Submandibular approach for a deeply ectopic mandibular second premolar: surgical decision-making considerations

Ectopic teeth are rare entities occurring outside their normal anatomical position, and ectopic mandibular premolars are particularly uncommon. This report describes the management of a deeply ectopic mandibular second premolar located at the inferior border of the mandible. A 16-year-old male patient was referred following incidental radiographic detection. Cone-beam computed tomography revealed buccal cortical perforation and a radiolucent lesion suggestive of a dentigerous cyst. Due to the deep location, limited intraoral access, and proximity to the inferior alveolar nerve, the tooth was removed under general anesthesia using an extraoral submandibular approach. Histopathological examination confirmed a dentigerous cyst. The postoperative course was uneventful, and complete bone healing was observed at 1-year follow-up. The extraoral approach may represent a safe and effective option in selected cases with limited intraoral accessibility.