Bilaterally impacted mandibular supernumerary premolars associated with unusual clinical complications
A 38-year-old male patient reported to the Department of Oral Medicine and Radiology with complaint of pus discharge from the right lower third of face of 2-3 months duration. Family, medical, and dental histories were non-contributory. Extra oral examination revealed a draining sinus surrounded by indurated granulation tissue on the right lower border of the mandible 4 cm away from the midline in the molar region [].\nIntraoral examination revealed caries broken right mandibular molar along with pus discharge from the same []. An orthopantomograph view was taken that revealed presence of completely developed bilateral supernumerary premolars below the first molars. Right supernumerary premolar was placed near the lower border of mandible and was surrounded by intense pericoronal radiolucency of about 5-6 mm without sclerotic borders. The right first molar was caries broken and showed periapical radiolucency with both root apices, and track of radiolucency was running down from the apex of mesial root to involve the pericoronal radiolucency of the right supernumerary premolar. On the left side, supernumerary premolar was placed near the apex of the first molar with its follicle almost in close approximation with the root apices of the first molar. Taurodontism was observed with all the molars []. Considering the clinical and radiographic findings, a provisional diagnosis of supernumerary premolar associated secondarily infected dentigerous cyst with extra oral draining sinus on the right side and supernumerary premolar occurring in close vicinity of the left first molar on the left side and taurodontism of all molars was made.\nThe right supernumerary premolar associated with the cystic lining around its crown along with the extra oral chronic indurated tissue was surgically removed extra orally under local anesthesia. Extraction of the right carious broken first molar was performed. Sinus lining was completely removed []. The left supernumerary premolar was surgically removed intra orally under local anesthesia. Post operative healing was uneventful [Figures and ].