Supernumerary teeth are often asymptomatic and impacted within the jawbone, typically identified during routine radiographic examinations. While cases of impacted fourth molars have been reported, bilaterally erupted fourth molars are exceedingly rare. This case report presents a unique instance of symmetrically erupted maxillary fourth molars, along with an impacted fifth molar in the right upper jaw. A 38-year-old male presented with food impaction and discomfort in the area of the left maxillary third molar. Clinical examination revealed bilaterally erupted fourth molars, and a panoramic radiograph incidentally uncovered an impacted fifth molar in the right maxilla. Cone beam computed tomography confirmed these findings. The left maxillary fourth molar was diagnosed with periapical periodontitis. Both the left maxillary third and fourth molars were extracted under local anesthesia. Periodic follow-up of the right fourth and fifth molars was recommended based on symptom progression and patient preference. The patient expressed satisfaction with the treatment plan and surgical outcome. This report documents a rare case of symmetrically erupted fourth molars with an associated impacted fifth molar in the maxilla. The treatment strategy and surgical approach should be tailored to the patient's symptoms and willingness to undergo the recommended procedures.