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| CASE REPORT |
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| Year : 2017 | Volume
: 8
| Issue : 4 | Page : 147-149 |
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Unusual impaction of mandibular second premolar
Siddharth Mehta1, R Vineetha2, Anjali Mehta3, Surendra Lodha4, Haritha Sreedharan5
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 Publication | 11-Oct-2017 |
Correspondence Address:
Siddharth Mehta
Department of Orthodontics, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijor.ijor_22_17
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 |
| Introduction | |  |
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 | | |
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].
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 | | |
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.
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 | | |
Diagnosing and classifying an impaction can help formulate a proper treatment plan.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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[Figure 1], [Figure 2]
[Table 1]
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