Impacted supernumerary tooth in the horizontal plate of palatine bone: a rare case report

Supernumerary teeth, defined as extra teeth beyond the normal series of dentition, can appear anywhere in the dental arch. They may present as solitary or multiple, unilateral or bilateral, and can be either erupted or impacted. Rarely, supernumerary teeth are found in ectopic locations outside the dental arches, such as the nasal cavity, inferior nasal conchae, maxillary sinus, ethmoid sinus, or skull. To our knowledge, only two cases of supernumerary teeth in the horizontal plate of the palatine bone have been reported globally in the literature. This case represents the third known instance.

A 10-year-old boy presented to the Oral and Maxillofacial Surgery outpatient department (OPD) with his parents, reporting a bony hard swelling on the palate that had been present for three years. The swelling was asymptomatic, with no associated pain or discomfort. Clinical examination revealed a non-tender, bony hard swelling on the midline of the posterior hard palate, with healthy overlying mucosa. A non-contrast computed tomography (NCCT) scan of the face confirmed the presence of an impacted supernumerary tooth in the middle of the horizontal plate of the palatine bone, with the crown oriented posteriorly and the root anteriorly. Surgical extraction was performed under general anesthesia. A palatal crevicular incision was made from the right second molar to the incisive papilla, and a full-thickness mucoperiosteal flap was raised. The impacted supernumerary tooth was located, the overlying bone was removed, and the tooth was extracted in its entirety. The flap was then closed primarily. Postoperative care included antibiotics, analgesics, and daily dressing for five days. The healing was uneventful, with no complications observed during the one-year follow-up.

In cases of swelling in the posterior hard palate, an impacted supernumerary tooth should be considered in the differential diagnosis. Although extraction is the preferred treatment, when supernumerary teeth are located near vital structures and are asymptomatic, close observation with periodic radiographic monitoring is a reasonable management option.