Case 1. A female, leucoderma, Brazilian patient, aged 7 years and 3 months, presenting mouth breathing and skeletal Class II, division 2 malocclusion, sought a private clinic for orthodontic treatment. The initial panoramic radiograph revealed no abnormalities in the dentition ().\nOrthodontic treatment started two years later, when the patient was aged 9 years and 4 months. The corrective phase of the treatment occurred after the interceptive phase. For the treatment of the Class II malocclusion, an orthopedic expansion device across the upper and lower arches was placed over a period of 12 months. After this period, a lingual bar was adapted, and a follow-up radiograph was required because tooth 84 exhibited no physiological mobility and was the last deciduous teeth to remain in the oral cavity. Control radiographs obtained at 31 and 38 months after the first initial radiographic assessment revealed the early formation of a supernumerary tooth in the right mandibular premolar region (Figures and ). There were no reports of supernumerary teeth in the family. Due to its location, surgical removal was indicated.\nBefore beginning the second phase of the treatment, additional tests and a new panoramic radiograph were requested, which revealed the formation of a supplemental supernumerary tooth, this time in the left mandibular premolar region (), which was also surgically removed.\nControl panoramic radiographs taken at two different moments along the orthodontic treatment demonstrated no evidence of further supernumerary teeth ().
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.