title: Bilateral mandibular fourth molars: A case report.
abstract: BACKGROUND
  Fourth molars are supernumerary teeth located distal to the third molars that may cause local alterations. Therefore an adequate diagnosis and treatment are essential. Removal of the supernumerary tooth and, in selected cases, maintenance of the tooth on the arch and frequent observation are the preferred treatments. If the extraction is recommended, it should be performed carefully by experienced oral surgeons to prevent damage to the anatomical structures.
  
  
  METHODS
  The oral examination of a 26-year-old woman revealed a left partially impacted mandibular molar responsible for pain and infection. Although it was assumed it was a third molar, the panoramic radiograph showed that the real third molar was completely impacted and that two partially impacted mandibular fourth molars were present bilaterally. Both of them were removed without complications and the left third molar was extracted after fragmentation to avoid any injury of the contiguous inferior alveolar nerve.
  
  
  CONCLUSIONS
  The extraction of the left fourth molars solved the pain. Even if the right fourth molar was asymptomatic, the patient accepted its extraction because of the evident radiographical pericoronitis and to avoid further complications. "Asymptomatic" does not mean absence of disease, but the patient's consent is mandatory before any decision.
authors.affiliation: Magister Program in Oral Implantology, Faculty of Dentistry, National University of La Plata, La Plata, Argentina.
authors.forename: A
authors.initials: A
authors.lastname: Costantino
authors.affiliation: Department of Oral Pathology, Faculty of Dentistry, National University of Cordoba, Cordoba, Argentina; CIMA Research Group, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile. Electronic address: gabriel_fonseca@argentina.com.
authors.forename: G M
authors.initials: GM
authors.lastname: Fonseca
authors.affiliation: CIMA Research Group, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile; Doctoral Program in Morphological Sciences, CEMyQ, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile; Center of Research in Biomedical Sciences, Universidad Autónoma de Chile, Temuco, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Cantín
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008334:Mandible / Q000601:surgery; D008964:Molar, Third / Q000000981:diagnostic imaging / Q000601:surgery; D011862:Radiography, Panoramic; D014081:Tooth Extraction; D014095:Tooth, Impacted / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014096:Tooth, Supernumerary / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Cas clinique; Case reports; Chirurgie orale; Fourth molars; Oral surgery; Quatrième molaire