Case Report: An overlooked inverted supernumerary tooth: a rare presentation with nasal invasion and its diagnostic and therapeutic implications.

BACKGROUND

Supernumerary teeth (STs) are common odontogenic anomalies, while inverted STs with palatal perforation and nasal invasion are extremely rare and carry a high risk of misdiagnosis. This case highlights the value of interdisciplinary awareness and advanced imaging.

CASE

INTRODUCTION

A 9-year-old boy with unilateral nasal obstruction (previously misdiagnosed as rhinitis) was referred to dentistry due to dental trauma. Initial panoramic X-ray identified an inverted ST but lacked clarity. Subsequent cone-beam computed tomography (CBCT) with multiplanar reconstruction and 3D segmentation confirmed an inverted ST in the anterior maxilla with palatal perforation and nasal invasion. The tooth was extracted via a minimally invasive palatal approach guided by a 3D model, resulting in immediate resolution of nasal symptoms and a good postoperative recovery.

CONCLUSION

Odontogenic causes must be included in the differential diagnosis for children with refractory unilateral nasal symptoms, highlighting the critical need for interdisciplinary collaboration between dentists and otorhinolaryngologists. While panoramic X-ray is a useful preliminary screening tool, CBCT is essential-not only for accurate preoperative diagnosis and safe, minimally invasive surgical planning but also for postoperative confirmation of complete removal.