CASE REPORT: THE FORTH MAXILLARY MOLARS IN WOMAN LIVING IN THE IV CENTURY A.D.
Authors: Kaskova L.F. , Yanko N.V. , Artemyev A.V. 
Published: April 2022

Supernumerary teeth in humans are considered as those in addition to the normal series of deciduous or permanent dentition. Distomolars or the forth molars that erupt behind wisdom teeth are found in 0,18–3,8% of the modern population, but are quite rare compared to other supernumerary teeth. Odontologic studies of ancient and contemporary populations allow not only evaluate health state, life style and diet of people, but explain etiology, clinic manifestations and treatment of dentomaxillary abnormalities. The forth molars mostly are mostly described in people over the period of the XIX-XXІ centuries and only few researchers presented this variant in ancient people.

The aim of the study was to estimate a case of supernumerary teeth in human remains, which represented by Chernyachov archarological culture artefacts. Sex and death age were established by methods widely accepted in anthropology. The method of analysis of dento-maxillary region developed by the authors and orthopantomography were used for dental examination.

An undamaged skeleton was found during archaeologic expedition nearby the town of Shyshaki, Poltava region (burial No 112) in 2016 and now are kept at Archaeological Site Preservation and Research Centre (Poltava). Archaeologists defined the remains dated by the end of the IV c. AD. The skeleton belonged to 1820 years` women was in a good state; no pathological changes of the skeleton were found. Maxilla of the skeleton had supernumerary forth molar (tooth 19) and alveolar sockets of teeth 13, 12, 21, 22, 25, 27, 28 and 29 recorded as being lost anteand postmortem. Teeth presented neither enamel hypoplasia nor tooth wear. Root of tooth 19 was immature.

Etiology of supernumerary teeth is still unclear yet, but there are no data supporting atavistic theory. Bilateral distomolars could be a symptom of systemic abnormalities of dentofacial region, but the skeleton studied had no pathological changes, so this abnormality could not be characterized as systemic. Supernumerary teeth could be described as a congenital anomaly associated with chromosome, autosome or dominant transmission, but the authors do not have enough evidence to prove such nature of this anomaly. This studied case is more likely related to the theory of hyperactivity of dental lamina during follicle development that dominates nowadays.

According to morphological classification, supernumerary teeth in our case are of premolar shape.

Сlinical manifestations of distomolars can be different. Distomolars can be asymptomatic and rarely found erupted; they may provoke no problems or hurt buccal mucosa. Also a retained distomolar may cause retention and pericoronaritis of the third molar, development of keratoand paradental cysts, localized periodontitis, decompression of lower alveolar nerve, or manifests itself in jaw fracture. Oral signs of retained distomolar are mobility of the third molar, discomfort feeling in retromolar area, bulging of mandible. Supernumery and retained teeth are mostly found by X-ray examinations usually taken for non-related dental problems. The distomolars investigated were retained and the mosy likely caused no problems.

Basic methods of the treatment of the fourth molars are extraction and observation, however, choice of the treatment method depends on clinical manifestations and estimation of individual risk factors.

Supernumerary retained fourth molars in the studied woman are non-systemic distomolars with premolar shape. Taking into account that most of the fourth molars are detected by X-ray examination, dentists should be careful not to miss this abnormality.