Mesiodens Diagnosis and Management

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. Although researchers have linked mesiodens to genetic factors and dental lamina proliferation, they still do not know its exact etiology. Often, it causes cyst development, misaligned teeth, food entrapment, poor aesthetics, and other oral health problems. Therefore, dentists recommend diagnosing and treating mesiodens early to avoid these pathologic and orthodontic issues. This essay examines recent research on the causes, prevalence, diagnoses, and treatments of this concern. In this essay, we will explore Mesiodens Diagnosis and Management.

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

2. 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. 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. Researchers have suggested many ideas, including the dualism of the tooth bud, the hyperactivity of the dental lamina, and a confluence of hereditary and environmental variables. However, they have widely supported only two hypotheses.

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.

The permanent dentition contains one-fifth of all supernumerary teeth, making them less prevalent in the primary dentition. Moreover, certain diseases, such as cleft lip and palate, Down syndrome, and cleidocranial dysplasia, may cause extra teeth or they may result from a single, independent defect.

Epidemiology

The reported frequency in the general population ranges from 0.15 to 1.9%, and it’s believed to a€ect 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.

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 the 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.

Dentists advise removing the mesiodens earlier to improve the prognosis. Since mesiodens frequently erupt into the oral cavity, they generally do not recommend extracting them during primary dentition to avoid 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.

After removing a mesiodens, dentists must closely monitor the dentition. They should reevaluate the case six months after the extraction, and if the permanent incisor fails to erupt normally within 12 months, they should perform a closed eruption with orthodontic mechanotherapy.

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.

The clinician raised a mucoperiosteal flap bilaterally through tunneling after administering anesthesia and excising the labial frenulum. After completing a delicate osteotomy, they carefully extracted the tooth using an “apexo” elevator. This method offers a predictable, conservative approach, lower operation complications, no scarring in the front maxilla, and no adverse cosmetic effects.

Dr. Qasim anesthetized the labial frenulum laterally using 4% lidocaine with 100,000 epinephrine. He excised the frenulum and widened the incision with a 15C blade and hemostatic forceps. To improve visibility in the area, he raised a mucoperiosteal flap bilaterally by tunneling. This allowed the flap to have considerable movement and retraction. Dr. Qasim sutured the flap’s margins with 5.0 nylon suture thread to separate and manipulate it without causing injury. The following images show the procedure, along with radiographic images, including an OPG and a periapical radiograph.

Radiographic Pictures:

Fig. 1 Periapical of the mesiodens in our case.

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.

Fig. 2 OPG of our mentioned case

Fig. 3 Clinical picture during the removal of mesiodens

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. Early identification of mesiodens reduces the need for less intensive therapy and alleviates corresponding concerns. Clinicians diagnose mesiodens through clinical and radiographic evaluation, and removing them during the early stages of mixed dentition helps align the surrounding teeth naturally. If the permanent teeth don’t erupt on their own. The need for further surgical and orthodontic care may become inevitable.

References

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