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Paramolar with bifid crown
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
Volume 76. Number 2 Iodoform gauze with a radiopaque filament A 19-year-old white man was referred from the dental inprocessing center to the oral surgery department at Darnell Army Community Hospital. The patient had an unknown radiopaque foreign body i.n the mandibular right third molar area (Fig. 1) that was discovered on routine examination of his screening panoramic radiograph. The patient denied a previous mandibular fracture or other history that would have required wire placement. He did st.ate that the symptomatic partially erupted third molar had been extracted 3 weeks earlier when he was home on leave. Sutures and packing were placed at the time of surgery. At his follow-up appointment, the surgeon’s partner removed the sutures, but the patient did not recall the packing being removed. Clinilcal examination revealed a thin blue cone
Radiology forum
257
shaped projection from the third molar socket. This was removed with a curved hemostat. Removal of this “thread” lead to the removal of a piece of iodoform gauze that had been partially granulated over in the socket. The surgical site went on to heal uneventfully. Investigation revealed the iodoform packing removed is similar to a packing marketed by Asurgical Supplly Co. (Brockton, Mass.) that contains a radiopaque filament. This case is presented as an unusual radiographic finding and to point out the advantages of using a dressing that is radiographically detectable. Lieutenant Colonel Russel K. Catterlin, DDS Lieutenant Colonel Roger R. Throndson, DDS U.S. Army Dental Activity Fort Hood, Texas The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
Fig. 1. Panoramic radiograph shows unknown material in mandibular right third molar socket. Paramolar with hifid crown A 25year-old man came for the extraction of a paramolar tooth situated palatally, between the right maxillary first amd second molar. Clinically, the crown of the tooth was seen to bear some resemblance to that of a premolar. A routine dental radiograph showed a radiopaque mass that resembled an odontome on the distal side of the crown of the paramolar tooth (Fig. 1). Because the crown of the paramolar had erupted into the oral cavity, a forceps extraction was attempted with the patient under local anesthesia. The extraction was very difficult, and the clinical crown fractured in the process. At this juncture, another crown was seen to lie beneath the first crown. The
Fig. 1,) Periapical radiograph shows paramolar tooth situated between maxillary first and second molar. On distal side of paramolar is radiopaque massthat resemblesodontome.
Radiologyforum
Fig. 2. Reconstructed specimen.
second crown and the root were successfully removed using elevations. The reconstructed tooth showed two crowns and a single root (Fig. 2). A radiograph of the specimen showed a tooth with a single pulp chamber and bifid crowns (Fig. 3).
DISCUSSION There are two possible theories to explain this finding. First, this could be a case of gemination of the paramolar, an attempt at division of a single tooth. The second possibility, which is a more remote one, is that of fusion of two supernumerary tooth germs. Paramolar teeth are not common findings, and, as far as we know, there is no previous report of a paramolar with two crowns.
Supernumerary teeth in twins Two 12-year-old white twin boys were seen at Lenval Children’s Hospital for orthodontic treatment. Pantomographic examination revealed a mirror-imaging of three mandibular supernumerary premolars in
ORAL SURGERY ORAL MEDICNE ORAL PATHOLOGY
August I993
Fig. 3. Radiograph of reconstructed tooth shows two distinct crowns and one root canal.
When a difficult extraction is encountered, one should include among the various causes of difficult extractions, the possibility of a tooth with two crowns, one of which is buried within bone.
Fun-CheeLoh, BDS, MDS, MSc, FAMS, FDS RCSEd Jinn-Fei Yeo, BDS, MS,> MDS, FAMS Department of Oral d Maxillofacial Surgery National University of Singapore National University Hospital 5 Lower Kent Ridge Road Singapore 0511 Republic oafSingapore
both children. In Marc the mandibular right side exhibits two supernumerary teeth, one between the first and the second premolar, the other between the second premolar and the first molar. The left side shows a supernumerary tooth between the second premolar and the first molar (Fig. I). And in Luc on the right,
Volume 76. Number 2 Iodoform gauze with a radiopaque filament A 19-year-old white man was referred from the dental inprocessing center to the oral surgery department at Darnell Army Community Hospital. The patient had an unknown radiopaque foreign body i.n the mandibular right third molar area (Fig. 1) that was discovered on routine examination of his screening panoramic radiograph. The patient denied a previous mandibular fracture or other history that would have required wire placement. He did st.ate that the symptomatic partially erupted third molar had been extracted 3 weeks earlier when he was home on leave. Sutures and packing were placed at the time of surgery. At his follow-up appointment, the surgeon’s partner removed the sutures, but the patient did not recall the packing being removed. Clinilcal examination revealed a thin blue cone
Radiology forum
257
shaped projection from the third molar socket. This was removed with a curved hemostat. Removal of this “thread” lead to the removal of a piece of iodoform gauze that had been partially granulated over in the socket. The surgical site went on to heal uneventfully. Investigation revealed the iodoform packing removed is similar to a packing marketed by Asurgical Supplly Co. (Brockton, Mass.) that contains a radiopaque filament. This case is presented as an unusual radiographic finding and to point out the advantages of using a dressing that is radiographically detectable. Lieutenant Colonel Russel K. Catterlin, DDS Lieutenant Colonel Roger R. Throndson, DDS U.S. Army Dental Activity Fort Hood, Texas The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
Fig. 1. Panoramic radiograph shows unknown material in mandibular right third molar socket. Paramolar with hifid crown A 25year-old man came for the extraction of a paramolar tooth situated palatally, between the right maxillary first amd second molar. Clinically, the crown of the tooth was seen to bear some resemblance to that of a premolar. A routine dental radiograph showed a radiopaque mass that resembled an odontome on the distal side of the crown of the paramolar tooth (Fig. 1). Because the crown of the paramolar had erupted into the oral cavity, a forceps extraction was attempted with the patient under local anesthesia. The extraction was very difficult, and the clinical crown fractured in the process. At this juncture, another crown was seen to lie beneath the first crown. The
Fig. 1,) Periapical radiograph shows paramolar tooth situated between maxillary first and second molar. On distal side of paramolar is radiopaque massthat resemblesodontome.
Radiologyforum
Fig. 2. Reconstructed specimen.
second crown and the root were successfully removed using elevations. The reconstructed tooth showed two crowns and a single root (Fig. 2). A radiograph of the specimen showed a tooth with a single pulp chamber and bifid crowns (Fig. 3).
DISCUSSION There are two possible theories to explain this finding. First, this could be a case of gemination of the paramolar, an attempt at division of a single tooth. The second possibility, which is a more remote one, is that of fusion of two supernumerary tooth germs. Paramolar teeth are not common findings, and, as far as we know, there is no previous report of a paramolar with two crowns.
Supernumerary teeth in twins Two 12-year-old white twin boys were seen at Lenval Children’s Hospital for orthodontic treatment. Pantomographic examination revealed a mirror-imaging of three mandibular supernumerary premolars in
ORAL SURGERY ORAL MEDICNE ORAL PATHOLOGY
August I993
Fig. 3. Radiograph of reconstructed tooth shows two distinct crowns and one root canal.
When a difficult extraction is encountered, one should include among the various causes of difficult extractions, the possibility of a tooth with two crowns, one of which is buried within bone.
Fun-CheeLoh, BDS, MDS, MSc, FAMS, FDS RCSEd Jinn-Fei Yeo, BDS, MS,> MDS, FAMS Department of Oral d Maxillofacial Surgery National University of Singapore National University Hospital 5 Lower Kent Ridge Road Singapore 0511 Republic oafSingapore
both children. In Marc the mandibular right side exhibits two supernumerary teeth, one between the first and the second premolar, the other between the second premolar and the first molar. The left side shows a supernumerary tooth between the second premolar and the first molar (Fig. I). And in Luc on the right,