Sir, abnormal positions of impacted teeth are commonly observed during routine radiographic examination.1 Of these, a total inversion of the involved tooth with the crown pointing towards the maxillary sinus and root apex towards the alveolar crest is considered to be quite rare.2 Of the six reported cases of inverted teeth, two were of impacted maxillary third molars. Asymptomatic inverted maxillary third molars are usually managed conservatively as surgical removal is often rendered difficult due to poor accessibility and the risk of inadvertent slippage of the tooth into the maxillary sinus or infratemporal fossa.3

A 30-year-old female reported to the dental clinic with a chief complaint of pain in the left maxillary posterior region for the past week. No significant dental and medical history was elicited. Clinical examination revealed a missing 28 with a distal periodontal pocket in relation to 27. An intraoral and panoramic radiograph revealed the presence of an impacted maxillary third molar in an inverted position (Fig. 1). Improving the distal periodontal pocket was considered to be difficult due to the presence of the impacted 28 and the patient was given the option to consider surgical removal of the impacted molar. Informed consent was obtained and the tooth was extracted by the transalveolar method. Care was taken to prevent accidental displacement of teeth into the infratemporal fossa or creation of oroantral communication. The postoperative period was uneventful. A careful risk-benefit assessment is mandatory prior to surgical removal of such inverted maxillary third molars.

Figure 1
figure 1

Panoramic view showing inverted molar on left side

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