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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 27-29

Mesiodens and its complication in anterior maxilla: A case report


1 Department of Pedodontics and Preventive Dentistry, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India
2 Department of Oral and Maxillofacial Surgery, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India
3 Department of Oral Pathology, Guru Govind Singh College of Dental Science and Research Centre, Burhanpur, Madhya Pradesh, India
4 Armansh Surgicare Dental and Maxillofacial Centre, Ahmedabad, India
5 Dr. Rao Dental Clinic and Orthodontic Care, Anand, Gujarat, India

Date of Web Publication26-Jun-2019

Correspondence Address:
Dr. Ankita Dixit
Department of Pedodontics and Preventive Dentistry, Ahmedabad Dental College and Hospital, Bhadaj-Ranchodpura Road, Near Science City, Ahmedabad 382115, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_12_19

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  Abstract 

Supernumerary teeth can present in various forms and in any region of the mandible or maxilla, but they are more common in anterior maxilla and when they are present between the roots of central incisors, they are termed as “mesiodens.” These teeth may remain embedded in the alveolar bone or can erupt into the oral cavity. When it remains embedded, it may cause disturbance to the developing teeth. Early detection is an important key to avoid development of any complications. This report presents a case of a 12-year-old girl with impacted supernumerary tooth in the maxillary anterior region between the roots of right central and lateral incisor, resulting in the rotation of central incisor, leading to unaesthetic appearance. To prevent further complications, immediate surgical removal of the supernumerary was recommended.

Keywords: Hyperdontia, mesiodens, premaxillary, supernumerary


How to cite this article:
Dixit A, Randhawa GS, Randhawa RK, Rawal A, Khubchandani R, Rao M. Mesiodens and its complication in anterior maxilla: A case report. Int J Oral Care Res 2019;7:27-9

How to cite this URL:
Dixit A, Randhawa GS, Randhawa RK, Rawal A, Khubchandani R, Rao M. Mesiodens and its complication in anterior maxilla: A case report. Int J Oral Care Res [serial online] 2019 [cited 2019 Jul 16];7:27-9. Available from: http://www.ijocr.org/text.asp?2019/7/1/27/259902




  Introduction Top


Supernumerary teeth are teeth in excess of the normal number. The prevalence of hyperdontia is reportedly between 0.15% and 3.9%.[1],[2] Extra teeth may be present in both the permanent and the primary dentition but are five times less frequent in the primary dentition.[3] Supernumerary teeth are found more often in the maxillary anterior region than in any other area of either dental arch, one of these supernumerary teeth are mesiodens, when present between the roots of central incisors.[4]

Supernumerary teeth in the premaxillary region are broadly of two types: one with normal morphology known as supplemental teeth and the other of abnormal shape. The latter class has been further categorized into the conical type (peg shaped) and the tuberculate type. The tuberculate supernumerary tooth seems to occur most frequently palatal to the upper central incisor and is late in its development than the conical tooth. It has also been documented that the conical-shaped supernumerary tooth does not usually affect the eruption of the adjacent permanent incisors but may cause their displacement. They may also be non-inverted or inverted. When non-inverted, it may remain unerupted palatal to the permanent incisors. When inverted, it may point posteriorly toward the nose or may even erupt into the nose. The frequency of inverted mesiodens constitutes approximately 9%–67% of all reported cases.[5],[6] Unless they are diagnosed early and managed properly, they may exert a variety of pathological effects on the developing permanent dentition, particularly those in the anterior maxilla can cause failure of eruption, displacement, rotation of the permanent maxillary incisors, and midline diastema.[4],[5],[7]


  Case Report Top


Case history: A 12-year-old patient reported to the private dental clinic in Jamnagar District, Gujarat, India, with the chief complaint of irregular anterior teeth in upper jaw. No significant medical history was observed. On clinical examination, her upper right central incisor was slightly mesially rotated. Other clinical findings included Grade II mobility with 53 and erupting 23, 33, 43, and 44. She was advised for intraoral periapical radiograph of incisor region, after which it was noted that inverted supernumerary teeth was present between the root of right central and lateral incisor [Figure 1]. A standard upper occlusal radiograph was also taken, which showed the presence of supernumerary tooth [Figure 2] and using same lingual opposite buccal technique with two intraoral periapical radiographs, it was confirmed that the presence of supernumerary tooth was on the palatal side.
Figure 1: Inverted supernumerary teeth seen between roots of incisors

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Figure 2: Occlusal radiograph showing inverted supernumerary teeth

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After considering the chief complaint of the patient and the location of the supernumerary tooth, a decision was made to surgically extract the supernumerary tooth before orthodontic intervention. She was prescribed antibiotic before the day of surgery and was recalled the next day. Proper anesthesia was achieved in the labial and palatal area in the region 21–13. Mucoperiosteal flap was raised and adequate bone was removed along with copious saline irrigation to expose the supernumerary tooth. Tooth was luxated with periosteal elevator and was removed [Figure 3]. Bony socket was inspected for any pathology and bone margins were smoothened with bone file and flap was repositioned and sutured with 3.0 black braided silk. The patient was kept on antibiotic, anti-inflammatory, and analgesic regimen for 5 days. After 8 days, she was recalled for assessment of healing, the sutures were removed and occlusal radiograph was taken [Figure 4].
Figure 3: Extracted supernumerary teeth

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Figure 4: Follow-up occlusal radiograph

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  Discussion Top


The literature reports that 80%–90% of all supernumerary teeth occur in the maxilla.[7] Half of which are found in the anterior region. Mitchell and Bennett[8] have suggested that different types of supernumeraries have been associated with different effects on the adjacent dentition. Foster and Taylor[9] examined this relationship and found that tuberculate types more commonly produced delayed eruption, whereas conical types more commonly produced displacement of the adjacent dentition.

Supernumerary tooth is a developmental anomaly and has been argued to arise from multiple etiologies. One of the theory suggested that it arises from dichotomy of tooth bud. Another theory well supported in literature is hyperactivity theory, which suggests that supernumeraries are formed as a result of local, independent, and conditioned hyperactivity of dental lamina. Hereditary has also shown to play a role in their occurrence.

They can affect the normal position and eruption of adjacent teeth and often require clinical intervention. It is essential not only to enumerate but also to identify the supernumerary teeth present clinically and radiographically before a definitive diagnosis and treatment plan can be formulated.[10]

In this case, the presence of supernumerary teeth caused medial rotation of the right central incisor giving unesthetic profile to the patient. On radiographic examination, the presence of supernumerary teeth was seen on the palatal aspect of right central and lateral incisors which was conical and inverted. To avoid future complication, extraction of supernumerary teeth was planned under local anesthesia.

Some researchers have argued for immediate surgical removal after diagnosis to permit spontaneous eruption of the permanent incisors and to avoid possible orthodontic problems, whereas others have advocated a delayed approach to avoid iatrogenic damage to the developing adjacent teeth.[11],[12] The immediate surgical removal of impacted supernumeraries is indicated when the chances of developing complications, if the supernumerary tooth was left untreated, are significant.[7] Surgical removal of supernumerary teeth is based on accurate radiographic localization, using periapical radiograph, occlusal radiograph, orthopantomogram, and cone beam computed tomography, which minimizes the risk of trauma to the permanent teeth when performed before the maturation of their apices and is also used to assess the number, location, path, and sagittal position of the impacted supernumerary tooth.[8],[13]


  Conclusion Top


Supernumerary teeth are relatively common developmental anomaly, which require intervention so as to avoid the development of future complication. Each case may require different treatment approaches depending on the age of the patient, location, number of supernumerary tooth, and the involvement of surrounding structure. The clinician should be well aware of the warning signs and should be able to diagnose the anomaly as early as possible, and proper treatment plan should be formulated.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Luten JR. The prevalence of supernumerary teeth in primary and mixed dentitions. J Dent Child 1967;34:346-53.  Back to cited text no. 1
    
2.
Brabant H. Comparison of the characteristics and anomalies of the deciduous and the permanent dentition. J Dent Res 1967;46: 897-902.  Back to cited text no. 2
    
3.
Grahnen LG. Numerical variations in primary dentition and their correlation with the permanent dentition. Odontol Revy 1961;12:348-57.  Back to cited text no. 3
    
4.
Tay F, Pang A, Yuen S. Unerupted maxillary anterior supernumerary teeth: Report of 204 cases. ASDC J Dent Child 1984;51:289-94.  Back to cited text no. 4
    
5.
Nik-Hussein NN. Supernumerary teeth in the premaxillary region: Its effects on the eruption and occlusion of the permanent incisors. Aust Orthod J 1990;11:247-50.  Back to cited text no. 5
    
6.
Jathar P, Panse A, Jathar M, Gawali P. Surgical removal of supernumerary teeth—A case report. IOSR J Dental Medical Sciences 2014;13:56-60.  Back to cited text no. 6
    
7.
Primosch RE. Anterior supernumerary teeth—assessment and surgical intervention in children. Pediatr Dent 1981;3:204-15.  Back to cited text no. 7
    
8.
Mitchell L, Bennett TG. Supernumerary teeth causing delayed eruption—A retrospective study. Br J Orthod 1992;19:4.  Back to cited text no. 8
    
9.
Foster TD, Taylor GS. Characteristics of supernumerary teeth in the upper central incisor region. Dent Pract Dent Rec 1969;20:8-12.  Back to cited text no. 9
    
10.
Scheiner MA, Sampson WJ. Supernumerary teeth: A review of the literature and four case reports. Aust Dent J 1997;42:160-5.  Back to cited text no. 10
    
11.
Humerfelt D, Hurlen B, Humerfelt S. Hyperdontia in children below four years of age: A radiographic study. ASDC J Dent Child 1985;52:121-4.  Back to cited text no. 11
    
12.
Solares R. The complications of late diagnosis of anterior supernumerary teeth: Case report. ASDC J Dent Child 1990;57:209-11.  Back to cited text no. 12
    
13.
Jung YH, Kim JY, Cho BH. The effects of impacted premaxillary supernumerary teeth on permanent incisors. Imaging Sci Dent 2016;46:251-8.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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