{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T16:04:57Z","timestamp":1784217897497,"version":"3.55.0"},"reference-count":22,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,5]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>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.<\/jats:p>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2025-268281","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T15:20:14Z","timestamp":1784215214000},"page":"e268281","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["CBCT-based selection of lingual access for removal of two impacted supernumerary teeth in the mandibular premolar region"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9670-1079","authenticated-orcid":false,"given":"Horatiu","family":"Urechescu","sequence":"first","affiliation":[{"name":"Maxillofacial Surgery, University of Medicine and Pharmacy Victor Babes, Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Cuzic","sequence":"additional","affiliation":[{"name":"Prosthodontics, University of Medicine and Pharmacy Victor Babes, Timi\u0219oara, Romania"},{"name":"TADERP Research Center\u2014Advanced and Digital Techniques for Endodontic, Restorative and Prosthetic Treatment, University of Medicine and Pharmacy Victor Babes, Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia","family":"Streian","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery, University of Medicine and Pharmacy Victor Babes, Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Pricop","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery, University of Medicine and Pharmacy Victor Babes, Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"2026071608200814000_19.7.e268281.1","first-page":"14","article-title":"Determination of the optimum time for surgical removal of unerupted anterior supernumerary teeth","volume":"32","author":"Omer","year":"2010","journal-title":"Pediatr Dent"},{"key":"2026071608200814000_19.7.e268281.2","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.ajodo.2023.01.004","article-title":"Interventions to facilitate the successful eruption of impacted maxillary incisor teeth due to the presence of a supernumerary: A systematic review and meta-analysis","volume":"163","author":"Seehra","year":"2023","journal-title":"Am J Orthod Dentofacial Orthop"},{"key":"2026071608200814000_19.7.e268281.3","doi-asserted-by":"crossref","DOI":"10.3390\/genes13122232","article-title":"Genetic, Epigenetic and Environmental Factors Influence the Phenotype of Tooth Number, Size and Shape: Anterior Maxillary Supernumeraries and the Morphology of Mandibular Incisors","volume":"13","author":"Khalaf","year":"2022","journal-title":"Genes (Basel)"},{"key":"2026071608200814000_19.7.e268281.4","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.1016\/j.tripleo.2008.01.035","article-title":"Characteristics of 283 supernumerary teeth in southern Chinese children","volume":"105","author":"Anthonappa","year":"2008","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"2026071608200814000_19.7.e268281.5","doi-asserted-by":"crossref","DOI":"10.3389\/fdmed.2025.1495025","article-title":"Radiographic localization of supernumerary teeth: a narrative review","volume":"6","author":"Mallineni","year":"2025","journal-title":"Front Dent Med"},{"key":"2026071608200814000_19.7.e268281.6","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s40368-013-0082-z","article-title":"Aetiology of supernumerary teeth: a literature review","volume":"14","author":"Anthonappa","year":"2013","journal-title":"Eur Arch Paediatr Dent"},{"key":"2026071608200814000_19.7.e268281.7","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjt101"},{"key":"2026071608200814000_19.7.e268281.8","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1002\/ajmg.a.61316","article-title":"Elements of morphology: Standard terminology for the teeth and classifying genetic dental disorders","volume":"179","author":"de La Dure-Molla","year":"2019","journal-title":"Am J Med Genet A"},{"key":"2026071608200814000_19.7.e268281.9","doi-asserted-by":"crossref","unstructured":"Prasad P , Ahirwal S , Kumar V , et al . 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