Clinical Assessment & Presentations
Intraoral Features
Loss of leeway space
Some of the earliest signs or presentation of ectopic premolars may be the loss of space due to early loss of deciduous molars. The first permanent molars have a tendency to drift mesially into the missing Es space and this can cause a loss of leeway space. This may also happen in the early loss of Ds. The loss of space is normally quicker and larger in the maxilla than the mandible. The dentist should be aware of the potential loss of space and decide or refer the patient for orthodontic assessment to determine if a space maintainer to prevent crowding and ectopic premolars is ideal for the patient.
Ectopic eruption of premolar
Ectopic premolars can present as a partially erupted or fully erupted teeth on the lingual or buccal alveolar ridge. Normally a sign of severe crowding these ectopic premolars do not have space to erupt in the normal arch form. Early assessment and referral to an orthodontist to assess if space creation for retrieval of the premolars or their extractions are warranted.
Radiographic signs
Unerupted ectopic premolars can be identified on panoramic radiographs. The milder ectopic premolars will often appear with their crowns tipped into the adjacent teeth due to the lack of arch space. In the above figure, the lower second premolars are mesially tipped into the first premolars and are erupting on the lingual side of the alveolus. In the upper arch, the left second premolar has erupted in a palatal position to the left first premolar and this can be seen with the almost complete superimposition of the two left premolars.
