20/08/2026
Case of the Day:
During pre-orthodontic planning for a 12-year-old patient, CBCT imaging revealed an incidental palatally impacted supernumerary tooth that was not detectable on the initial panoramic radiograph.
The systemically healthy patient presented for routine orthodontic assessment, with mild maxillary anterior crowding and concerns regarding dental alignment and aesthetics.
Although the panoramic radiograph appeared unremarkable, the CBCT scan identified a deeply positioned conical supernumerary tooth within the palatal cortical bone.
Its location had masked it on the panoramic image because of anatomical overlap and superimposition from the hard palate.
Surgical removal was performed under general anesthesia. A full-thickness palatal mucoperiosteal flap was raised, followed by a conservative and precise osteotomy to expose and retrieve the impacted tooth.
The procedure was completed without compromising the vitality, periodontal support, or integrity of the adjacent teeth.
This case highlights the value of three-dimensional imaging in selected orthodontic patients, particularly when conventional radiographs may conceal impacted or supernumerary teeth.
The case was first referred by dr Mohamed naeem
For pediatric evaluation of MIH affected first permanent molars
And then referred to orthodontic assessment
Lucky to be among such a great team
Dr Khaled AboulAzm
Dr Mohamed Naeem Mostafa
Nada Mamdouh and Rowan Mamdouh
General anesthesia deleivered and maintained by Dr Sherif al Hadi
