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CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 134-137

Radix paramolaris (supernumerary third root) in primary mandibular second molar: Report of two cases


Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India

Date of Web Publication17-Nov-2014

Correspondence Address:
N B Nagaveni
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-0149.144861

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  Abstract 

An awareness pertaining to the variations in root morphology in primary teeth is highly important among clinicians to render best treatment and in the maintenance of these teeth in the oral cavity. Primary mandibular second molars usually have two roots with three canals. Very rarely an additional supernumerary root occurs and when this extra root is situated mesiobuccally it is referred as radix paramolaris (RP) and when it is present distolingually to the main distal root it is called as radix entomolaris. Most of the times, this extra root remain undiagnosed due to its overlapping with the main mesial root on radiographic examination leading to endodontic failures. The aim of this paper is to present two cases of RP in primary mandibular second molars and to describe its clinical significance.

Keywords: Primary mandibular second molar, radix paramolaris, root morphology


How to cite this article:
Nagaveni N B, Bajaj M, Shruthi AS, Poornima P. Radix paramolaris (supernumerary third root) in primary mandibular second molar: Report of two cases . Niger J Exp Clin Biosci 2014;2:134-7

How to cite this URL:
Nagaveni N B, Bajaj M, Shruthi AS, Poornima P. Radix paramolaris (supernumerary third root) in primary mandibular second molar: Report of two cases . Niger J Exp Clin Biosci [serial online] 2014 [cited 2021 Oct 17];2:134-7. Available from: https://www.njecbonline.org/text.asp?2014/2/2/134/144861


  Introduction Top


Thorough knowledge of primary tooth and its root canal anatomy is very important for successful clinical practice. The occurrence of dental anomalies is fewer in the primary teeth than in the permanent dentition. [1]

Anatomic characteristic of primary mandibular second molar is generally presented as a tooth with two roots, one mesial and the other distal. Very rarely an additional third root (supernumerary root) is seen and according to Bolk [2] when it is placed mesiobuccaly to the mesial root is called "radix paramolaris (RP)" and when it is located distolingually to the main distal root is called "radix entomolaris."A supernumerary root formation in primary teeth is quite a rare entity. Tratman in 1938 [3] reported that three rooted mandibular molars were rare with a frequency of <1% in the primary dentition and common in the permanent dentition. Literature shows numerous articles on the prevalence of three rooted permanent mandibular first molars [4] whereas prevalence studies on three rooted primary molars are very few in number. [5],[6]

Primary teeth are frequently affected by caries at an early age and may require successful endodontic treatment for their long-term retention in the oral cavity until their exfoliation. For the success of pulp therapy in primary teeth, it is very essential to remove the infected pulp completely from all roots and canals followed by thorough chemo-mechanical cleaning and obturation to provide a hermetic seal. Therefore, awareness and understanding of the presence of additional roots and unusual root canal morphology is essential. The aim of this paper is to describe the presence of RP in the primary mandibular second molars in two Indian patients.


  Case reports Top


Case 1

A 6-year-old male patient reported to the Department of Pedodontics and Preventive Dentistry complaining of pain in the right lower back tooth region since 4 days. On intra-oral examination gross destruction of 85 due to long standing, dental caries was found. Periapical radiographic examination showed root resorption with respect to the same tooth with interradicular bone loss due to infection [Figure 1]. On careful observation, an extra root attached to mesial root was noticed. This was diagnosed as RP. As the tooth was in nonrestorable condition, extraction of the tooth followed by space maintainer was planned. Under local anesthesia, the tooth was extracted. Care was taken during extraction to avoid fracture of the extra root during luxation. Following extraction, the presence of RP was confirmed [Figure 2] and [Figure 3].
Figure 1: Periapical radiograph showing radix paramolaris in 85 (arrow)

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Figure 2: Picture of radix paramolaris from different views (arrows)

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Figure 3: Radix Paramolaris morphology from different sides (arrows)

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Case 2

An 8-year-old male patient reported complaining of decayed tooth in the right lower back region. Patient's general status was good. On intra-oral examination, the right mandibular second molar was grossly destructed due to long standing dental caries [Figure 4]a. Patient also exhibited caries in left first and second molars. Periapical radiographic examination revealed presence of extra root attached to the mesial root [Figure 4]b. Based on the literature search this extra root was diagnosed as RP. As this tooth was also in nonrestorable condition, extraction was carried out under local anesthesia.
Figure 4: (a) Intraoral photograph showing grossly destructed 85 (arrow). (b) Periapical radiograph of 85 with radix paramolaris (arrow)

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  Discussion Top


Primary mandibular second molars normally have two roots, one mesial and other distal with the formation of additional roots being very rare, but do occur.

The prevalence of 3-rooted primary molars varies in different populations. Literature search revealed only two publications regarding the prevalence of three rooted primary mandibular second molars. The first report is by Yang et al. [5] who in 2013 analyzed the prevalence of three rooted primary second molars using cone beam computed tomography and found 27.52% prevalence in Chinese children. The second documentation is done by Liu et al. [6] who evaluated the prevalence of three rooted second molars using vertical bitewing radiographs among Chinese patients. They found a prevalence of 9% in these patients with a 28% bilateral incidence of a symmetrical distribution of three rooted second molars [Table 1].
Table 1: Documented studies/cases of three rooted primary mandibular second molars in the literature

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This limited data suggests for further studies on the prevalence of three rooted primary second molars in different races and populations. There is no gender wise predilection or sidewise predominance of three rooted primary second molars in the reported studies. [5],[6] In our cases, both RP roots occurred in male patients and on the right side.

Three-rooted primary mandibular second molar associated with various other anomalies have been published. Winkler and Ahmad [10] reported multi-root anomalies in the primary mandibular first molars and second molars of Native American children. Tu et al. [11] in their study found two cases of multi-root variations in the primary mandibular first and second molars. Acs et al. [12] reported combination of shovel incisors, three-rooted primary molars, talon cusp and supernumerary tooth in a 7-year-old hispanic male patient. The skull of a 5-year-old Native American exhibited macrodontia, shovel-shaped maxillary central incisors, three-rooted mandibular primary molars, dens invaginatus, agenesis of maxillary canines, and crenulated occlusal surfaces of the first permanent and second primary molars in an archaeological exploration study done by Mann et al. in 1990. [13] In the presented two cases other abnormalities of the teeth were not found.

Accurate clinical knowledge of the general morphology of the specific variation of a tooth is essential before contemplating pulpectomy and extraction. The potential considerations of 3-rooted primary second molars in endodontic, orthodontic or surgical management have been mentioned by Younes et al. [14] While performing pulp therapy in primary teeth, the clinician should be aware of the possibility of the supernumerary root. Appropriate straight-line access preparation and location of the orifice of the extra distolingual root typically warrants modification of the trapezoidal form, to improve the localization and access to the root in primary mandibular second molar. [15]

The more complicated morphology of primary molars roots along with this extra root variant makes the extraction procedure difficult. Moreover, the developing premolar is always placed in the interradicular area surrounded by thin primary molar roots. Therefore, during extraction procedure, one should make sure that the crown of the premolar is not trapped in the inter-radicular area of the primary molar as this could cause accidental removal of the developing permanent tooth bud. The dentist also should examine extracted 3-rooted primary molar to ensure that all roots have been removed. Since it is not known whether these abnormal root configurations affect the normal exfoliation of the primary teeth, it is unclear whether these anomalous teeth present orthodontic problems. Moreover, the present of extra third root in primary molars have forensic value for identifying people of certain ethnic race like Mongoloid people. [8] A recent study done in Indian population shows the prevalence of 5.6% three rooted primary molars in Indian children. [7] From this fact, it is evident that every clinician should be alert while treating a child belonging to Indian ethnic group and look for the possibility of this extra root when performing any treatment for primary teeth.


  Conclusion Top


All clinicians should know the significance of the root anomalies like RP in the primary mandibular molars. Exodontic or endodontic procedure involving the primary second molars with this anomalous root configuration may render clinical complications especially when they are not anticipated.

 
  References Top

1.
Carabelli G. Systematisches Handbuch Der Zahn-heikunde. 2 nd ed. Vienna: Braumuller and Seidel; 1844. p. 114.  Back to cited text no. 1
    
2.
Bolk L. Bemerkkun u ber wuzelvariationen ammens children unteren molaren. Z Morphol Anthropol 1915;17:605-10.  Back to cited text no. 2
    
3.
Tratman EK. Three rooted lower molars in man and their racial distribution. Br Dent J 1938;64:264-74.  Back to cited text no. 3
    
4.
Garg AK, Tewari RK, Kumar A, Hashmi SH, Agrawal N, Mishra SK. Prevalence of three-rooted mandibular permanent first molars among the Indian population. J Endod 2010;36:1302-6.  Back to cited text no. 4
    
5.
Yang R, Yang C, Liu Y, Hu Y, Zou J. Evaluate root and canal morphology of primary mandibular second molars in Chinese individuals by using cone-beam computed tomography. J Formos Med Assoc 2013;112:390-5.  Back to cited text no. 5
    
6.
Liu JF, Dai PW, Chen SY, Huang HL, Hsu JT, Chen WL, et al. Prevalence of 3-rooted primary mandibular second molars among chinese patients. Pediatr Dent 2010;32:123-6.  Back to cited text no. 6
    
7.
Srivathsa SH. Prevalence of three rooted deciduous mandibular molars in Indian children. Int J Dent Sci Res 2014. [in press].  Back to cited text no. 7
    
8.
Yang C, Yang R, Zou J. Investigation of root and canal morphology of human primary mandibular second molar by cone-beam CT. Zhonghua Kou Qiang Yi Xue Za Zhi 2013;48:325-9.  Back to cited text no. 8
    
9.
Ramamurthy N, Srinivasan I. Bilateral three-rooted primary lower molars. Indian J Dent Res 2012;23:700.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.
Winkler MP, Ahmad R. Multirooted anomalies in the primary dentition of Native Americans. J Am Dent Assoc 1997;128:1009-11.  Back to cited text no. 10
    
11.
Tu MG, Liu JF, Dai PW, Chen SY, Hsu JT, Huang HL. Prevalence of three-rooted primary mandibular first molars in Taiwan. J Formos Med Assoc 2010;109:69-74.  Back to cited text no. 11
    
12.
Acs G, Pokala P, Cozzi E. Shovel incisors, three-rooted molars, talon cusp and supernumerary tooth in one patient. Pediatr Dent 1992;14:263-4.  Back to cited text no. 12
    
13.
Mann RW, Dahlberg AA, Stewart TD. Anomalous morphologic formation of deciduous and permanent teeth in a 5-year-old 15 th century child: A variant of the Ekman-Westborg-Julin syndrome. Oral Surg Oral Med Oral Pathol 1990;70:90-4.  Back to cited text no. 13
    
14.
Younes SA, al-Shammery AR, el-Angbawi MF. Three-rooted permanent mandibular first molars of Asian and black groups in the Middle East. Oral Surg Oral Med Oral Pathol 1990;69:102-5.  Back to cited text no. 14
    
15.
Nagaveni NB, Umashankara KV. Radix entomolaris and paramolaris in children. A review of the literature. J Indian Soc Pedod Prev Dent 2012;30:94-102.  Back to cited text no. 15
[PUBMED]  Medknow Journal  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]


This article has been cited by
1 A Case Report of Occurrence of Type B Radix Entomolaris in Permanent Mandibular First Molars
Yanina Singh
CODS Journal of Dentistry. 2018; 10(1): 21
[Pubmed] | [DOI]
2 Prevalence of Three-rooted Primary Mandibular First Molars in Children of Davangere, Karnataka, India
Mebin G Mathew,Anila Vilsan,Safina Masroor
CODS Journal of Dentistry. 2017; 9(1): 7
[Pubmed] | [DOI]



 

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