Multidisciplinary evaluation and clinical management of mesiodens

Supernumerary teeth are a disorder of odontogenesis relatively common in the oral cavity and characterized by an excess number of teeth. The term mesiodens is used to refer to an unerupted supernumerary tooth in the central region of the premaxilla between the two central incisors. The complications associated with mesiodens include: lack of eruption of permanent teeth, the deviation of the eruption path, rotations, retention, root re-absorption and pulp necrosis with loss of vitality, and diastema. Early detection of mesiodens is most important if such complications are to be avoided. This report describes the treatment of a maxillary central incisor impacted by a mesiodens. The case initially required only surgical treatment, to remove the supernumerary tooth. Successively, orthodontic therapy was done to bring into position the left permanent central incisor, which erupted physiologically, but rotated 90 degrees around along its long axis.     

Mesiodens--diagnosis and management of a common supernumerary tooth

Mesiodentes are the most common supernumerary teeth, occurring in 0.15% to 1.9% of the population. Given this high frequency, the general dentist should be knowledgeable about the signs and symptoms of mesiodentes and appropriate treatment. The cause of mesiodentes is not fully understood, although proliferation of the dental lamina and genetic factors have been implicated. Mesiodentes can cause delayed or ectopic eruption of the permanent incisors, which can further alter occlusion and appearance. It is therefore important for the clinician to diagnose a mesiodens early in development to allow for optimal yet minimal treatment. Treatment options may include surgical extraction of the mesiodens. If the permanent teeth do not erupt in a reasonable period after the extraction, surgical exposure and orthodontic treatment may be required to ensure eruption and proper alignment of the teeth. In some instances, fixed orthodontic therapy is also required to create sufficient arch space before eruption and alignment of the incisor(s). Early diagnosis allows the most appropriate treatment, often reducing the extent of surgery, orthodontic treatment and possible complications. This paper outlines the causes and modes of presentation of mesiodentes, and presents guidelines for diagnosis and management of nonsyndromic mesiodentes.     

Mesiodens: a radiographic study in children

We analyzed the frequency and radiological features of mesiodens in a group of children in Turkey. The study was based on a radiographic review of 23,000 pediatric patients (male: 12,667 female; 10,333) who visited the Department of Oral Diagnosis and Radiology during the period 2003-2005 (3 years). The presence of an unerupted supernumerary tooth, or tooth bud between the 2 central incisors or as unilateral or bilateral teeth in the midline of the maxilla was noted as mesiodens on radiographs. Eighty-five cases of mesiodens in 69 patients were found. Complete documentation, including radiographs, for these 69 patients were studied and analyzed. In addition to gender and age, the following information about the mesiodens was recorded: 1) number; 2) shape; 3) position; 4) complications caused by the mesiodens; 5) treatment. Of the 69 patients, the ratio of boys (47 cases) to girls (22 cases) was 2.1:1. Fifty-three (76.8%) of the children had 1 mesiodens, and 16 (23.1%) had 2 mesiodentes bilaterally to the midline. Of the 85 mesiodentes, 67 (78.8%) were fully impacted, 6 (7%) were partially erupted, and 12 (14.1%) were fully erupted. Most of the mesiodentes (55.2%) were found in the vertical position, followed by inverted position (37.6%), and horizontal position (7%). The main complications were delayed eruption of the permanent incisors (38.8%), maxillary midline diastema (17.6%), axial rotation or inclination of erupted permanent incisors (16.4%), and resorption of the adjacent teeth (4.7%) The prevelance of mesiodens has been estimated to be 0.15% to 2.2% of the population.     

Anterior maxillary supernumerary teeth: A clinical and radiographic study

Clinical records and radiographs of 90 patients with 113 anterior maxillary supernumerary teeth (mesiodens) have been evaluated. Although uncommon, mesiodentes are the most frequent supernumerary teeth and may disturb the eruption and/or position of the adjacent permanent incisors. Clinical and radiographic examination may disclose the number, direction and location of mesiodentes and their effects on neighbouring teeth. In the present study the majority of the supernumerary teeth lay palatal to the central incisors. Complete or partial eruption of a mesiodens was rare, hence the importance of radiographs to locate supernumerary teeth in the premaxilla. Pathological findings included the formation of dentigerous cysts in three patients and complete ossification of the pericoronal space with resorption of the crown of the mesiodentes in eight cases. Retention and malposition of the adjacent permanent incisors occurred in 39 and 24 cases, respectively.     

Retention of permanent incisors by mesiodens: a family affair

The term mesiodens refers to a supernumerary tooth that is present in the midline of the maxilla between the two central incisors. One or two mesiodentes may be present. We present a rare case of two sisters, in both of whom a pair of mesiodentes caused the retention of permanent incisors. They were referred to our hospital with asymptomatic delayed eruption of upper incisors. This article is written to point out genetic factors as the possible origin of supernumerary teeth.     

Esthetic management of fused carious teeth: a case report

A rare case of a carious supernumerary tooth fused to the labial surface of a maxillary right central incisor is reported. Root canal therapy on the maxillary right central incisor was performed owing to the pulpal communication between the supernumerary tooth and the maxillary right central incisor after removing the carious supernumerary tooth structure. The defect was then restored with anterior resin composite and the esthetics reestablished.

CLINICAL SIGNIFICANCE

Clinical significance lies in identifying a rare case of fusion of supernumerary tooth to a permanent tooth and treating the anomaly in the most conservative way.     

Extraoral endodontic treatment, odontotomy and intentional replantation of a double maxillary lateral permanent incisor: case report and 6-year follow-up

AIM: To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY: Double tooth is a dental irregularity consequent to fusion of two or more teeth or dental gemination. The teeth most commonly involved are deciduous, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, functional and periodontal problems can result. This paper reports a clinical case of a double tooth in the position of the maxillary right lateral permanent incisor. Combined orthodontic, endodontic and surgical treatment (intentional replantation) allowed the tooth to be retained without periodontal compromise and with a positive orthodontic result both immediately and 6 years following intervention. *A conservative approach that addresses periodontal, pulpal and tooth tissues, can result in the retention of a double tooth. *Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective.     

A supernumerary tooth fused to the facial surface of a maxillary permanent central incisor: case report

A case of a supernumerary tooth fused to the facial surface of a maxillary permanent central incisor is reported. Root canal therapy on the maxillary central incisor was performed due to pulpal communication between the supernumerary tooth and the maxillary central incisor after removing the supernumerary tooth structure. The communication was sealed with mineral trioxide aggregate. The difference between fusion and gemination is discussed.     

Hemisection and vital treatment of a fused tooth – literature review and case report

Abstract Fusion and gemination of permanent teeth are developmental anomalies of the dental hard tissues which may require endodontic and surgical treatment for functional, orthodontic or aesthetic reasons. Following a review of the dental literature on tooth fusion and gemination, a case of fusion of a maxillary central incisor and a supernumerary tooth and its endodontic and surgical treatment is presented.     

Reshaping a mesiodens

A mesiodens is a supernumerary tooth that is found in the midline of the maxilla. Fifteen percent erupt usually between the ages of 3 and 7. The standard treatment is extraction of the supernumerary to allow the permanent incisors to erupt properly. This case report describes an instance where the primary incisor was prematurely exfoliated due to the eruption of the mesiodens. Because of the favorable position of the mesiodens in the dental arch, it was decided to reshape the supernumerary to resemble a primary incisor. This was accomplished successfully, and the mesiodens is being monitored to assess any need to trim or add to the bonding material as the child grows.     

A multidisciplinary approach to the treatment of an intruded maxillary permanent incisor complicated by the presence of two mesiodentes

Treatment of a traumatically intruded maxillary incisor with an immature apex remains controversial. Treatment options include observation, surgical repositioning, or orthodontic forced eruption. Likewise, the ideal timing of surgical removal of a mesiodens is highly controversial: immediate versus delayed intervention. The complications associated with untreated supernumerary teeth include: overretention of primary teeth, delayed eruption of permanent incisors, rotations, impaction, diastema, pulp necrosis and root resorption. Less common sequelae include enlarged follicular sacs, cystic degeneration and nasal eruption. This paper describes another risk factor associated with delayed removal of a mesiodens previously not mentioned in the dental literature, namely potential complications arising from a traumatic injury, in particular intrusion, of the maxillary permanent incisors.     

Orthodontic treatment for an unerupted and severely rotated maxillary central incisor. A case report.

BACKGROUND: Many reports have indicated the treatment for permanent teeth with disturbed eruption due to the presence of supernumerary teeth. However, successful treatment for an unerupted maxillary incisor with severe rotation and another maxillary incisor with disturbed eruption by a supernumerary tooth is quite rare. CASE REPORT: We treated a 7-year-old Japanese male with an unerupted and severely rotated maxillary right incisor, along with a maxillary left incisor due to interference with eruption by an inverted supernumerary tooth. Orthodontic treatment using surgical exposure, traction and guidance of the rotated right incisor, and maxillary expansion following extraction of the supernumerary tooth were performed. FOLLOW-UP: At 27 months following extraction of the supernumerary tooth, and comprehensive orthodontic treatment led the malposititioned central incisors to a functional position and stable occlusion.     

Supernumerary deciduous teeth with multiple maxillary impacted mesiodens: A case report

Maxillary impacted mesiodens are frequently encountered in pediatric dentistry. Much research has been conducted concerning their incidence, position, and form. Supernumerary teeth erupting in the primary dentition with maxillary impacted mesiodens are very rare. In January 2011, a nine-year-old boy presented for dental treatment and was found to have supernumerary deciduous teeth. Upon panoramic radiography, multiple impacted mesiodens were found; therefore, computed tomography (CT) was performed for further examination. One month later, the boy was referred to our department for extraction of the deciduous supernumeraries and impacted mesiodens. We suspected that these supernumeraries, mesiodens, and remaining primary teeth would lead to problems with the eruption of the permanent teeth. Therefore, by ascertaining the exact position of the mesiodens and the successional permanent teeth using CT, extraction was performed under general anesthesia in March 2011 without any error. Six months postoperatively, panoramic radiographs showed no superfluous structure that appeared to be a tooth. We suggest that when multiple maxillary impacted mesiodens are found, their exact positions can be located using CT before extraction.     

A case of supernumerary primary and permanent canines

A case of supernumerary primary and permanent canines is presented. A 9Y4M-old boy was referred to our clinic for consultation regarding a maxillary supernumerary primary canine. An oral examination showed 2 primary canines with a similar morphology between the maxillary left lateral incisor and first primary molar. The primary canine in the opposite quadrant had the appearance of a fused-tooth, with composite resin restoration seen in the border. Orthopantomography revealed that permanent successors were present for each primary tooth in the maxillary left region, whereas only a single permanent canine was developing in the opposite quadrant. The 2 primary canines in the maxillary left region were extracted at 9Y4M. The mesially located permanent canine emerged into the oral cavity at 10Y1M and was extracted at 10Y9M. At 12Y2M, the other permanent canine located in the distal position had nearly reached the occlusal plane and the maxillary right permanent canine had arrived at the occlusal plane. Dental age was evaluated by assessing the tooth formation stages in 4 orthopantomographs taken between 8Y5M and 12Y2M, and found to be nearly the same as chronological age. However, the dental ages of the maxillary left permanent canine that had erupted earlier than the one located distally and of the left permanent canine were approximately 1 year behind chronological age. In addition, the dental age of the left permanent canine located distally was 2.5 years behind until the patient reached the age of 10Y9M, after which tooth development was accelerated following extraction of the mesially located permanent tooth.     

Modified maxillary vestibular approach with subperiostal intranasal dissection for surgical extractions of mesiodentes impacted in the floor of the nasal cavity

Introduction

Impacted mesiodentes in the inverted position may interfere with the base of the nasal cavity or the nasal septum. They can rarely erupt into the nose as well. Traditionally they are extracted via intraoral approaches (transpalatal or vestibular). Also, an endoscopically assisted transnasal approach can be used. In this paper, the authors are the first to present a group of patients suffering from impacted mesiodentes who have been surgically treated using a modified maxillary vestibular approach with subperiostal intranasal dissection.

Fusion of the permanent maxillary right incisor to a supernumerary tooth in association with a gemination of permanent maxillary left central incisor: a dental, genetic and dermatoglyphic study

The relationship between fusion of the permanent maxillary right central incisor to a supernumerary tooth in association with gemination of permanent maxillary left central incisor and dermatoglyphics were investigated.     

Dentigerous cyst associated with multiple mesiodens: a case report

Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. When observed with erupted and complete dentition the diagnosis is a surprise; as about 95% of dentigerous cysts involve the permanent dentition and only 5% are associated with supernumerary teeth. The usual age of clinical presentation of dentigerous cyst due to supernumerary tooth is during the first four decades. Mesiodens is a supernumerary tooth situated between the maxillary central incisors. More frequently the mesiodens occurs unilaterally, but it may also be bilateral, while three or more supernumerary teeth in the median region of the palate are more rarely found. We report a rare case of dentigerous cyst in association with multiple mesiodens in a 14-year-old female patient.     

Hemisection of a fused tooth

Fusion is a developmental anomaly which occurs due to a union of 1 or more adjacent teeth during morphodifferentiation of the dental germs. The present case report presents the hemisection of a maxillary central incisor fused with a supernumerary tooth. A 10-year-old boy was referred to clinic with the chief complaint of the presence of a large anterior tooth. Intraoral and radiographic investigations indicated fusion between the left central incisor and a supernumerary tooth. The fused tooth was separated with a diamond bur, and the supernumerary tooth was extracted. The left central incisor was restored with composite resin and the diastema between the maxillary central incisors was closed with orthodontic treatment. The left central incisor was still healthy after a follow-up examination period of 24 months. An ideal overjet and overbite relation was achieved at the end of the orthodontic treatment. Hemisection can be considered as an appropriate treatment alternative for a permanent tooth fused with a supernumerary tooth.     

Multi-lobed mesiodens with a palatal talon cusp: a rare case report

Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch and the talon cusp is a rare dental developmental anomaly seen on the lingual surface of anterior teeth. This paper presents a rare clinical case of development of talon cusp in a mesiodens with multiple lobes, which interfered with both occlusion and appearance of an 11-year-old patient. During clinical interview, the patient reported difficulty on mastication. Clinical and radiographic examination revealed that a supernumerary tooth with completely formed root was causing an occlusal interference. The supernumerary tooth was diagnosed as multi-lobed mesiodens associated with a palatal talon cusp. The treatment plan consisted in the extraction of the supernumerary tooth followed by orthodontic treatment for diastema closure and tooth alignment.     

Histological and chemical analyses of mesiodens development and mineralization

ObjectiveThis study aimed to compare the developmental timing and mineralization quality of mesiodentes, i.e., supernumerary teeth located mainly in the midline of the maxilla between the central incisors, with the developmental timing and mineralization quality of permanent and primary central incisors.DesignSixteen mesiodentes, nine permanent and seven primary central incisors were collected. The location of the neonatal line was determined using a light microscope at 10× or 20× enlargements. Chemical composition of the enamel at two locations was analyzed using energy dispersive X-ray spectrometer.ResultsNeonatal lines were observed in eight out of 16 mesiodentes, in all primary central incisors and in none of the permanent central incisors. Chemical analyses showed that mesiodentes mineralization was impaired, resulting in higher amount of organic ions and reduced inorganic ions. Discriminant analysis showed minimal overlap of mesiodentes with either primary or permanent centrals.ConclusionsMesiodentes development begins before birth in 50% of the cases but later than the primary centrals. Mineralization of mesiodens is impaired with less mineral content and higher organic content. The results showed that mesiodentes are a special group of teeth with defective morpho-differentiation and mineralization, with little similarity to primary or permanent central incisors.