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Introduction

Supernumerary tooth is one of the developmental


problems occurring in 0.15% to 1.9% of the
population.

Mesiodens is a supernumerary tooth present in


the midline between the two central incisors

Single or paired
Erupted or impacted
Cause delayed or ectopic eruption of the
permanent incisors (alter occlusion and
appearance)

Oral problems such as malocclusion, food

impaction, poor aesthetics, and cyst formation.

Supernumerary
and the
Both the permanent
teeth
primary dentitions but are 5 times
(Luten jr.)

less frequent in the primary


dentition(Sykaras SN 1975

M=F
Specific cause of the development

of the extra teeth has not yet been


established.

Theories

conical-small peg-shaped conical tooth located between the


maxillary central incisors term odontoma refers to any tumor of
odontogenic origin.represents a hamartomatous malformation
rather than a neoplasm

Mesiodens

Bolk (1917)
Occur individually or as multiples
(mesiodentes)

May appear unilaterally or bilaterally,


and often do not erupt.

Alter both occlusion and appearance

by altering the eruption path and the


position of the permanent incisors.

Associated with various craniofacial


anomalies,

Cleft lip and palate,


Gardners syndrome and

subject remains controversial

THEORIES

Phylogenetic reversion (atavism): mesiodentes


represented a phylogenetic relic of extinct ancestors who
had 3 central incisors.(von Arx T.)

Dichotomy: tooth bud is split to create 2 teeth, one of


which is the mesiodens (Sedano 1969)

Hyperactivity of the dental lamina: remnants of the


dental lamina or palatal offshoots of active dental lamina
are induced to develop into an extra tooth bud, which
results in a supernumerary tooth (Primosch RE. 1981)

Phylogenetic reversion (atavism) has now been discarded by the embryologists.


Supporters of dichotomy THEORY represents complete gemination which occurs frequently
in the anterior maxilla.
Genetic theory: Autosomal dominant inheritance with incomplete penetration
most popular theory involves hyperactivity of the dental lamina.

Types
of
Basis of their occurrence in the
Mesiodentes
dentition (rudimentary
Permanent
mesiodentes)

conical (small, peg-shaped)


tuberculate (barrel-shaped anterior
with more than one cusp)

molariform (small premolar-like or


molarlike)

Primary dentition (supplementary


mesiodentes)

Complications

Delayed eruption,
Crowding,
Spacing,
Impaction of

permanent incisors,

Abnormal root
formation,

Alteration in the path


of eruption of
permanent incisors,

Median diastema,

Cystic lesions,
Intraoral infection,
rotation,

Root resorption of the

adjacent teeth or even


eruption of incisors in
the nasal cavity

(Gorlin 2001)

Failure
of
Eruption
Tuberculate type of mesiodens

more likely causes delay in


eruption due to its position, which
is mostly located palatally related
to the maxillary incisors

Bartolo et al (2010) reported that


63% of patients with unerupted

Displacement or
Rotation

Scheiner and Sampsons review (1997)


It has been mentioned that it is
more probable that conical types often cause
displacement of the adjacent tooth

Important to check the presence of any supernumerary tooth prior to treatment of rotated
incisor or diastema

Crowding or
A supernumerary incisor may
Abnormal
Diastema
increase the crowding
potential
and may cause an aesthetic
problem in the upper anterior
region.

Root resorption
of
the
adjacent
Root
Abnormalities
teeth due to the presence of
supernumerary teeth may occur
quite rarely

Dilaceration is a developmental

anomaly in the tooth shape and its


structure, which may happen as
sharp bending of the tooth in
either the crown or the root
portion.

Loss of tooth vitality has been


reported in rare conditions .

Cyst Formation
Asaumi et al (2004)

in an 11-year
retrospective study reported that cyst
formation due to supernumerary teeth
was observed in 11% of the cases.

Eruption into the


complication reported to be
Another
Nasal
Cavity
associated with mesiodens is
ectopic eruption, even in the nasal
cavity.

Radiography in addition to clinical


examination helps the clinician in
the diagnosis.

Clinically, a white mass may be

seen in the nasal area,


radiographically appearing as a
tooth-like radiopacity

Depends on the type and position of

Management

the tooth.

Munns

stated that the earlier the


mesiodens is removed, the better the
prognosis.

Two methods for extraction of


mesiodens

1.Early extraction before root


formation of the permanent
incisors

2.Late extraction after root

formation of the permanent


incisors

Garvey recommended monitoring of mesiodens in the


following situations

Satisfactory eruption of the succeeding teeth,

It has also been recommended to keep unerupted


symptomless mesiodens, which do not affect the
dentition.

These teeth, which are usually found by chance, are


better left in place under observation (Garvey 1999 )

Absence of any associated pathologic lesions and risk of


damage to the vitality of the related teeth.