Delayed Third Molar Development: Report of a Case

<i>Introduction: </i>The delayed development of third molar teeth occurs due to a variety of genetic, evolutionary, environmental, nutritional, and systemic medical factors, as well as maxillary and mandibular developmental skeletofacial disorders. These factors, either alone or in combination, have the potential to influence the complex growth and development of the dentition, including the third molar teeth. <i>Objective: </i>This case report presents an unusual occurrence of differential third molar development in a seventeen-year-old Caucasian female. Tooth #1, the maxillary right third molar tooth, developed in delayed fashion compared to the other three third molars. The purpose of this report is to draw attention to the importance of obtaining contemporaneous panoramic radiographic imaging as a critical component of the examination and treatment planning process when third molar teeth are being consider for removal. <i>Case Presentation: </i>This report presents a case of a seventeen-year-old Caucasian female who had originally presented at age fifteen for examination and consultation regarding proposed removal of her impacted and developing third molar teeth, due to a history of recently completed orthodontic treatment. Her panoramic radiograph at that time demonstrated the absence of #1, and was considered to be a result of agenesis. The parents elected to defer removal of her third molars at that time. She subsequently returned for another consultation appointment at seventeen years of age, at which time panoramic radiographic evaluation demonstrated a minimally developed tooth #1, as compared to her other three third molar teeth. <i>Conclusions: </i>Delayed development of a given tooth, in particular a third molar tooth, can be easily misdiagnosed as agenesis, depending upon the age of the patient when the radiograph was taken. In this case, early removal of the patient’s third molars would have resulted in inadvertent surgical omission, thereby necessitating additional surgical intervention.