The connate tooth is a rare developmental anomaly that refers to two teeth united together. The connate tooth is more commonly referred to as double teeth. Supernumerary teeth are additional teeth that may not resemble the morphology of teeth and may occur in any region of the dental arch. Cone-beam computed tomography helps diagnose and visualize concrescence. Diagnosing this rare developmental anomaly is challenging since it occurs beneath the gingival margin. Cone-beam computed tomography helps identify and plan treatment for such concrescence of impacted supplementary teeth to prevent postoperative surgical complications such as maxillary tuberosity or oroantral fistula fracture. Purpose. To present and detect a case of a rare developmental tooth anomaly an impacted connate supplemental tooth by CBCT (Cone Beam Computed Tomography) and it’s treatment. Materials and Methods. The article presents a rare clinical case of a connate tooth in which fusion and concrescence between two impacted supplemental teeth in a 36-year-old male diagnosed using cone-beam computed tomography. CBCT data is presented, which reveals the position of complex anomaly. The clinical significance of CBCT in diagnosing complex supernumerary teeth and its treatment was described. Results. CBCT is essential and helps identify the exact three-dimensional location of rare pathologies such as impacted connate supernumerary teeth. Discussion. CBCT helps precisely locate the position of an impacted connate supplemental tooth. The use of CBCT preoperatively helps to locate complex supernumerary teeth and surgical treatment planning. Conclusion. Cone-beam computed tomography is essential for the identification and exact three-dimensional location of impacted complex supernumerary teeth for surgical treatment planning. Dentists must have a sound knowledge of rare developmental tooth anomalies such as impacted connate teeth with fusion and concrescence. © 2024 Elsevier B.V., All rights reserved.