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The term mesiodens describes a conical supernumerary tooth located between the maxillary central incisors. Complications of these teeth include: disturbance of the eruption pattern of neighbouring teeth; spacing; crowding; displacement or total failure of eruption. Finally, they can migrate and cause damage to neighbouring structures. This case report describes a clinical case in which a mesiodens migrated over an eight-year period distally from the anterior of the maxilla along the palate. Radiographic techniques of plain radiography and Cone Beam Computed Tomography were used to locate its exact position.
Clinical Relevance: This paper discusses briefly the aetiology and complications of mesiodentes, and highlights the fact that they can migrate in the maxilla significant distances from their original position. This raises the question as to whether or not their position should be monitored.
Article
A supernumerary tooth is one that is additional to the normal series and can occur singly, in multiples, unilaterally or bilaterally and in the maxilla, the mandible or both.1 Their reported prevalence ranges between 0.3−0.8% in the primary dentition and 0.1−3.8% in the permanent dentition.2,3,4 The aetiology of supernumerary teeth is not completely understood, with various theories existing for the different types of supernumerary teeth, including:
Their exact aetiology remains unknown, but current knowledge suggests a complex interplay between developmental processes, genetic factors and favouring the dental lamina hyperactivity theory.7,8
Classification is according to morphology or location.9
Morphological classification can be:
Classification based on location may include:
A mesiodens is usually a conical supernumerary tooth located between the maxillary central incisors.2 It may also take a tuberculate, supplemental or an odontome form, and be found in a regular, inverted or horizontal orientation.10 These supernumerary teeth are usually located palatal to the permanent incisors, rarely lying in the line of the arch or labially.11 The mesiodens is usually small and short, with a triangular or conical crown.12 As a result, mesiodentes tend to be initially detected radiographically following clinical examination, often as a result of dental disturbances in the premaxilla. In order to determine the position of a supernumerary tooth accurately, several conventional radiographic views are required.13 However, the use of Cone Beam Computed Tomography (CBCT) can be used to provide accurate three-dimensional (3D) images of related dental and bony structures and has been shown to be helpful in pre-treatment evaluation.14
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