(Background) Hyperdontia is an excess in the total number of teeth and if their morphology resembles a normal tooth, they are called supplementary teeth. Its etiology is not yet understood in its entirety but there are several hypotheses on the matter. (Aim) In this case report, we present the accidental finding of a supernumerary tooth in a 57-year-old woman through a digital panoramic x-ray and we discuss its approach. (Material and Methods) When the computed cone beam tomography was requested, the tooth was characterized with morphometric measurements. (Results) The mesiodens, small, with a conical crown and curved root, was observed in a palatal position relative to teeth 1 1 and 1 2, in distoversión (its crown was in contact with the root of tooth 1 2). It is noted slight root resorption and discontinuity of the palatal alveolar cortex. The cortex of the nasal cavity and the alveolar vestibular cortex were preserved. In this context, it was decided to maintain the supernumerary tooth and observe its evolution every 3 years. This approach was based on the fact that throughout the intraosseous progression of the tooth, it has never caused symptoms or complications for the patient. In addition, the benefits of extraction are not so clear. (Conclusion) As a rule, supernumerary teeth are extracted early to avoid possible complications; however, in cases like this, the treatment decision must be based on adequate clinical and imaging examinations, complemented by a risk-benefit analysis of the treatment, and considering the patient’s desires.