An unusual case of Ectopic Eruption of Supernumerary Mandibular Molar tooth in Coronoid. Int J Oral Health Med Res 2017;4(5):51-54

1. International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2018 | VOL 4 | ISSUE 5 51
CASE REPORTMathew P et al.: Ectopic Eruption of Supernumerary Mandibular Molar
Correspondence to:
Dr. Philip Mathew, Department of Oral &
Maxillofacial Surgery and Dentistry, Jubilee
Mission Medical College Hospital and Research
Institute, Kerala, India
Contact Us: www.ijohmr.com
An unusual case of Ectopic Eruption of
Supernumerary Mandibular Molar tooth in
Coronoid
Philip Mathew1
, Rahul VC Tiwari2
, Aswin Mullath3
, Jisha David4
, Heena Tiwari5
Ectopic eruption of teeth in the oral cavity is a common phenomenon noticed by clinicians in a day to day practice.
Various etiologic factors are involved for the same reason. The unusual presentation of teeth can be present in jaw bone
or in other associated structures. Published literature also report such cases. Impacted tooth sequela to pathology. We
are presenting a case report of ectopic eruption of the supernumerary mandibular molar tooth in coronoid.
KEYWORDS: Impacted tooth, Ectopic eruption, Molar tooth, Coronoid
AASSSAAsasasss
Ectopic essentially signifies "the wrong position." The
nearness of an ectopic molar might be the consequence of
formative aggravations (ectopic eruption, impaction, or
ankylosis), pathologic procedures (dislodged by cyst), or
iatrogenic movement. The ectopic eruption, which
implies eruption into the wrong place, is well on the way
to happen in the eruption of maxillary first molars
furthermore, mandibular lateral incisors.1,2
Treatment of
such tooth is removal. If no indications or pathology is
clear, perception might be the treatment of decision.
Intercession comprises of a concise time of orthodontic
treatment or the evacuation of teeth (essential or
changeless) with the endeavor to dispense with tooth
impaction. For ectopic first or second molars, a joined
orthodontic-surgical approach ought to dependably be
considered to permit eruption into ordinary position.
Migration needs repositioning of an ectopic tooth
surgically or orthodontically.3
The point of intercession
or movement is to keep up the respectability of the curve
and impediment. In any case, extraction ought to be
considered if the above measures are considered
outlandish, or the tooth is symptomatic or is related to
pathologies such as ankylosis or cystic changes. There
have been reports of an ectopic molar tooth in the
maxillary sinus4,5
and in condylar region forming a
dentigerous cysts.6–9
The present report portrays an uncommon case of an
ectopic molar average to the coronoid process of
mandible leading to pathology. Published literature has
given data regarding ectopic eruptions their position and
approaches for surgical removal (Table 1).
The etiology of ectopic eruption is still a mystery, and
many theories have been suggested, including trauma,
infection, cyst, tumor, crowding, and developmental
abnormalities. In many cases, however, the etiology
cannot be identified.10
Mostly, the etiology is associated
with tooth and its immediate anatomic environment. In
the present case, the origin of the tooth is controversial. It
may be either a mandibular molar that migrated during
development or an iatrogenically displaced maxillary
molar. This is a case report of a 46-year-old male who
presented with a complaint of pain and swelling and
How to cite this article:
Mathew P, Rahul VCT, Mullath A, David J, Tiwari H. An unusual case of Ectopic Eruption of Supernumerary Mandibular Molar tooth in Coronoid. Int J
Oral Health Med Res 2017;4(5):51-54.
INTRODUCTION
1,2,4-Department of Oral & Maxillofacial Surgery and Dentistry, Jubilee Mission
Medical College Hospital and Research Institute, Thrissur, Kerala, India. 3-PG Student,
Department of Oral & Maxillofacial Surgery, KMCT Dental College, Calicut, Kerala,
India. 5-Department of Dentistry, Government Dental Surgeon, CHC Makdi,
Kondgaon, Chhattisgarh, India.
ABSTRACT
CASE REPORT
Table 1: Ectopic third molars in literature

2. International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2018 | VOL 4 | ISSUE 5 52
CASE REPORTMathew P et al.: Ectopic Eruption of Supernumerary Mandibular Molar
difficulty in mouth opening. On clinical examination,
there was intraoral swelling on the left side. It was also
persistent in extra oral region. The periodontal health was
compromised. Patient also gives a history of extraction
and uneventful healing with maxillary left third molar.
Orthopantomogram was advised which showed bilateral
impacted supernumerary tooth was present (Figure 1). In
the right side, it was present on ramus of mandible
involving the inferior alveolar nerve. Tooth was
incompletely formed according to its normal anatomical
structure. On left side the supernumerary tooth was
present on coronoid process of mandible forming
radiolucent mass extending into ramus of mandible
involving crown of supernumerary tooth.
Clinicoradiographically it was diagnosed as dentigerous
cyst. All the required pre-operative hematological
investigations, chest X ray, electrocardiogram was
obtained and surgical removal of impacted tooth was
planned under general anesthesia. Intravenous antibiotics,
analgesics and anti-inflammatory drugs were given
before the procedure as prophylaxis. Intra oral approach
was preferred using vertical incision extending distally to
third molar towards external oblique ridge reaching the
anterior border of ramus and coronoid was given. Tissue
was reflected and lesion was exposed (Figure 2).
Removal of infected mass was performed and impacted
tooth was exposed in oral cavity (Figure 3). The
supernumerary tooth was surgically removed (Figure 4).
Surgical closure was done using 4-0 vicryl absorbable
sutures. Postoperative instructions and medication was
prescribed.
Ectopic teeth are located in the jawbones or regions other
than the alveolar arch. Ectopic eruption of a tooth is rare;
however, there have been few reports of tooth in the nose,
mandibular condylary and coronoid processes and
maxillary sinus.11-14
Most of the cases in the mandibular
coronoid and condylary regions had symptomatic signs;
common symptoms of the clinical examination were pain,
trismus, swelling, and temporomandibular joint problems.
On the other hand, ectopic teeths are often discovered in
routine clinical or radiographic examinations; as some of
the cases were asymptomatic, like the case study above.
The aetiology of ectopic eruption is still unclear, and
reaches have suggested many theories, including trauma,
infection, pathologic conditions, crowding and develop
mental anomalies. However, it is likely to be an ectopic
mandibular third molar for the following reasons: (1) the
sinus discharge is in the mandible; (2) a pericoronal
radiolucency can be seen around the crown; (3) if the root
was located within the bony part of the coronoid process;
absence of severe trismus after the maxillary molar
extraction, and (5) an iatrogenically displaced maxillary
third molar is usually positioned distal to the posterior
maxillary wall and higher up in the infratemporal fossa.
Figure 1: Orthopantomogram showing a mandibular third molar
tooth present in Chondroid region of mandible.
Figure 2:Incision and Exposure of Lesion
Figure 3:Impacted mandibular third molar in the choronoid
region of mandible.
Figure 4:Extracted tooth
DISCUSSION

3. International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2018 | VOL 4 | ISSUE 5 53
CASE REPORTMathew P et al.: Ectopic Eruption of Supernumerary Mandibular Molar
Odontogenesis is a complex process, and abnormal tissue
interactions between the oral epithelium and the
underlying mesenchymal tissue during development may
potentially result in ectopic tooth development and
eruption.15
A mandibular third molar may be displaced by
a lesion such as a cyst or a tumor.16
The displacement of
tooth buds by the expansion of progressively growing
dentigerous cysts may result in the displacement of the
tooth to other areas. In some of the reports in the
literature review, the cysts associated with the ectopic
third molars were very small like our case. Such cysts
may have once occupied the entire ramus, but their walls
may have been perforated, which resulted in drainage and
decompression.16,17
This pathological process may
support the idea that a dentigerous cyst was the etiologic
factor of ectopic eruption in the subject of our case. For
ectopic mandibular third molars associated with the
condylar process of the mandible, various approaches
have been used to gain access for retrieval of the tooth.
Szerlip reported an ectopic third molar in the condylar
process removed by an intraoral approach.18
Bux and
Lisco reported a third molar associated with a dentigerous
cyst in the subcondylar region and approached it through
a cutaneous incision below the mandibular angle
followed by a submasseteric dissection to create a
subperiosteal tunnel leading to the surgical site.19
Tumer
et al reported a third molar and a cyst in a similar position
and excised them through a preauricular approach.20
Recently, Suarez-Cunqueiro et al used an endoscopic
approach to remove an ectopic mandibular third molar in
the condylar process and claimed advantages such as
good illumination, clear and magnified visualization of
the operating field, and more conservative surgery.21
Possible risk of damage to the facial nerve and scars on
the skin could also be avoided with an endoscopic
approach.22
They therefore advocated that endoscopy be
used to remove ectopic third molars, not only in the
condylar process but also in other ectopic locations, such
as the maxillary sinus and nasal fossa. However, adequate
training beforehand is essential. In this case, a pure
intraoral approach was sufficient since the coronoid
process is accessible via a wide incision along the
ascending ramus. Adequate isolation was achieved by
placing a sigmoid notch retractor buccally in the sigmoid
notch, a Kocher artery forceps clamping the tip of the
coronoid process, a channel retractor, and a periosteal
elevator medially distal to the tooth. In this way, further
displacement distally during manipulation was prevented.
A coronoidectomy could be considered in case of
inadequate access but was found to be unnecessary.
Unusual presentation of impacted or ectopic tooth is a
common phenomenon, but the presence of an ectopic
supernumerary molar on coronoid process of mandible
tooth is rare. In such condition the tooth is also associated
with pathology and infection, surgical removal of tooth is
indicated under proper antibiotic coverage and pre-
operative hematological and radiological investigations.
We acknowledge Doctors of Department of Oral and
Maxillofacial Surgery, Department of Emergency
Medicine and Department of Radiodiagnosis of Jubilee
Mission Medical College Hospital and Research Centre
for their help and support.
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8. Tumer C, Eset AE, Atabek A. Ectopic impacted
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Oral Surg Oral Med Oral Pathol 1969;28:511.
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13. Baykul T, Doğru H, Yasan H, Cina Aksoy M.
Clinical impact of ectopic teeth in the maxillary
sinus. Auris Nasus Larynx. 2006;33:277- 81.
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tooth: an unusual cause of epistaxis in a child. Ear
Nose Throat J. 2012;91:242-4.
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Dentigerous cyst associated with an ectopic third
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Dent Res. 2007;18:141-3
CONCLUSION
ACKNOWLEDGEMENT
REFERENCES

4. International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2018 | VOL 4 | ISSUE 5 54
CASE REPORTMathew P et al.: Ectopic Eruption of Supernumerary Mandibular Molar
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18. Szerlip L. Displaced third molar with dentigerous
cyst—An unusual case.J Oral Surg 1978;36:551–
552.
19. Bux P, Lisco V. Ectopic third molar associated with
a dentigerous cyst in the subcondylar region: Report
of case. J Oral Maxillofac Surg 1994;52:630–632.
20. Tumer C, Eset AE, Atabek A. Ectopic impacted
mandibular third molar in the subcondylar region
associated with a dentigerous cyst: A case report.
Quintessence Int 2002;33:231–233.
21. Suarez-Cunqueiro MM, Schoen R, Schramm A,
Gellrich NC, Schmelzeisen R. Endoscopic approach
to removal of an ectopic mandibular third molar. Br J
Oral Maxillofac Surg 2003;41:340–342.
22. Debes RR, Miller SB. Molar in coronoid process.
Oral Surg Oral Med Oral Pathol 1969;28:511.
Source of Support: Nil
Conflict of Interest: Nil