CBCT-based selection of lingual access for removal of two impacted supernumerary teeth in the mandibular premolar region.

Supernumerary teeth may lead to crowding, eruption disturbances and orthodontic complications, particularly when located in the mandibular premolar region. We report the case of a male teenager referred for orthodontic assessment in whom cone-beam CT (CBCT) revealed two impacted supplementary supernumerary teeth positioned lingually in the left mandibular premolar region, in close proximity to the adjacent roots and without cortical perforation.Surgical removal was indicated. A comparison of potential access routes based on CBCT analysis showed that a buccal approach would have required a longer transosseous path and more extensive bone removal across the adjacent roots. Therefore, a lingual approach was selected as the most direct and least invasive option. The supernumerary teeth were removed under local anaesthesia using a lingual full-thickness flap and limited osteotomy.Healing was uneventful, with no neurosensory deficit and stable radiographic findings at the 2-year follow-up. This case highlights that the choice of surgical approach should be based on a CBCT-guided comparison of access pathways. In selected mandibular premolar cases, a lingual approach may reduce bone removal and risk to the adjacent teeth when it provides the shortest and safest route, provided that lingual soft tissue risks are carefully managed.