópico na região de incisura mandibular, com radiolucência aumentada ao redor da coroa, em um paciente do gênero masculino, de 28 anos e sem sintomatologia. Acompanhamento radiográfico pode ser indicado, no entanto, em pacientes sintomáticos ou com alterações patológicas associadas, a extração deve ser considerada. Diante disso, o tratamento de escolha foi a extração do dente 38 sob anestesia geral, por via intraoral, tendo em vista a posição dentária, radiolucência e morbidade associadaà cirurgia. O tecido mole circundante foi enviado para análise anatomopatológica. O paciente evoluiu sem intercorrências durante avaliação pós-operatória.
... However, this type of approach could be complicated by sinusitis or an oroantral fistula. In literature, a total of 34 cases were retrieved from the systematic analysis that reported having ectopic wisdom teeth in the maxillary sinus that can cause symptoms such as headache, facial pain, sinusitis or swelling, nasal obstruction, rhinorrhea compressing the nasolacrimal canal [50,51] or can be completely asymptomatic [48,52]. According to the present systematic search, the age of diagnosis is very heterogeneous and symptoms-correlated, while the most common presentation of ectopic upper third molar was associated to a posterior wall (24.13%), the lateral wall (22.41%), the medial wall (18.96%), inferior wall (17.24%), orbit floor (15.51%). ...
Background:
The purpose of the present case report was to investigate a very rare ectopic third molar removal by a trans-sinusal approach and report the study findings through a systematic review of the literature on this topic.
Case presentation:
A 38-year-old female patient was visited for pain at the level of the right maxillary region. No relevant medical history was reported. The CBCT tomography assessment revealed an impacted third tooth at the level of the postero-lateral maxilla.
Review methods:
An electronic search was performed through Boolean indicators query on Pubmed/Medline, EMBASE, Cochrane Library databases. The clinical reports were identified and selected in order to perform a descriptive analysis. The surgical approach concerned a trans-sinusal access to the site for the ectopic tooth removal with a lateral antrostomy. No evident inflammatory alteration was associated to the ectopic tooth and a non-relevant post-operative sequelae was reported at the follow up.
Results:
A total of 34 scientific papers were retrieved from the database search. Only two cases reported a wait-and-see radiographical follow-up approach, while the most common treatment was surgical removal, also for asymptomatic cases.
Conclusion:
The third-molar ectopic tooth into the maxillary sinus is an uncommon occurrence that is beast treated by an in-chair intraoral tran-sinusal approach, with a consistent reduction of the invasivity, a mild morbidity and a successful functional outcome.
... Due to its importance, tooth impaction is discussed in most branches of dentistry, including surgery, pediatrics, orthodontics, and prosthesis, so that an accurate and timely treatment plan would be adopted and correct therapeutic decisions would be made in order to prevent further complications such as periodontal problems, caries in the adjacent tooth, root resorption in the adjacent tooth, crowding, cysts, tumors (16)(17)(18), and idiopathic pains (19). ...
Background & Aims: The present study aimed to determine the prevalence of impacted third molar as well as impaction angulation and depth.
Materials & Methods: In this cross-sectional descriptive study, 261 panoramic radiographs belonging to patients visiting dental clinics and offices in Ghaemshahr, Iran, were evaluated and the presence of impacted wisdom teeth was examined. Moreover, the angulation of impacted teeth, impaction depth, and the relationship of the tooth to the mandibular ramus were recorded. The data were recorded, collected, and statistically analyzed in SPSS 22 using the non-parametric chi-square test. p
... The management of ETMMs depends on the presence of symptom(s) and associated pathologies (large cyst with a risk of mandibular fracture, patient at risk of infection). Asymptomatic ETMMs not associated with a disease or a cyst should be monitored annually [22][23][24]. Other ETMMs, symptomatic or associated with a cyst, should be extracted [2,4,6,12]. ...
Objectives
To identify the preferred surgical approach (intra- or extra-oral) to remove an ectopic third mandibular molar (ETMM) according on its location and presence of an associated cyst or cutaneous fistula, and to determine the indications for a graft or osteosynthesis.Materials and methodsA surgical practice questionnaire was distributed to oral and maxillo-facial surgeons attending a National Congress of the French Society of Stomatology, Maxillo-facial and Oral Surgery. A systematic review of the literature and meta-analysis was carried on Pubmed, Cochrane, Embase and ScienceDirect databases using the MeSH terms: “Ectopic teeth”, “Third molar”, “Mandibular”. One hundred and forty-three surgeons answered the questionnaire and the meta-analysis included 66 articles.ResultsFrom the questionnaire, the preferred surgical approach was intra-oral except when the ETMM was in the condyle, when it was extra-oral (69.5%; p < 0.001). In the meta-analysis, an extra-oral approach was only indicated when a cutaneous fistula was present (90% vs. 35.9%; p = 0.002), irrespective of ETMM location. In the questionnaire and meta-analysis, the presence of a cyst did not change the approach (p < 0.05). The indications for a graft or osteosynthesis were a condylar location (p < 0.001), while a cutaneous fistula decreased the indication (p = 0.04) and a cyst (p = 0.009) was only associated with a graft.Conclusions
The preferential approach was intra-oral, except when the ETMM was condylar or a cutaneous fistula was present when an extra-oral approach was preferred. Osteosynthesis or a graft were more likely when the ETMM was in the condyle.Clinical relevanceThis study will help to orientate surgeons vis-à-vis ETMM treatment.
... The duration of clinical signs and symptoms varied from a few months to 7 years [16]. About 15% of the cases in the present review were found to be asymptomatic [15,25,33,34,36,40]. ...
Objective:
To perform a systematic review of the characteristics of ectopic mandibular third molar (EMTM) in terms of its clinical presentation, radiographic findings, associated lesions, management and post-operative complications.
Materials and methods:
We searched the Pubmed, Medline, Embase and EBSCO databases for full-text, peer-reviewed journal publications from January 1965 to August 2020. Data extraction was done using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.
Results:
Our search yielded 45 case reports involving 48 EMTM teeth. The mean age of the patients was 46.3 years with an age range of 22-80 years. Thirty-two cases were seen in women as compared to 13 cases in men. The majority of the cases (42) were unilateral, with only three bilateral cases. Among the 48 EMTM teeth, 21 were seen in the condylar region followed by 13 in the ramus, seven in the sigmoid notch, three in the angle and two each in the coronoid process and the lower border of the mandible. Twenty-five EMTM teeth had histopathologically confirmed dentigerous cysts, eight teeth had chronic infection/inflammation/granulation tissue, two had radicular cysts, two had infected cysts, two teeth had normal follicular spaces, and associated lesions were not mentioned for nine teeth. The most common symptoms were swelling (33 teeth) and pain (29 teeth), and six teeth were asymptomatic. Surgical removal through intraoral approach was carried out for 27 teeth, while an extra-oral approach was adopted in 15 teeth, a spontaneous regression of the pericoronal radiolucency was noticed in one tooth, four teeth were not treated and choice of treatment was not mentioned for one tooth. Mild transient paraesthesia was frequently observed; however, serious post-surgical complications were not reported.
Conclusions:
The present review found that EMTM can present with complex clinicopathological characteristics, with a majority of the cases being asymptomatic in the beginning and turning out to be symptomatic with lesions at later stages, requiring surgical intervention.
... An ectopic tooth can be found in mandibular condyle, coronoid process or maxillary sinus and for heterotopic tooth, meatus acusticus externus, nasal septum, infratemporal fossa or nasal fossa are some of the places in the literature. [5][6][7][8][9]11,13,[15][16][17][18][19][20][21][22] Heterotopic teeth are asymptomatic in most of the cases and are usually found in a routine clinical and radiological examination. 23 But there are some cases in the literature that patient has complaints such; mouth opening limitations, pain during mandibular movement, headache, swelling and pain. ...
... Ectopic or heterotopic tooth diagnosed during routine radiographic examinations with no symptoms or pathologies do not require any treatment. 9,12,17,20,22,33 If the impacted tooth surgery decision has been made , the procedure should be chosen individually for each case according to the placement and pathology of the tooth. Follow up decision or surgery desicion should be made after the potential risks factors, possible complications and benefits of the surgery evaluated mindfully. ...
... Follow up decision or surgery desicion should be made after the potential risks factors, possible complications and benefits of the surgery evaluated mindfully. 12,20 S So ou ur rc ce e o of f F Fi in na an nc ce e During this study, no financial or spiritual support was received neither from any pharmaceutical company that has a direct connection with the research subject, nor from a company that provides or produces medical instruments and materials which may negatively affect the evaluation process of this study. C Co on nf fl li ic ct t o of f I In nt te er re es st t No conflicts of interest between the authors and / or family members of the scientific and medical committee members or members of the potential conflicts of interest, counseling, expertise, working conditions, share holding and similar situations in any firm. ...
... These teeth are often incidentally diagnosed and require treatment only when symptomatic or associated with any pathology. [1][2][3][4][5] Obscure facial pain and trismus are the most common symptoms. Owing to the rarity of this condition, few cases have been reported in the literature and the optimal management of ectopic, mandibular third molar is still uncertain. ...
... 7 Surgical removal of these teeth can be done either extraorally or intraorally. The most common extraoral approaches are submandibular, retromandibular and preauricular approach with the advantage of very good surgical exposure but not devoid of shortcomings such as extraoral scar, striping of masticatory muscles leading to post operative trismus and facial nerve injury [1][2][3][4] Intraoral approach avoids these shortcomings of extraoral approach but compromises the most important aspect of surgical approach i.e. providing very small access which may requires coronoidectomy sometimes to improve the accessibility. 1,2 In order to get better access Alling et al introduced two techniques; 1. Sagittal split osteotomy of mandibular posterior body and ramus to provide surgical access to ectopic tooth. ...
Ectopic occurrence of mandibular third molar is a rare incidence. Usually found along with a cystic lesion or diagnosed incidentally during routine check-up. Owing to the rarity, only few cases were reported in the literature. The common site is the mandibular condyle followed by sigmoid notch, and often found in females. The frequent symptoms are obscure facial pain, trismus or the symptoms of the associated pathology like dentigerous cyst. The etiopathogenesis is uncertain and optimal management is still unclear. The symptomatic tooth should be removed either intraorally or extraorally. Here we report a case of ectopic mandibular third molar in ramus region surgically removed intra orally by high lingual split access osteotomy.
