439 - Mesiodens - A Case Report on Treatment Modalities and Management

Purpose: A nine year old female patient in mixed dentition presented for her routine six month recall examination. Clinical examination revealed only severe maxillary crowding with constricted maxillary arch, and mild mandibular crowding. Upon the issuance of routine radiographs, a supernumerary tooth was discovered on the maxillary anterior occlusal film, located apically to #9 with root facing incisal and crown facing apically.

A mesiodens is the most common supernumerary tooth. Mesiodens are usually conical in shape, with 85% of mesiodens presenting as unerupted within the maxillary arch. It is important to understand the relevance of early detection of mesiodens, and the best treatment option for this finding.

Methods:   The fully bony-impacted, unerupted mesiodens was removed via intravenous sedation. A lingual trough was created on the palate to visualize the mesiodens intraorally. Mesiodens was then extracted, taking care not to disrupt the fully formed roots of the patient’s tooth #9 and #10. 

Results: Patient underwent procedure successfully with F4 behavior. A one week follow up examination confirmed adequate healing and well-being of the patient. Patient is now ready to undergo interceptive orthodontic treatment to correct her severe maxillary crowding.

Conclusion: This case highlights the importance of early detection of mesiodens and the modality in which to best manage this oral pathological finding. Early detection is key to providing a positive oral health outcome, with the ability to correct malocclusion effectively and prevent the chance of further pathological advancements such as root resorption of secondary incisors or tooth impaction.

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