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 Table of Contents  
Year : 2017  |  Volume : 8  |  Issue : 4  |  Page : 147-149

Unusual impaction of mandibular second premolar

1 Department of Orthodontics and Dentofacial Orthopedics, Manipal College of Dental Sciences, Manipal, Karnataka, India
2 Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Karnataka, India
3 Private Practitioner, Mahaveer Charitable Hospital, Jaipur, Rajasthan, India
4 Private Practitioner, Umrao Dental Care, Bhilwara, Rajasthan, India
5 Intern, Manipal College of Dental Sciences, Manipal, Karnataka, India

Date of Web Publication11-Oct-2017

Correspondence Address:
Siddharth Mehta
Department of Orthodontics, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijor.ijor_22_17

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The present case report demonstrates an unusual impaction of mandibular second premolar and a new classification for impaction of mandibular premolar based on the previous case reports.

Keywords: Etiology, impaction, orthopantogram, second premolar

How to cite this article:
Mehta S, Vineetha R, Mehta A, Lodha S, Sreedharan H. Unusual impaction of mandibular second premolar. Int J Orthod Rehabil 2017;8:147-9

How to cite this URL:
Mehta S, Vineetha R, Mehta A, Lodha S, Sreedharan H. Unusual impaction of mandibular second premolar. Int J Orthod Rehabil [serial online] 2017 [cited 2023 Sep 25];8:147-9. Available from: https://www.orthodrehab.org/text.asp?2017/8/4/147/216504

  Introduction Top

An impacted tooth is a tooth that fails to erupt into the oral cavity within the developmental time frame. Tooth impaction is frequently encountered eruption anomaly detected during dental checkup. Most commonly impacted tooth is mandibular third molar followed by maxillary canine and seldom premolars.[1]

  Case Report Top

An adult female reported to the department of orthodontics with minor crowding in the upper and lower dentition. Her medical history was not significant. Clinical examination revealed Angle's Class I molar relation on the left side, a super Class I molar relation on the right side, and missing second premolar in the right quadrant. An orthopantogram was advised which revealed an unusual impaction of lower right second premolar in the body of the mandible [Figure 1].
Figure 1: Orthopantogram presentation of the case

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The radiolucency around the right second premolar was homogeneous with no overlapping radiopaque or radiolucent point suggestive of normal follicle. The patient was advised to undergo fixed orthodontic treatment. The impacted premolar was not extracted as it was very close to the lower border of the mandible, and the patient was advised to have regular radiographic examination to check for any cystic/undesirable changes.

  Discussion Top

Heredity, systemic disorders such as hypothyroidism, mutations in parathyroid hormone receptor 1,[2] previous trauma, abnormal position of tooth bud, ankylosis of deciduous molar, space deficiency, follicular sac inflammation, supernumerary teeth/cyst/adenoma, or idiopathic factors have been considered as etiological factors [3] for tooth impaction. At the molecular level, initiation of tooth eruption corresponds to the onset of epidermal growth factor (EGF)-receptor expression.[4] A deprivation in EGF receptor causes apoptosis of follicular cells which leads to lack of production of interleukin 1 alpha by enamel organ which, in turn, leads to no secretion of colony-stimulating factor 1, no upregulation of gelatinase activity, and no downregulation of Type I collagen production. As collagen remains undissolved, path of least resistance for tooth eruption is not provided leading to impaction. The initial angulation of the tooth bud and early loss of the deciduous mandibular molar are 2 important factors that can lead to distal migration and impaction of the second premolar tooth.[5] The same reason fits the most probable explanation in this case as well.

A literature research showed classifications pertaining to impacted third molars and maxillary and mandibular canines. A classification by Muparapu [6] segregates transmigration of mandibular canine into 5 types. Data on impaction and transmigration of lateral incisors or premolars are limited. This is an initial attempt to classify impacted mandibular second premolars. Early diagnosis and classification of impaction allows a universal method of communication for clinicians and also prevents compromises in treatment planning, patient esthetics, and function.

Depending on previous presentations [7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] of mandibular second premolar impaction, a new classification [Table 1] and [Figure 2] for mandibular second premolar impaction is suggested.
Figure 2: Classification

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Table 1: Classification of impaction

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However, in all of the above cases of impactions, treatment plan should be judged on the basis of closeness to lower border of the mandible, resorption of the adjacent teeth, cystic changes, or patient symptoms. Thus, early diagnosis can prevent undesirable changes and help prepare a proper treatment plan.

  Conclusion Top

Diagnosing and classifying an impaction can help formulate a proper treatment plan.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Andreasen JO, Peterson JK, Laskin DM. The impacted premolar. Textbook and Color Atlas of Tooth Impactions: Diagnosis Treatment and Prevention. Copenhagen, Denmark: Munksgaard; 1997. p. 177-95.  Back to cited text no. 1
Frazier-Bowers SA, Simmons D, Wright JT, Proffit WR, Ackerman JL. Primary failure of eruption and PTH1R: The importance of a genetic diagnosis for orthodontic treatment planning. Am J Orthod Dentofacial Orthop 2010;137:160.e1-7.  Back to cited text no. 2
Shashikiran ND, Kumar NC, Reddy VV. Unusual presentation of inverted impacted premolars as a result of dentigerous cyst: A case report. J Indian Soc Pedod Prev Dent 2006;24:97-9.  Back to cited text no. 3
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Shroff B, Kashner JE, Keyser JD, Hebert C, Norris K. Epidermal growth factor and epidermal growth factor-receptor expression in the mouse dental follicle during tooth eruption. Arch Oral Biol 1996;41:613-7.  Back to cited text no. 4
Shapira Y, Kuftinec MM. Intrabony migration of impacted teeth. Angle Orthod 2003;73:738-43.  Back to cited text no. 5
Mupparapu M. Patterns of intra-osseous transmigration and ectopic eruption of mandibular canines: Review of literature and report of nine additional cases. Dentomaxillofac Radiol 2002;31:355-60.  Back to cited text no. 6
Pasha Z, Choudhari S, Rathod A, Sulabha AN. Bilaterally impacted mandibular supernumerary premolars associated with unusual clinical complications. J Pharm Bioallied Sci 2013;5:166-9.  Back to cited text no. 7
Kara MI, Ay S, Aktan AM, Sener I, Bereket C, Ezirganli S, et al. Analysis of different type of transmigrant mandibular teeth. Med Oral Patol Oral Cir Bucal 2011;16:e335-40.  Back to cited text no. 8
Alves DB, Pedrosa EF, Andreo JC, de Carvalho IM, Rodrigues Ade C. Transmigration of mandibular second premolar in a patient with cleft lip and palate – Case report. J Appl Oral Sci 2008;16:360-3.  Back to cited text no. 9
Shahoon H, Esmaeili M. Bilateral intraosseous migration of mandibular second premolars in a patient with nine missing teeth. J Dent (Tehran) 2010;7:50-3.  Back to cited text no. 10
Neha, Tripathi T, Rai P, Singh N. Facilitated eruption of an impacted premolar 8 years post-eruption timing- think before you treat!!! J Clin Diagn Res 2015;9:ZD14-6.  Back to cited text no. 11
Loh HS, Ho KH. Unerupted and ectopic mandibular premolars. Oral Surg Oral Med Oral Pathol 1986;62:358.  Back to cited text no. 12
Matteson SR, Kantor ML, Proffit WR. Extreme distal migration of the mandibular second bicuspid. A variant of eruption. Angle Orthod 1982;52:11-8.  Back to cited text no. 13
Okada H, Miyake S, Toyama K, Yamamoto H. Intraosseous tooth migration of impacted mandibular premolar: Computed tomography observation of 2 cases of migration into the mandibular neck and the coronoid process. J Oral Maxillofac Surg 2002;60:686-9.  Back to cited text no. 14
Infante-Cossio P, Hernandez-Guisado JM, Gutierrez-Perez JL. Removal of a premolar with extreme distal migration by sagittal osteotomy of the mandibular ramus: Report of case. J Oral Maxillofac Surg 2000;58:575-7.  Back to cited text no. 15
Fuziy A, Costa AL, Pastori CM, F de Freitas C, Torres FC, Pedrão LL, et al. Sequential imaging of an impacted mandibular second premolar migrated from angle to condyle. J Oral Sci 2014;56:303-6.  Back to cited text no. 16
Sutton PR. Migrating nonerupted mandibular premolars: A case of migration into the coronoid process. Oral Surg Oral Med Oral Pathol 1968;25:87-98.  Back to cited text no. 17
Clark S, Malden NJ. Extreme distal migration of premolar in association with an unusual fracture of the mandible. Oral Surg Oral Med Oral Pathol 1989;68:563-4.  Back to cited text no. 18
Nag R, Mathur R, Mathur J. Transmigration of unerupted mandibular second premolar associated with chronic nonspecific osteomyelitis: Report of a rare case. Indian J Stomatol 2014;5:31-2. 2p.  Back to cited text no. 19
Kuba Y, Taniguchi K, Kuboyama H, Motokawa W, Braham RL. Inverted impaction of second premolar: Two case reports. J Clin Pediatr Dent 1995;19:205-9.  Back to cited text no. 20
Burns SJ. Inversion, rotation and ectopic eruption of a mandibular second premolar. Int J Paediatr Dent 1991;1:39-41.  Back to cited text no. 21


  [Figure 1], [Figure 2]

  [Table 1]

This article has been cited by
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Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2020;
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