Impacted inverted parapremolar

The presence of supernumerary teeth in a maxillary premolar region is not uncommon. Supernumerary teeth in the premolar region are known as parapremolars.¹ According to orientation, supernumerary teeth can be vertical, inverted or transverse.² The presence of these teeth may result in various clinical problems like failure of eruption of adjacent teeth, displacement, crowding, and dentigerous cyst formation.³

A 12-year-old patient reported to Faculty of Dentistry, SEGi University with the complaint of spacing between upper right back teeth. Intra-oral examination revealed spacing between the maxillary right premolars. An intra-oral periapical radiograph showed an impacted inverted supernumerary tooth present between the maxillary premolars. To rule out the possibility of bilateral supernumerary teeth, an orthopantomogram was taken (Figure 1). The need to extract the inverted, impacted parapremolar followed by orthodontic treatment for space closure was explained to the parents and informed consent was obtained from them. A portion of root of the inverted parapremolar was removed by sectioning. Guttering around the buccal bone was performed and a crown portion of the tooth was removed. Orthodontic therapy is currently ongoing to close the space between the premolars (Figure 2).

A clinician needs to be aware of the possibility of impacted supernumerary teeth and should recognize signs suggestive of their presence. Clinical problems associated with impacted inverted mesiodens has been previously reported,³ but spacing associated with impacted inverted parapremolars has not been reported thus far. Surgical management of the impacted supernumerary teeth, orthodontic management and management of keratinized gingival tissue are critical factors that can affect the prognosis in such cases.⁴ Early identification and appropriate treatment of impacted supernumerary teeth and the associated conditions can prevent or minimize the complications.²