Erupted maxillary conical mesiodens in deciduous dentition in a Bengali girl - A case report

Abstract

Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch. It is the most significant dental anomaly affecting permanent dentition mainly and primary dentition rarely. It may occur as an isolated dental anomalous condition or may be associated with a syndrome. Many theories have been promulgated to explain its etiology. But an exact etiology is still obscure. Incidence of mesiodens in children varies from 0.15 to 3.8%. Boys are affected more (2 : 1) than Girls. Morphologically, mesiodens may be of three types: the most commonly seen is conical, while tuberculate and supplementary types.

Introduction

Numerical superiority in a dentition when compared to normal is known as Hyperdonua. The tooth or teeth causing this numerical excess is/are called the supernumerary tooth or teeth.

The supernumerary tooth present in the midline of the maxilla between the two central incisors is referred to as 'mesiodens.' The plural number of mesiodens is mesiodentes. The incidence of mesiodens in permanent dentition ranges from 0.15 to 3.8%, whereas in primary dentition it ranges from 0 to 1.9%.They are twice more common in boys, while no significant sex distribution is noted in primary supernumerary teeth. Mesiodens may erupt normally, stay impacted, appear inverted, take an ectopic position, or follow an abnormal path of eruption. It is seen that the frequency of erupted primary supernumerary teeth is much higher than that of the permanent supernumerary teeth (73 vs25%). Mesiodens or mesiodentes may precipitate a variety of complications, for example, crowding, delayed eruption, diastema, rotations, cystic lesions, and resorptions of adjacent teeth, etc., to the developing dentition/occlusion of a child. Supernumerary teeth may occur as a single isolated dental anomaly or in association with other developmental anomalies, or syndromes such as cleft palate and cleft lip, cleido-cranial dysostosis, Down's syndrome, and Gardner's Syndromes. The incidence of supernumerary teeth in cleft lip and cleft palate case may be as high as 28%.

Supernumerary teeth of the premaxillary region may appear in a variety of shapes though the most common type is conical or peg shaped (61%).The other two commonly present are tuberculate and supplemental (adjacent tooth like).

Over the years, suggestions or theories have been put forward to explain the etiology of supernumerary teeth, which includes phylogenetic reversion (atavistic theory), split in tooth bud (dichotomy theory), locally conditioned hyperactivity of the dental lamina (dental lamina theory), and a combination of genetic and environmental factors (unified etiologic explanation).

Case Report

The parents of a 4-year-old girl reported to the Department of Pedodontics and Preventive Dentistry of Dr. R. Ahmed Dental College and Hospital, Kolkata with the chief complaint of a gradual development of an odd appearance of teeth. The girl was following childhood immunization schedule strictly. The medical and family history was noncontributory. No significant abnormality was noted in the extra-oral examination (Figure 1).

Intra-oral examination revealed a complement of the primary dentition in a well-maintained oral health. A conical mesiodens was noted between the central incisors  (Figure 2). Intra-oral periapical radiograph of the maxillary anterior region showed a completely formed mesiodens with a conical crown and a root  (Figure 3). Orthopantomogram also revealed the mesiodens  (Figure 4).

The mesiodens was extracted under local anesthesia, after making a preoperative impression for record  (Figure 5),  (Figure 6),  (Figure 7).

Discussion

The first report of supernumerary teeth appeared between 23 and 79 ad. Mesiodens account for a 45-67% of all super numerary teeth. Balk (1917) defined mesiodens as the most common of supernumerary teeth located mesial to both centrals, appearing peg shaped in a normal position or inverted position. Regezi and Sciubba mentioned that the anterior midline of maxilla is the most common site of supernumerary tooth in which case the supernumerary tooth is known as mesiodens. Very few supernumerary teeth have been reported for the primary dentition. The present case is quite unusual as this reports a mesiodens in primary dentition and that too in a girl.

Supernumerary teeth are classified according to their shape and size (morphology) and location. The present case, reports of a conical mesiodens.

Conical mesiodens has certain characteristics, which are as follows:

· They are usually located between the permanent maxillary central incisors but rarely erupt labially.

· They erupt during childhood.

· They usually have complete root formation ahead of the adjacent teeth.

· They rarely cause delay in eruption of central incisors, but may cause alteration of path of eruption of these teeth.

A labially positioned mesiodens may cause palatal deflection of an incisor that may erupt with a rotation or in reverse bite rotationship. Other clinical problems associated with mesiodens are the development of malocclusion, ectopic eruption of adjacent teeth, cystic changes in the follicle, etc. Detection of mesiodens or supernumerary teeth is best achieved by clinical examination and radiography (IOPA, Occlusal, Orthopantomogram).

If there is no concomitant hypodontia, the choice of treatment of mesiodens is removal. In case of unerupted mesiodens, before surgical extraction is attempted, the location of the tooth/teeth and the state of root formation of adjacent teeth must be ascertained.

In the present case, the erupted conical mesiodens in the four-year-old girl was a great aesthetic concern to the parents. And an immediate extraction of the mesiodens was undertaken under local anesthesia to pervert the development of psychological trauma in the child, to minimize complications, and to achieve a good prognosis.

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