Case 2. A male, leucoderma, Brazilian patient, aged 9 years and 11 months, presenting Class 3 malocclusion, sought a private clinic for orthodontic treatment, which was planned in two phases (interceptive and corrective), to be completed with orthognathic surgery. Similarly to Case 1, the initial panoramic radiographs revealed no abnormalities in the dentition (Figures and ).\nIn the first phase of the orthodontic treatment, a modified HAAS expander associated with a facial mask was used for 8 months. Two years later, a new expander and facial mask were recommended for further 6 months.\nDuring the planning of the second phase of the treatment, with complete permanent dentition, an orthodontic/surgical approach was deemed necessary after facial growth had been completed. When additional tests were performed, the radiographic follow-up revealed the presence of three supernumerary teeth in the premolar region (Figures and ). Surgical removal of all third molars as well as the 3 supernumerary teeth was performed in a hospital setting under general anesthesia, along with the surgery for the correction of deviated nasal septum ().\nAt 20 years and 5 months, during orthognathic surgery planning, a new radiographic image showed a supplemental supernumerary tooth in the left mandibular premolar region (), which was also surgically removed.
A 15-year-old male patient (III-1) from Shanghai visited the department of pedodontics of the Affiliated Stomatology Hospital of Tongji University with a chief complaint of pain in the right posterior mandibular region. The patient's medical and family histories were inconclusive. Patients from this family have had a family history of Gardner syndrome.