The tomograms precisely indicated that the crown of the right macrodont pre-molar was aligned lingually and was in very close proximity to the root of the moreover first premolar. Both the 2- and 3-dimensional tomographic images con-firmed that the second premolars had multitubercular crowns and single conical roots with a large, single root canal space (Figure 3). Figure 3 Cone beam CT scans of the macrodont premolars: A. Frontal view, B. Horizontal view. 3D tomograms of the jaws (C), and the right (D) and left (E) macrodont premolars, showing their position, size and morphology. The teeth were surgically removed in 2 consecutive sessions under local anesthesia. Both teeth were sectioned at the cervical level before elevation due to abnormal dimension of the tooth crowns (Figure 4).

Healing was uneventful in both the cases. The crowns of the extracted premolars measured 15.3 mm (right) and 13.16 mm (left) mesiodistally, and 10.7 mm (right) and 10.5 mm (left) buccolingually. After 2 months, fixed appliance therapy was initiated by the orthodontist to correct malocclusion. DISCUSSION Being an extremely rare condition,13 macrodontia of mandibular second premolars has been reported exclusively in children (8�C14 years) with only 1 exception.8 Indeed, disturbances with the eruption of macrodont second premolars and concomitant disruption of developing occlusion or alveolar/gingival enlargement become evident before or between the ages of 11 and 12, when the eruption of mandibular second premolars usually occurs.

10 Thus, any intervention should be completed before maturity, and, in light of previous reports, extraction appears to be the only available intervention.10,12,13 Following extraction, orthodontic treatment should be started in a timely manner due to disturbances in the arch and occlusion after surgical intervention.12,18 The interpretation of conventional radiographs is dependent on the clinician��s appreciation as well as his/her knowledge and experience in assessing 2-dimensional images. Radiographic images may fail to locate accurately some anomalies relative to neighboring teeth because of superimposition of adjacent structures. In the present case, the conventional radiographs provided insufficient information to diagnose accurately the location of the macrodont premolars in the vertical and horizontal plane, as well as their exact relationship to the neighboring teeth and inferior alveolar verve.

Supplementing plain view radiography with CBCT demonstrated great usefulness in showing the 3-dimensional orientation of impacted Drug_discovery premolars within the alveolus, while allowing for detailed, non-destructive investigation of tooth morphology. The additional dose to the patient from the CBCT investigation can be justified by the present case; the information gained was of clear benefit in planning the surgical technique, particularly, in the macrodont left premolar.