Geminated Supernumerary Premolar Impacted in the Palate: A Report of a Rare Case and Review of the Literature.

Supernumerary teeth are dental anomalies characterized by the presence of an excessive number of teeth in relation to normal dentition. Among these, the supernumerary premolars have a prevalence of 0.29% to 0.64%, making it a very rare finding. On the other hand, gemination is a developmental disturbance in the shape of the teeth where a partial cleavage of a single tooth germ results in the formation of a singular root and a singular pulp chamber but two partially or totally separated crowns. Although these anomalies as individual entities are fairly common in clinical practice, the occurrence of both anomalies in a single tooth is an extremely rare occurrence. We hereby report a rare case of impacted geminated supernumerary premolar in a 45-year-old female patient. A thorough search of the literature revealed that only four cases listing this anomaly have been reported in the literature thus deserving a mention. In addition to the case presentation, the authors have also reviewed the existing literature on this anomaly.

The Palatal Elevation Technique (PET) for Intra-alveolar Extraction of Grossly Decayed Maxillary Third Molars.

Intra-alveolar extraction of maxillary third molars always poses a challenge to dental practitioners owing to limited accessibility and minimal space for dental forceps application. Dental elevators facilitate the extraction of such teeth. In the traditional technique as described in the literature, the elevator is always introduced from the mesiobuccal aspect of the tooth to engage the space between the interdental bone and the offending tooth to use it as a fulcrum. However, certain situations prevent proper application of the elevator from the buccal aspect of the offending tooth to bring about luxation. One such situation is a grossly decayed third molar tooth, especially from the mesiobuccal aspect with destruction of the tooth substance extending below the cementoenamel junction. Another such situation is observed in patients presenting with thick and inextensible cheeks but a good interincisal opening. In either situation, it becomes very challenging to achieve a good purchase for luxation of the offending third molar. The authors have therefore described a modified technique of tooth elevation, the palatal elevation technique (PET), using the palatal bone instead of the buccal bone as the fulcrum which was observed to be effective in such situations. In the authors' view, PET is simple and quick and can effectively be employed as an alternative to the traditional technique of tooth elevation in all cases that require an intra-alveolar extraction of maxillary third molars.