ANATOMICAL VARIATIONS OF MAXILLARY DISTOMOLARS AND THEIR RELATIONSHIP WITH THE MAXILLARY SINUS: A CBCT-BASED REVIEW

Dorin Ioan Cocoș, Kamel Earar, Mariana Păcurar

Abstract

Supernumerary molars represent an uncommon anatomical variation of the dentition, with distomolars being among the rarest forms encountered in clinical practice. Their occurrence is most frequently documented in the maxilla, where their location distal to the third molar and their frequent impaction introduce diagnostic and surgical challenges. Unlike anterior supernumerary teeth, which are usually clinically evident, maxillary distomolars tend to remain asymptomatic and are often discovered incidentally on imaging. Their anatomical proximity to the maxillary sinus increases the risk of perforation or oroantral communication during extraction, highlighting the need for precise preoperative assessment. Conventional panoramic radiography is useful for initial detection but cannot reliably evaluate sinus involvement or three-dimensional anatomical variation. In contrast, CBCT provides superior accuracy in assessing the depth of impaction, morphology, and spatial relationships with the sinus floor. This review synthesizes current evidence regarding the etiology, anatomical features, radiological characterization, and clinical implications of maxillary distomolars, emphasizing the relevance of CBCT in treatment planning. Understanding their three-dimensional behavior supports a more predictable, anatomy-guided surgical approach and reduces the likelihood of postoperative complications. Improved imaging-based classification systems are essential for future refinement of risk assessment and management strategies.

DOI : 10.62610/RJOR.2025.3.17.26