Morphology Analysis of Human Fourth Molars Using Computed Microtomography - Pilot Study


  • Ana Clélia Roussenq Baracho
  • Eun Sol Cho
  • Nayara Ramos de Almeida Torres
  • Thiago Gomes da Silva
  • Antonio Adilson Soares de Lima



Supernumerary tooth, Fourth molar, Hyperdontia, X-Ray Microtomography, Forensics


Analyze the morphological characteristics of fourth molars from non-syndromic patients using computed microtomography (microCT). Five human fourth molars (case group) and other three third molars (control group) were obtain from Biobank of UFPR Dentistry School. The teeth were submitted to macroscopic and microCT analysis. Sample characteristics: 60% of the teeth from the lower arch, mainly from the right lower arch (40%). The results showed that eighty percent of the teeth were impacted and all of them presented normal morphology. The microCT revealed that one of the fourth molars had hypercementosis. Concerning the root canal anatomy, all of the fourth molars studied had just one principal root canal. Four teeth had one collateral canal that ended at the lateral face of the root. The volume average of root canal, dentine and enamel were respectively 9.27 mm3, 122.64 mm3 and 74.71 mm3. The averages between these variables in third molars were 46.98 mm3, 473.25 mm3 and 198.34 mm3, respectively. Proportionally, the volume of the fourth molars was five times less than the third molars, but the dentine and enamel volume were, respectively, 3.8 and 2.7 times less than third molars. The fourth molar teeth usually showed only one principal root canal and it can be associated with other alterations, such as hypercementosis. Although the fourth molars were smaller, the proportion of enamel volume is bigger than third molar in comparison.


de Oliveira FT, Capelozza AL, Lauris JR, de Bullen IR. Mineralization of mandibular third molars can estimate chronological age--Brazilian indices. Forensic Sci Int. 2012;219(1-3):147-150.

De Tobel J, Radesh P, Vandermeulen D, Thevissen PW. An automated technique to stage lower third molar development on panoramic radiographs for age estimation: a pilot study. J Forensic Odontostomatol. 2017;35(2):42-54.

Baskarraj Monica, Gupta Y Mogit, Kumari R Ranjana, Samuel A Victor, Kannan Sri Sakthi Dorai, Mahesh Ramakrishnan Forensic odontology: Supernumerary teeth, their importance, and a radiographic study in identifying supernumerary teet Int Journal of Forensic Odontology. 2016;1(2):39-42.

Ceperuelo D, Lozano M, Duran-Sindreu F, Mercadé M. Supernumerary fourth molar and dental pathologies in a Chalcolithic individual from the El Mirador Cave site (Sierra de Atapuerca, Burgos, Spain). Homo. 2015;66(1):15-26.

Schmidt A, Assao G, Ramalho-Ferreira L, Faverani,D O. An Uncommon Occurrence of Three-Fourth Molars Concomitant to Hypodontia in a Nonsyndromic Patient Journal of Craniofacial Surgery. 2017;28(2):482–483.

Refoua Y, Arshad M, An unusual case of bilateral Maxillary and Mandibular supernumerary teeth. J Dent. 2006;3:140–2.

Ohata H, Hayashi K, Iwamoto M, Muramatsu K, Watanabe A, Narita M, Suga K, Takano N, Shibahara T. Three Cases of Distomolars. Bull Tokyo Dent Coll 2013; 54(4):259–64.

Rajab LD, Hamdan MA. Supernumerary teeth: review of the literature and a survey of 152 cases. Int J Paediatr Dent. 2002;(12):244–54.

Brook AH. Dental anomalies of number, form and size: their prevalence in British school children. J Int Assoc Dent Child. 1974;(5):37–53.

Mitsea A, Vardas E, Papachatzopoulou A, Kalfountzos G, Leventis M, Tsiklakis K. The frequency of non-syndromic distomolar teeth in a Greek population sample? J Clin Exp Dent. 2015;7(5):589-94.

Kaya E, Güngör K, Demirel O, Özütürk Ö.Prevalence and characteristics of non-syndromic distomolars: a retrospective study. J Investig Clin Dent. 2015;6(4):282-6.

Hattab FN, Yassin OM, Rawashdeh MA. Supernumerary teeth: report of three cases and review of the literature. ASDC J Dent Child. 1994;(61):382–93.

Tochihara Y. Study of supernumerary teeth in the molar region in man. The Shikwa Gakuho. 1936;41:24–37.

Okamoto O, Saito M, Imai S, Fujikawa M, Akiba M, Kishida M. Supernumerary teeth of the mandible: report of 16 cases. The Shikwa Gakuho 1963;(63):552–8.

Yashiro M, Yosue T, Kai Y, Kawano T, Hosoi K, Sumi T, Takei H, Furumoto K, Ihara S. Radiographical study of supernumerary teeth with special reference to the upper molar region. Shigaku. 1987;(75):1013–21.

Finkelstein T, Shapira Y, Pavlidi AM, Schonberger S, Blumer S, Sarne O, Shpack N. Prevalence and Characteristics of Supernumerary Teeth in Israeli Orthodontic Patients J Clin Pediatr Dent 2019;43(4):244-51.

Bolk L. Supernumerary teeth in molar region in man. Dental Cosmos. 1914;56:154–67.

Sumida T, Murase R, Yoshimura T, Aramoto T, Ishikawa A, Hamakawa H. A case of impacted supernumerary fourth molar in the bilateral mandibular ramus. Oral Science Inter. 2009;6(2):106-8.

Demirjian, H. Goldstein, J.M. Tanner, A new system of dental age assessment, Hum. Biol. 1973;45:211–27.

Mincer HH, Harris EF, Berryman HE The ABFO study of third molar development and its use as an estimator of chronological age. J Forensic Sci 1993;38:379–90.

Anthonappa RP, King NM, Rabie AB, Mallineni SK. Reliability of panoramic radiographs for identifying supernumerary teeth in children. Int J Paediatr Dent 2012;22:37-43.

Silva DN, Bezerra MF, Guimarães KB, Brücker MR. Métodos radiográficos no diagnóstico de quartos molares mandibulares. Revista da Faculdade de Odontologia. 2007;12(2):79-83.

Bjørk MB, Kvaal SI, CT and MR imaging used in age estimation: a systematic review. J Forensic Odontostomatol. 2018;1(36):14-25.

Fernández-Bodereau E, Dedossi G, Asencio VO, Fernández-Domínguez M, Gehrke AS, Aragoneses JM, Calvo-Guirado JL. Comparison of Different Bone Filling Materials and Resorbable Membranes by Means of Micro-Tomography. A Preliminary Study in Rabbits Materials 2019;12(8):1197.

Thesleff I. Interactions between the extracellular matrix and the cell surface determine tooth morphogenesis and the cellular differentiation of the dental mesenchyme. Ontogenez. 1989;20(4):341-9.

Jernval J, Thesleff I.Tooth shape formation and tooth renewal: evolving with the same signals. Development. 2012;139(19):3487-97.

Thesleff I, Tummers M. Tooth organogenesis and regeneration. In: StemBook. Cambridge (MA): Harvard Stem Cell Institute; 2008.

McCollun M, Sharp PT. Evolution and development of teeth. J Anat. 2000;199(1-2):153-159.

Schulze C. In: Thoma’s Oral Pathology. 6th ed. St Louis, Mo: CV Mosby; 1970. Developmental abnormalities of the teeth and jaws; p. 112–22.

Hall BK. Developmental mechanisms underlying the formation of atavisms. Biological Reviews. 1984;59(1):89–122.

Moore SR, Wilson DF, Kibble J. Sequential development of multiple supernumerary teeth in the mandibular premolar region – a radiographic case report. Int J Paediatr Dent. 2002;12:143–5.

Gunduz K, Muglali M. Non-syndrome multiple supernumerary teeth: A report. J Contemp Dent Pract. 2007;8:81–7.

Yague-Garcia J, Berini-Aytes L, Gay-Escoda C. Multiple supernumerary teeth not associated with complex syndromes: a retrospective study. Med Oral Patol Oral Cir Bucal. 2009;14:331–6.

Diaz A, Orozco J, Fonseca M. Multiple hyperodontia: report of a case with 17 supernumerary teeth with nonsyndromic association. Med Oral Patol Oral Cir Bucal. 2009;14:229–31.

Gardiner JH. Supernumerary teeth. Dent Pract. 1961;12:63–73.

Núñez SM, Chun YH, Ganss B, Hu Y, Richardson AS, Schmitz JE, Fajardo R, Yang J, Hu JC, Simmer JP.Maturation stage enamel malformations in Amtn and Klk4 null mice. Matrix Biol. 2016;52(54):219-33.




How to Cite

Ana Clélia Roussenq Baracho, Eun Sol Cho, Nayara Ramos de Almeida Torres, Thiago Gomes da Silva, & Soares de Lima, A. A. (2020). Morphology Analysis of Human Fourth Molars Using Computed Microtomography - Pilot Study. Brazilian Journal of Forensic Sciences, Medical Law and Bioethics, 9(4), 570–581.



Original Article