An interesting article titled “Bilateral Inverted and Impacted Mandibular Third Molars: A Rare Case Report” written by Yara Mohamed Talib and et. al appears in Cureus on March 23, 2023 (vol. 15, no. 3, e36573. ). The article discussed two cases of inverted and impacted lower wisdom teeth that is very rare and very few cases have been reported in literature.
In the article discussion is made of an impacted wisdom tooth that occurs when the tooth is unable to erupt normally because of a lack of room or a blockage from eruption. When a tooth is in a buccolingual position it is also noted as an inverted impaction. In the article two cases of bilateral impacted lower wisdom tooth were reported along with the radiographs.
In the first case a 50 year old woman from Jordan presentned with persistent bleeding while brushing and missing front teeth and pain in the lower jaw. An orthopantomogram was performed and showed bilateral, impacted wisdom teeth that were inverted. Further, cone beam computed tomography (CBCT) was performed. The woman was told to have wisdom teeth sugery but she refused to undergo the surgery as she was concerned for her other dental problems.
In the second case, a 32 year old woman from Syria had severe pain in a tooth and had a periapical infection and distal caries. She had an inordinate amount of plaque and calculus deposition and in the past had loss teeth due to decay. An orthopantomogram was performed and it was found that she had an inverted wisdom tooth.
This image is from Yara Mohamed Talib and et. al , “Bilateral Inverted and Impacted Mandibular Third Molars: A Rare Case Report,” Cureus, March 23, 2023, vol. 15, no. 3, e36573 and has a Creative Commons license.
The authors state that inversion is a malposition of a tooth where it has reversed in the upside-down position. Tooth inversion can occur due to a peculiar growth of odontogenic epithelium before the tooth bud forms. The authors state that conservative treatment is prefered for bilateral inverted lower wisdom tooth if they are pathology-free and fully covered by bone and mucosa. They say:
“For the removal of teeth that are inverted, there are no established therapeutic guidelines. The safest course of action is conservative treatment, which postpones tooth extraction until pathological symptoms appear.”
When considering surgery for such teeth the health and age of the patient and potential for complications shoul be considered. Surgically extracting inverted wisdom teeth can require aggressive bone removal. The authors would like to see additional case reports of inverted wisdom teeth collected in the future.
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