Volume 18, Issue 1
Maxillofacial

Mesiodens: Diagnosis & Management

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Qasem Obiedat - BDS
Maxillo-Facial Surgeon; Jordanian Ministry of Health | Amman, Jordan - qasemobeidatsurg@gmail.com


Maxillofacial

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Qasem Obiedat. Mesiodens: Diagnosis & Management. Smile Dental Journal. 2023;18(1):08-10.

 

ABSTRACT

The mesiodens is an extra tooth that is situated in the middle of the two central incisors. It is the most prevalent supernumerary teeth. Whereas genetic factors and dental lamina proliferation have been linked to mesiodens, its exact etiology is still unknown. Often, it causes cyst development, misaligned teeth, food entrapment, poor aesthetics, and other oral health problems. Therefore, to avoid these pathologic and orthodontic issues, early diagnosis and treatment are advised. This essay examines recent research on the causes, prevalence, diagnoses, and treatments of this concern.

 

KEYWORDS

Mesiodens diagnosis, mesiodens removal, esthetic concerns of mesiodens, orthodontic treatment after mesiodens removal, supernumerary teeth in adults, surgical extraction.

 

INTRODUCTION

Mesiodens comes from a Latin origin “mesio” meaning “medio” or middle and “dens” meaning tooth. It is a supernumerary tooth that usually resides between the upper central incisors as the occurrence is rare in the lower region. Mesiodens usually results in oral problems such as malocclusion, food impaction and poor aesthetics. It’s the most prevalent type of supernumerary teeth.

 

In some syndromes, mesiodens may present as a part of the symptoms; however, this condition might be seen in normal individuals. It seems that positive family history is one of the predisposing factors.

 

AIM OF THE STUDY

This study aims to cover most of the major topics related to mesiodens diagnosis, surgical removal considerations post-surgical extraction recommendations relevant influencing factors associated with the supernumerary tooth eruption. As well as, understanding the various removal techniques and their effects on the patient`s dentition.

 

LITERATURE REVIEW

  1. Mesiodentes compose of 3 or more mesiodens (supernumerary teeth) and are uncommon compared to mesiodens (single supernumerary tooth) found in the midline of the maxilla. Typically, mesiodentes are asymptomatic, impacted and have a cone-like crown and one root.1

 

They often have their roots facing the occlusion and their crowns towards the nasal cavity in an inverted configuration.1

 

  1. The prevalence of supernumerary teeth in permanent teeth is 1–14%, in accordance with the literature. When compared to females, males are impacted around twice as often. Most extra teeth (90–98%) are found in the maxilla, and 90% of them are only found in the pre-maxilla.2

 

Listed from the most to the least frequent locations of supernumerary teeth:

  • The mesiodens
  • Maxillary fourth molars
  • Maxillary premolars
  • Mandibular premolars
  • Maxillary lateral incisors
  • Mandibular fourth molars
  • Maxillary premolars

 

ETIOLOGY

The etiology behind supernumerary teeth formation is unclear. Many ideas, including the dualism of the tooth bud, the hyperactivity of the dental lamina, and a confluence of hereditary and environmental variables have been suggested. However, only two widely accepted hypotheses have been supported.

  1. the dichotomy hypothesis of dental germs, a tooth bud divides into two pieces, producing two teeth that may be of equal or different sizes.
  2. The dental lamina’s local, autonomous, or conditioned hyperactivity causes the development of extra teeth.

 

One-fifth of all supernumerary teeth are found in the permanent dentition, making them less prevalent in the primary dentition. Moreover, the presence of extra teeth may be a single, independent defect or may be linked to certain diseases, such as cleft lip and palate, Down syndrome, cleidocranial dysplasia, etc.

 

EPIDEMIOLOGY

The reported frequency in the general population ranges from 0.15 to 1.9%, and it’s believed to affect more men than women. According to reports, 82% of the time it affects the maxilla, more precisely the premaxillary area compared to the anterior region of the mandible.

 

Radiographic diagnosis

Radiography most accurately Cone-beam computed tomography (CBCT), is used for the diagnosis of supernumerary teeth including mesiodens. Due to the fact that CBCT has the ability to get around most of the technical challenges of plain radiographs projection and the capacity to provide a high-resolution three-dimensional (3D) interpretation of the maxillofacial tissues.3

 

Management

When a mesiodens is present, it is critical that it be treated quickly. This is due to the possibility that leaving it could result in dental issues later in life, such as a diastema (space between your two front teeth), displacement of surrounding teeth, increased crowding in the area of the mesiodens, problems with bite creation, and root resorption of nearby teeth, as well as, delayed eruption of surrounding teeth.

 

Therefore, the mesiodens in a timely related manner is mandatory.

 

The way supernumerary teeth are handled depends on their type, where they are in the mouth, and where they are in the dentition cycle. It is advised to remove the mesiodens sooner in order to improve the prognosis. Since mesiodens frequently erupt into the oral cavity, it is generally not recommended to extract them during primary dentition since doing so increases the risk of injuring the permanent incisor. However, following the removal of mesiodens, the permanent central incisors spontaneously emerge in the early mixed dentition stage. Additionally, it encourages optimized tooth alignment and reduces the need for orthodontic therapy. Following the removal of a mesiodentes, the dentition must be closely monitored.

 

Reevaluation is advised six months following mesiodens extraction and if the permanent incisor does not erupt normally after 12 months of extraction, closed eruption accompanied with orthodontic mechanotherapy is recommended.

 

DISCUSSION

In this study, a lateral tunneling technique and frenulum incision are used to remove a maxillary mesiodens. The scientists discovered that this method effectively removed the mesiodens without harming the nearby teeth or tissues.

 

Preventing incision releases and filling the surgical site with platelet-rich fibrin (PRF). A 13-year-old patient was referred to our clinic to remove a supernumerary tooth positioned between the maxillary central incisors. A mucoperiosteal flap was raised bilaterally through tunneling following anesthesia and the excision of the labial frenulum. The tooth was carefully extracted using an “apexo” elevator after a delicate osteotomy was completed. This method offers a predictable, conservative approach, lower operation complications, no scarring in the front maxilla, and no adverse cosmetic effects.

 

The labial frenulum was anesthetized laterally with 4% lidocaine+ 100,000 epinephrine. The frenulum was excised and the incision was made wider using a 15C blade and hemostatic forceps.

 

A mucoperiosteal flap was raised bilaterally by tunneling to improve the area’s visibility. As a result, the flap had considerable movement and could retract. The flap’s margins were sutured with 5.0 nylon suture thread in order to separate and manipulate it without injury.4

 

The labial frenulum was anesthetized laterally with 4% lidocaine+ 100,000 epinephrine. The frenulum was excised and the incision was made wider using a 15C blade and hemostatic forceps.

 

A mucoperiosteal flap was raised bilaterally by tunneling to improve the area’s visibility. As a result, the flap had considerable movement and could retract. The flap’s margins were sutured with 5.0 nylon suture thread in order to separate and manipulate it without injury.4

 

The following are some images taken during the procedure by dr. Qasim, as well as radiographic images OPG and a periapical radiograph:

 

Radiographic Pictures:

 

Clinical Picture:

 

LIMITATIONS

Our access to pediatric and adult patients was heavily limited as a result of the worldwide epidemic (COVID 19). Also, the unavailability of a cone beam computed tomography device, which is necessary for the identification of mesiodens, as well as the destruction and inaccuracy of data records in the majority of medical facilities as a consequence of the relatively high daily number of outpatients. Rather than the difficulty reaching those files and data without a permit.

 

CONCLUSION

Mesiodens, which develops as a result of genetic and environmental causes, is the most typical type of supernumerary teeth in the permanent dentition. Males are twice as impacted as females. The need for less intensive therapy and the emergence of corresponding concerns are both reduced by early identification of mesiodens. Mesiodens can be diagnosed by clinical and radiographic evaluation, and their removal during the early stages of mixed dentition aids in the natural alignment of the surrounding teeth. If the permanent teeth don’t erupt on their own. The need for further surgical and orthodontic care may become inevitable.

 

REFERENCES

  1. Akay G., Özdede M., Güngör K. An evaluation of mesiodentes: A retrospective study with cone-beam computed tomography. Selcuk Dent J. 2018;5:203-11 (Doi: 10.15311/selcukdentj. 359537
  2. Khambete N., Kumar R. Genetics and presence of non-syndromic supernumerary teeth: A mystery case report and review of literature. Contemp Clin Dent. 2012;3(4):499–502. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636847/#:~:text=Presence%20of%20supernumerary%20teeth%20is,thought%20to%20have%20genetic%20component.
  3. Omami M., Chokri A., Hentati H., Selmi, J. Cone-beam computed tomography exploration and surgical management of palatal, inverted, and impacted mesiodens. Contemp Clin Dent. 2015;6(1):289-93. https://pubmed.ncbi.nlm.nih.gov/26604591/
  4. Guião-Fernandes D., Avelar K., Melo V., Caetano A. Clara, Padovani L. A Conservative approach to a mesiodens removal via frenectomy incision. A case report. Advances in Oral and Maxillofacial Surgery. 2022;5. https://www.sciencedirect.com/science/article/pii/S2667147621002260
  5. Mukhopadhyay, S. Mesiodens: A clinical and radiographic study in children. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2011;29(1):34-8. https://journals.lww.com/jped/Fulltext/2011/29010/Mesiodens__A_clinical_and_radiographic_study_in.8.aspx
  6. Qamar R., Bajwa J. I., Rahbar muhammad. Mesiodens - etiology, prevalence, diagnosis and management. Mesiodens - etiology, prevalence, diagnosis and management. POJ. 2013;5(2):73-6. https://applications.emro.who.int/imemrf/Pak_Orthod_J/Pak_Orthod_J_2013_5_2_73_76.pdf
  7. Seladi-Schulman J. Mesiodens (extra tooth) causes and why it should be treated. Healthline. 2021 https://www.healthline.com/health/dental-and-oral-health/mesiodens#risks
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