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Literature Review BAOJ Dentistry
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BAOJ Dentistry
Perez-Albacete Martinez C, et al., BAOJ Dentistry 2015, 1:1

1: 002

Review Article

Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review

Lucas Penalva PM1, Perez-Albacete Martinez C1*, Ramrez Fernandez MP1, Mate Snchez De Val JE1, Calvo Guirado JL1
Universidad Catolica San Antonio de Murcia (UCAM) Murcia, Spain

The presence of supernumerary teeth, between the two central
incisors, known under the term mesiodens, is one of the most
common developmental problems in children. It represents 5080% of supernumerary, with its higher frequency in the maxilla and
men 2:1. Most of the mesiodens have a single root, it has conical
crowns or triangle, is heteromorphic. The etiology of mesiodens is
unclear; the best theory is hyperactivity of the dental lamina. These
teeth can cause different disorders such as malposition of adjacent
teeth, anomalous eruption, and delayed eruption of permanent
maxillary central incisor interincisal diastema and cyst formation.
The aim of this work was to make a literature review of the different
oral aspects involving mesiodens.
Material and methods
To make the literature review, we used different database for finding
articles related to mesiodens. Of the total of articles we founded,
those which did not fulfill the inclusion criteria were discarded.
Mesiodens is the most common supernumerary tooth observed
more in men than in women 2:1. It can cause pathological
conditions so an early diagnosis with panoramic radiography,
complete with occlusal or periapical at different angles, besides
a clinical diagnosis is recommended. The treatment of choice is
extraction supernumerary, this will depend on their morphology,
position, the potential effect on teeth and surrounding structures,
and patient age.
Keywords: Diagnosis; Etiology; Mesiodens; Supernumerary Teeth;

Or hyperdontia supernumerary teeth is the increased number of
normal dental formula, twenty deciduous and permanent thirty-two
[1-5]. The most common type of supernumerary teeth according to
Alberti et al. [6] in 1,577 children was the mesiodens representing
83% of the 0.38% of supernumerary teeth; the proportion of males:
females was 2: 1, the most common age was 9 years old and the
most common location maxilla in its previous zone.
Mesiodens named for Bolk [7] features appear in the midline distal
jaw between 11 and distal 21, representing 80% of all supernumerary
BAOJ Dentistry, an open access journal

Its orientation can occur at all levels of space and erupt only 25%
of cases usually interincisal mouth and via palatal level, in 75% of
cases occur retained without rash [8].
There are several theories to explain what time or what embryological
formation is generated:
For hyperactivity of embryonic epithelial cells, tooth germ cells
are equal, but some can differentiate into invaginations that would
result in new dental tissues, either from the dental lamina, either
at the time that the tooth bud is separated from the dental lamina,
being attached to this by the dentis gubernaculum, from this new
tooth buds may originate either by overactivity of the outer layer
sheath Hertwing or from epithelial remains of Malassez.
For split the dental follicle, the theory of dichotomy, some factors
such as trauma, evolutionary mutations, can cause accidental
follicle division into two or more fragments, according to the
theory of atavism, with few defenders, it is mesiodens the third
incisor primates would be a phylogenetic reversal [9].
Supernumerary teeth may be associated with some syndromes, such
as Fabrys syndrome, cherubism, Apert syndrome, cleidocranial
dysplasia or Crouzon disease, cleft lip, cleft palate, Gardner
syndrome and other as hereditary fibromatosis , associated with
hearing loss and supernumerary teeth [10] however, the appearance
of a mesiodens can occur in individuals with no syndrome.
Fernandez et al. found that the prevalence of supernumerary teeth
is between 0.5 and 3.8% in the permanent dentition and between
0.35 and 0.6% in the temporary dentition. The most frequent group
was the mesiodens (46.9%) [11].
*Corresponding author: Perez-Albacete Martinez C, International
Dentistry Research Cathedra, UniversidadCatlicaSan Antonio de
Murcia (UCAM) Murcia, Spain, E-mail:
Rec Date: jULY 31, 2015, Acc Date: August 20, 2015, Pub Date: August
24, 2015.
Citation: Lucas Penalva PM, Perez-Albacete Martinez C, Ramrez
Fernandez MP, Mate Snchez De Val JE, Calvo Guirado JL (2015)
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review.
BAOJ Dentistry 1: 002.
Copyright: 2015 Perez-Albacete Martinez C, et al. This is an openaccess article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source
are credited.

Volume 1; Issue 1; 002

Citation: Lucas Penalva PM, Perez-Albacete Martinez C, Ramrez Fernandez MP, Mate Snchez De Val JE, Calvo Guirado JL (2015)
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review. BAOJ Dentistry 1: 002.

Its frequency in the Caucasian population varies between 0.15 and

1% predominance of males in a 2 to 1 in the permanent dentition


When the rash is done through the nasal floor completely, they
are called nasal prongs manifesting itself as a local tumor that
causes nasal deformity, with airway obstruction, headache or other
facial pain, epistaxis, rhinorrhea and purulent rhinitis erupts with
speed and is quickly visible, also it has great mobility and is easily
removable [14-16].

Early Diagnosis

Mesiodens show great variety in size [2,17,18] and forms [1,19,2022]. They can imitate the way of normal teeth (eumorphic), or have
an unusual morphology (heteromorphic) as:
Conical or peg teeth: size smaller than normal teeth, with conical
crown and a rudimentary whole root. It is the most common form.
Tuberculate tooth: smaller than normal tooth crown and root
tubers is unique, incomplete, thick and curved.
Infundibular tooth: tooth similar to normal size but with
invaginations inward at the crown, giving it look like a funnel.
Molariform tooth: shaped molar or premolar and incomplete root
Delayed eruption of a permanent tooth more than six months and
the dental mal-positioning can be the first clinical manifestation of
a supernumerary tooth [23].
Inclusion of permanent teeth: often cause deformation of the
buccal or lingual / palatal surface of alveolar process, with the
prolongation of the presence of primary teeth. It is the most
common complication [1,24,19,25,16-18,26,31].
Dental Mal-Positioning: In the incisal region, crowding or
malposition we will investigate the existence of a mesiodens. The
most common is the torsoversin and lip movement [25,26].
Diastema: The presence of diastema advisable to perform a
radiographic examination to rule out mesiodens included, in which
case it should be removed when the patient is still in the growth
phase and may close the interproximal space without orthodontic
treatment [1,16,17,19,24,27,28,32,33].
Abnormal Eruptions: Can erupt into atypical locations away
from the dental arch, such as the eruption into the nostrils and
into the maxillary sinus, leading to a private clinic in pain, airway
obstruction and infection [2,8,15,24,34].

Page 2 of 5

Functional And Aesthetic Problems: Caused by malposition

involved mesiodens.
Clinical examination: Mesiodens diagnosis is based on clinical
and radiographic findings.
By inspection, we can see that erupted mesiodens those found in
the oral cavity; also do a presumptive diagnosis in cases where we
observe a delay in the eruption of the maxillary central incisors,
bad position of teeth, diastema etc. Palpation inform us about the
situation and whether there mesiodens accessible to the touch
[8,35] pericoronal cysts.
Radiological examination: It provides data on the shape, number,
location and relations with adjacent structures. To find the location
of the supernumerary tooth occlusal radiographs and periapical
radiographs with different horizontal angles [1,32,36,25,3740] are used. It is also necessary to rule out a panoramic
radiography supernumerary teeth without clinical signs, as most of
supernumerary teeth are asymptomatic [10]. When in doubt you
can make a Cone Beam CT, showing the exact location in the 3
Differential diagnosis: Heteromorphic supernumerary teeth
should preferably be differentiated from odontoma. Both may
even coexist, as in Gardners syndrome. The compound odontoma
frequently located between the anterior teeth [29-31].
Supernumerary teeth may also be confused with other injuries
that occur with radiopacity, as cementomas, cysts, tumors
(cementoblastoma, adenomatoid odontogenic tumor) and retained
deciduous teeth [41,42].
The inverted teeth can migrate and this makes it advisable to
develop cysts extraction invested mesiodens is essential extracting
tuberous forms early for the central incisor erupts in an acceptable
time, and causing much more frequently than the delay in conical
eruption of the incisors.
However, unless a conical mesiodens cause malposition, central
incisor crowding or other problems, you can be left in place as it is
located above and away from the erupted teeth [43].
There are two streams to the moment of extraction of a

Cyst Formation: The follicle of an enclosed tooth can be the

source of a dentigerous or follicular cyst, up to 6% of cases [3]. The
dentigerous cyst can become infected, suffer histological changes, or
even become an ameloblastoma or intracystic carcinoma [25,29-31].

Early Tooth Extraction: Performed before 6 years. Its aim is to

prevent future orthodontic problems and the need for complicated
surgical procedures. It has a better prognosis than the extraction
late. Its disadvantages are the risk of damaging the roots of the
permanent incisors, psychological difficulties for the child to
tolerate surgery, and finally that this surgery may ultimately prove
unnecessary, because sometimes just erupting without affecting
the permanent teeth.

Rhizolysis and Periodontal Lesions: Compression on the

roots of adjacent teeth retained by the supernumerary tooth

Late Tooth Extraction: Performed at 8-10 years after complete root

formation of permanent incisors. The risk of damaging the apex of

Pulp Pathology: Forming a cavity, or the existence of a root

resorption, they can induce the full range of pulp pathology [2,8].

BAOJ Dentistry, an open access journal

Volume 1; Issue 1; 002

Citation: Lucas Penalva PM, Perez-Albacete Martinez C, Ramrez Fernandez MP, Mate Snchez De Val JE, Calvo Guirado JL (2015)
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review. BAOJ Dentistry 1: 002.

permanent teeth is less than making early extraction, at this time

the child is better prepared to face surgery. Thus authors like Koch
et al. [44], advised late only perform extraction and extraction in
early symptomatic cases of supernumerary teeth. The drawback is
the increased risk of lack of space, requiring more aggressive in
that case and complicated orthodontic and surgical treatment.
Most permanent incisors included because of a mesiodens,
approximately 75% erupt spontaneously after the supernumerary
tooth is extracted [2,36]. Then we must control the eruption of
the central incisors erupted not waiting at least six months, and
checking that there is sufficient space in the dental arch so that they
can be located [2,45].
If we find that there is no spontaneous eruption of the incisors
we perform surgical exposure of them [16,21] and orthodontic
traction using brackets attached directly to the labial surface of the
incisor [46].
The aim of this review was to conduct a comprehensive literature
review of the existing literature on the etiology, epidemiology,
symptoms, diagnosis and treatment of mesiodens.

Method and Results

The database used for making the literature review included
PubMed, LILACS, EMBASE, Google Scholar, MedLinePlus,
Cochrane and Dialnet.
The key words used for making the search at the different database
were Mesiodens OR supernumerary teeth [All Fields] AND
treatment OR, etiology OR clinic OR orthodontic treatment
OR management OR, prevalence OR, the following keywords
were used case OR orthodontic OR radiographic OR
extraction OR radiographic OR review [All Fields].
The inclusion criteria for the different articles searched for making
this research work were: original articles or literature reviews from
January 1981 until January 2015 that were written in English,
Spanish, Italian, French, German or Portugueses.
Articles which the main topic was not mesiodens it etiology,
diagnosis, clinical aspects or treatment were discarded; also articles
which we cannot get the full text or articles in which mesiodens
or related aspects of it were superficially mentioned along the
After using inclusion and exclusion criteria, we used a total of
55 articles for making a literature review of the different aspects
involving mesiodens.

Studies have shown that the formation of supernumerary tooth
is due to an epithelial overactivity, but there is disagreement as to
what training from or what embryological point is generated [9].
Mesiodens may be single or multiply, Hernandez et al. [47] refer
cases of double mesiodens in children. Gndz et al. [48] collected
69 cases of patients who had a mesiodens 53 (76.8%) and 16 patients
BAOJ Dentistry, an open access journal

Page 3 of 5

two (23.1%). Salcido et al. [49] found 36 cases with mesiodens:

only 31 (86.1%) and 5 double (13.9%). Ferres Padro et al. [50] they
found in 42 cases mesiodens: only 36 (45.6%), 4 double (5.1%) and
2 mesiodens more than three (2.5%).
Fernandez et al. [51] performed 145 supernumerary extraction
in 102 patients. Mesiodens was the most frequent: 46.9% of the
patients had. Also it was for Salcido et al. [49], who reviewed to
2,245 patients and found 102 supernumerary teeth in 72 patients,
36 of whom presented. Ferrs Padro et al. [50] conducted the
extraction of 113 unerupted supernumerary teeth in 79 pediatric
patients. Mesiodens was the most frequent supernumerary teeth
(53.2% of patients), with a total amount of 42.
The panoramic radiograph performed as control visit tells us the
presence of supernumerary teeth without clinical signs exist, since a
high percentage are asymptomatic. Studies like those of Fernandez
et al. [51] and Gndz et al. [48], who extracted mesiodens 68
and 85 respectively, show that in 39.7% of cases the first study and
22.3% in the second were asymptomatic.
At other times cause complications. Fernandez et al. [51] found
that 51.5% of the 68 had been extracted mesiodens inclusion of
permanent teeth, 7.4% and diastema tooth malposition, and in a
case of a follicular cyst formation. Gndz et al. [48] reported that
38.8% of the 85 occurred mesiodens extracted delayed eruption of
permanent incisors in interincisal diastema 17.6%, 16.4% change in
the position of the permanent incisors erupted and 4.7% resorption
of adjacent teeth.
Besides orthopantomography in some cases we must complete the
radiological study with a periapical, occlusal, lateral skull X-ray
or CT scan to determine the exact location and relationship to
adjacent structures, prior to any extraction [38-40].
Mesiodens are 80% of all supernumerary teeth according Danalli
[1] as a result of the measurement from distal to the distal 11 to
21, while the percentage found by Bolk ranges from 45-66%, with
those diagnosed in the midline [7]. In a study of a total of 36 they
were diagnosed mesiodens mesiodens in 30 patients (average of 1.2
per patient mesiodens), corresponding to 1.5% of the total sample.
Prevalence was similar to that described in studies by Hurlen and
Humerfelt [52] (1.4%) and Salcido-Garcia et al. [49] (1.6%), and is
very close to the observed average frequency for prevalence values
collected (1.67%).
Raymundo et al. [53] anomalies observed in the number of teeth in
the permanent dentition in 909 patients aged 6-12. The prevalence
of supernumerary teeth was 2.2%, mostly located in the anterior
area; the mesiodens was the most common supernumerary teeth
Gorse et al. [54] 329 surgical procedures performed between
2002 and 2009 for diagnosis of retained parts odontomas
supernumeraries and found 110 cases of supernumerary teeth
(57.3%) in the anterior maxilla (87.3%), the range the most
common age 6-11 years (82.7%).
The management of supernumerary teeth depends on the type and

Volume 1; Issue 1; 002

Citation: Lucas Penalva PM, Perez-Albacete Martinez C, Ramrez Fernandez MP, Mate Snchez De Val JE, Calvo Guirado JL (2015)
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review. BAOJ Dentistry 1: 002.

tooth position. Mesiodens removal is often indicated in certain

situations, such as delayed eruption, displacement of adjacent
organs or orthodontic interference [55]. Early extraction mesiodens
has a better prognosis [56].
In the primary dentition it is usually not indicated mesiodens
extraction for the high risk of displacing or damaging the
development of the permanent incisors. In the mixed dentition,
there are two trends in the treatment best suited to perform the
extraction time: early removal (before the radicular formation
of permanent incisors) and late (after completion of the root
formation) [20]. Its removal allows early, in most cases, the
spontaneous eruption of the incisors affected, preventing associated
complications and other more complex subsequent treatments.

With the limits of this review concerning to mesiodens, we can
concluded that: Mesiodens is the most common supernumerary
tooth observed more in men than in women 2: 1. The most common
form of presentation is conoide, erupting only 25% of the time and
located palatal to the central incisors. It can cause pathological
conditions so an early diagnosis with panoramic radiography,
complete with occlusal or periapical at different angles, besides a
clinical diagnosis is recommended.
The treatment of choice is extraction supernumerary, this will
depend on their morphology, position, the potential effect on teeth
and surrounding structures, and patient age.

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Citation: Lucas Penalva PM, Perez-Albacete Martinez C, Ramrez Fernandez MP, Mate Snchez De Val JE, Calvo Guirado JL (2015)
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review. BAOJ Dentistry 1: 002.
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