Application of digital positioning guide plates for the surgical extraction of multiple impacted supernumerary teeth: A case report and review of literature

Figure 1 Preoperative panoramic radiograph. The yellow arrows show the positions of the seven impacted SNTs. The red circle shows a local low-density area close to the pulp cavity in tooth #36.

Figure 2 Preoperative cone-beam computed tomography images. A: Right maxilla imaging of the supernumerary teeth (SNTs); B: Left maxilla imaging of the SNTs; C: Right mandible imaging of the SNTs; D: Left mandible imaging of the SNTs. Left: Horizontal images; Middle: Coronal images; Right: Sagittal images.

Figure 3 Treatment process for tooth #36. A: Gutta-Percha cone fitting and working length confirmation with a periapical radiograph; B: Postobturation periapical radiograph. C: Restoration of tooth #36 with an all-ceramic crown.

Figure 4 Design and fabrication process of the digital positioning guide plates. From left to right, (1) oral scan; (2) reconstruction of the shapes of the impacted Supernumerary teeth; (3) preoperative analysis and design of the surgical guide plate with computer-aided design software; and (4) fabrication of the surgical guide plate with a (computer-aided manufacturing) 3D printer.

Figure 5 Surgical supernumerary teeth extraction procedure. A: Supernumerary teeth (SNT) extraction from the right maxilla; B: SNT extraction from the left maxilla; C: SNT extraction from the right mandible; D: SNT extraction from the left mandible; from left to right: the surgical guide plate in position, exposure of the SNTs, and extracted SNTs and third molars.

Figure 6 Postoperative panoramic radiograph. The seven impacted supernumerary teeth and two impacted mandibular third molars were completely extracted.

Figure 7 Postoperative cone-beam computed tomography imaging. A: Right maxilla imaging of the supernumerary teeth (SNTs); B: Left maxilla imaging of the SNTs; C: Right mandible imaging of the SNTs; D: Left mandible imaging of the SNTs. Left: Horizontal images; Middle: Coronal images; Right: Sagittal images.