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Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 211-213

Double inverted mesiodentes: Report of an unusual case

1 Department of Pediatric Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India
2 Department of Oral Pathology and Microbiology, Government Dental College and Research Institute, Bengaluru, Karnataka, India
3 Department of Prosthodontics, Government Dental College and Research Institute, Bengaluru, Karnataka, India

Date of Web Publication17-Sep-2014

Correspondence Address:
Srinath Krishnappa
Department of Pediatric Dentistry, Government Dental College and Research Institute, Victoria Hospital Campus, Fort, Bengaluru - 560 002, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2277-8632.140953

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This report presents an extremely rare occurrence of two inverted impacted mesiodentes in a 16-year-old child patient. Extraction of both mesiodentes was indicated, owing to the abnormal diastema, rotation and impaction of teeth. Anterior cross bite as well as slightly concave profile was associated features in the child who presented with skeletal Class I relationship of the jaws. Development of these abnormalities would have been prevented if the impacted mesiodentes had been diagnosed and extracted early.

Keywords: Impaction of teeth, mesiodentes, midline diastema

How to cite this article:
Krishnappa S, Srinath S, Krishnappa V, Singh R. Double inverted mesiodentes: Report of an unusual case. J NTR Univ Health Sci 2014;3:211-3

How to cite this URL:
Krishnappa S, Srinath S, Krishnappa V, Singh R. Double inverted mesiodentes: Report of an unusual case. J NTR Univ Health Sci [serial online] 2014 [cited 2020 Apr 1];3:211-3. Available from: http://www.jdrntruhs.org/text.asp?2014/3/3/211/140953

  Introduction Top

By definition, supernumerary teeth are extra teeth in comparison to normal dentition. It is more common in the central region of the upper or lower jaw; however, its occurrence in the mandible is rare. The most common type of supernumerary tooth as indicated by Alberti et al. [1] is mesiodens.

The reported prevalence in the general population ranges between 0.15% and 1.9% and it is reported to be more common in males rather than females. [2] It has been reported that in 82% of the cases it occurs in the maxilla, specifically in the premaxillary region. [3] More rarely, they can be located in the premolar and distomolar regions and appear as supernumerary premolars or supernumerary fourth and fifth molars. [4]

In one-fourth of the cases, mesiodentes do spontaneously erupt into the oral cavity. In the cases that have not erupted, they interfere with eruption of the other permanent teeth causing malocclusion. [5]

This case report is a rare one where in two inverted mesiodentes were impacted in a 16-year-old girl, causing various abnormalities.

  Case report Top

A 16-year-old girl was referred to the Department of Pediatric Dentistry, Government Dental College and Research Institute Bengaluru with a chief complaint of irregularly placed upper front teeth. The child was concerned about the unesthetic appearance [Figure 1].
Figure 1: Child presented with anterior cross bite, diastema, rotated right upper canine, (right lateral incisor is palatally blocked out)

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Clinical examination revealed that the child had concave profile [Figure 2], anterior divergence and positive lip step with Angle's Class III molar relation. There was anterior cross bite with reverse over jet [Figure 1] and both the upper and lower incisors were protrusive and proclined [Figure 3]. Crowding in the maxillary anterior region as well as midline diastema was noted [Figure 1]. Maxillary right canine was rotated and the right maxillary lateral incisor was blocked out palatally. Lateral cephalogram showed that there was a skeletal Class I relation with orthognathic maxilla and prognathic and protrusive mandible [Figure 3]. Orthopantomogram showed the impacted maxillary left canine [Figure 4].
Figure 2: Lateral view showing concave profi le

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Figure 3: Lateral cephalogram showing protrusive and proclined upper and lower incisors

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Figure 4: Orthopantomogram showing the impacted left upper canine

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Intra oral periapical and occlusal radiographs in the maxillary anterior region revealed the presence of two mesiodentes, which were inverted and impacted and found to be located palatally to the apices of the maxillary central incisors [Figure 5]. There was no relevant medical and family history and the child was otherwise healthy and not associated with any syndrome.
Figure 5: Two mesiodentes located apical to apices of upper incisors

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After a detailed examination, the decision was made to extract the mesiodentes and to initiate necessary orthodontic treatment. The mesiodentes were extracted under local anesthesia [Figure 6] and [Figure 7].
Figure 6: Palatal view post-extraction

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Figure 7: Extracted mesiodentes

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  Discussion Top

In the present case, Impaction of left upper canine, abnormal diastema, palatally blocked out right lateral incisor, rotated right upper canine were attributed to the presence of mesiodentes and these features have been observed in earlier reports, which included various complications as a result of the presence of mesiodens, including 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. [6],[7] Prognathic and protrusive mandible observed in the present case may be due to anterior cross bite and reverse over jet. However the presence of anterior cross bite and slightly concave profile associated with the presence of mesiodentes were the associated findings observed in the present case.

Extraction is not the only treatment choice for impacted mesiodentes. If the mesiodens remains in place without symptoms and does not adversely affect the adjacent teeth, it may be left in place and observed periodically. [8] however, in the present case considering the various abnormalities and age of the patient surgical removal of the mesiodentes was judged necessary.

There is controversy in the literature regarding the time of removal of any unerupted mesiodens. The immediate removal versus delay in surgical intervention following root development of the central incisor and the lateral incisor about the age of 8 to 10 years has been mentioned. [9] Clinician should consider patient condition in the final decision; however, a recent study of Yagüe-García et al.[10] emphasized that the early removal of the supernumerary teeth in order to prevent complications is the treatment of choice.

Therefore when the succedaneous teeth do not erupt satisfactorily into the oral cavity or when there is presence of associated pathologic lesion and risk of damage to the vitality of the related teeth, the mesiodens should be extracted. Maxillary occlusal and periapical radiographs assist the process of diagnosis of mesiodens, for the purpose of precise view in the anterior region anterior occlusal or periapical radiograph is helpful. However, greater detail concerning the location of mesiodens could be obtained through computerized axial tomography which also can help evaluate their relationship with the adjacent tooth structures.

  Conclusion Top

Presences of mesiodentes were associated with abnormal diastema, rotation of teeth, impactions, displacement and crowding of teeth as well as with anterior cross bite. Development of these abnormalities can be prevented by timely diagnosis and extraction.

  References Top

1.Alberti G, Mondani PM, Parodi V. Eruption of supernumerary permanent teeth in a sample of urban primary school population in Genoa, Italy. Eur J Paediatr Dent 2006;7:89-92.  Back to cited text no. 1
2.Van Buggenhout G, Bailleul-Forestier I. Mesiodens. Eur J Med Genet 2008;51:178-81.  Back to cited text no. 2
3.Ferrés-Padró E, Prats-Armengol J, Ferrés-Amat E. A descriptive study of 113 unerupted supernumerary teeth in 79 pediatric patients in Barcelona. Med Oral Patol Oral Cir Bucal 2009;14:E146-52.  Back to cited text no. 3
4.Kokten G, Balcioglu H, Buyukertan M. Supernumerary fourth and fifth molars: A report of two cases. J Contemp Dent Pract 2003;4:67-76.  Back to cited text no. 4
5.Asaumi JI, Shibata Y, Yanagi Y, Hisatomi M, Matsuzaki H, Konouchi H, et al. Radiographic examination of mesiodens and their associated complications. Dentomaxillofac Radiol 2004;33:125-7.  Back to cited text no. 5
6.Prabhu NT, Rebecca J, Munshi AK. Mesiodens in the primary dentition - a case report. J Indian Soc Pedod Prev Dent 1998;16:93-5.  Back to cited text no. 6
7.Gorlin RJ, Cohen MM, Hennekam RC. Syndromes of the Head and Neck. 4 th ed. Oxford: Oxford University Press; 2001. p. 547-1108.  Back to cited text no. 7
8.Rajab LD, Hamdan MA. Supernumerary teeth: Review of the literature and a survey of 152 cases. Int J Paediatr Dent 2002;12:244-54.  Back to cited text no. 8
9.Alaçam A, Bani M. Mesiodens as a risk factor in treatment of trauma cases. Dent Traumatol 2009;25:e25-31.  Back to cited text no. 9
10.Yagüe-García J, Berini-Aytés L, Gay-Escoda C. Multiple supernumerary teeth not associated with complex syndromes: A retrospective study. Med Oral Patol Oral Cir Bucal 2009;14:E331-6.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]


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