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| CASE REPORT |
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| Year : 2018 | Volume
: 9
| Issue : 1 | Page : 44-47 |
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Bilaterally erupted conical and tuberculate mesiodentes
Sameer Punathil, Nikhil Chandran, Archana Pai B H, Laxmi Gireesh, Shabna Moyin
Department of Pedodontics, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| Date of Web Publication | 16-Mar-2018 |
Correspondence Address:
Dr. Nikhil Chandran
Department of Pedodontics, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala - 673 321
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/srmjrds.srmjrds_67_17
Supernumerary tooth is a developmental anomaly seen in the oral cavity and has been attributed to arise from multiple etiologies. A mesiodens is a supernumerary tooth seen in the midline of the maxillary dental arch. It can cause an ectopic or delayed eruption of the maxillary central incisors, alter the occlusion, compromise esthetics and may also lead to the formation of dentigerous cysts. It mainly arises in three different anatomical forms, i.e., conical, tuberculate, or supplemental mesiodens. It may arise unilaterally or bilaterally, or as singular or multiple supernumerary teeth. This paper reports a rare case of bilateral mesiodentes of conical and tuberculate types in the mixed dentition period while emphasizing on early radiographic diagnosis and management.
Keywords: Hyperdontia, mesiodens, mixed dentition, supernumerary teeth
How to cite this article:
Punathil S, Chandran N, Pai B H A, Gireesh L, Moyin S. Bilaterally erupted conical and tuberculate mesiodentes. SRM J Res Dent Sci 2018;9:44-7 |
How to cite this URL:
Punathil S, Chandran N, Pai B H A, Gireesh L, Moyin S. Bilaterally erupted conical and tuberculate mesiodentes. SRM J Res Dent Sci [serial online] 2018 [cited 2023 May 31];9:44-7. Available from: https://www.srmjrds.in/text.asp?2018/9/1/44/227770 |
| Introduction | |  |
Supernumerary teeth are teeth in excess of the normal series occurring in any region of the dental arch with predilection for the premaxilla. The hyperdontia may be single or multiple, unilateral or bilateral, erupted or unerupted and in one or both jaws.[1] Multiple supernumerary teeth are generally in the presence of certain syndromes such as cleft lip and palate, cleidocranial dysplasia, Gardner's syndrome, Fabry–Anderson's syndrome, Rothmund–Thomson syndrome, and Nance–Horan syndrome.[2] Over the years, various theories have been suggested regarding its etiology, which include dichotomy of the tooth bud, hyperactivity of the dental lamina, and a combination of genetic and environmental factors.[3]
The most common site of a supernumerary tooth is the palatal midline between the two maxillary central incisors, where it is termed as mesiodens. The presence of multiple mesiodens are called “mesiodentes.”[4] There are four morphological different types of supernumerary teeth in permanent dentition; conical, tuberculate, supplemental, and odontome. The conical which is a small peg-shaped tooth is the most common supernumerary found in the permanent dentition. Tuberculate supernumerary tooth is larger in size than the conical, barrel-shaped with several tubercles or cusps and have incomplete or abnormal root formation compared to permanent incisors.[1] A mesiodens may erupt normally, stay impacted, appear inverted, or take a horizontal position. Asymptomatic unerupted mesiodens may be discovered during radiological examination of the premaxillary area. Mesiodens may give rise to a variety of complications, such as impaction, delayed eruption and ectopic eruption of adjacent teeth, crowding, diastema, axial rotation and displacement, radicular resorption of adjacent teeth, and dentigerous cyst.[5]
This paper reports a case of bilateral mesiodentes of two different anatomic morphologies impenging the unerupted maxillary central incisors emphasizing on early radiographic diagnosis and management.
| Case Report | | |
A 7-year-old male patient reported to the Department of Pedodontics and Preventive Dentistry, Sree Anjaneya Institute of Dental Sciences, Calicut, with a chief complaint of irregularly shaped teeth in his upper front teeth region with an unesthetic appearance [Figure 1]a,[Figure 1]b,[Figure 1]c The familial, medical, and dental history were noncontributory. Extraoral examination did not reveal any abnormalities. Intraoral examination revealed a mixed dentition and in addition, there were two mesiodentes of conical and tuberculate type present in between the primary maxillary lateral incisors. The tuberculate mesiodens seemed to impinge the occlusion by distally tilting the erupting left permanent mandibular central incisor. No other interference in occlusion was noted, and the soft tissues appeared normal. To investigate further, routine radiographic (intraoral periapical radiographs, occlusal, and orthopantomograph) examinations [Figure 2], [Figure 3], [Figure 4] were carried out to evaluate the status of the mesiodentes, as well as the other teeth and to exclude the presence of any other impacted supernumerary teeth. The radiographs showed two mesiodens of conical and tuberculate type between the primary maxillary lateral incisors and also revealed rotated unerupted permanent maxillary central incisors. A multidisciplinary approach was planned to approach this case in which initially it was decided to extract the mesiodentes under local anesthesia [Figure 5] and [Figure 6]. This would be followed by constant recall to assess the eruption of the permanent maxillary central incisors to decide the extent of orthodontic treatment. | Figure 2: Intraoral periapical radiograph showing the mesiodentes with complete root formation
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 | Figure 3: Occlusal radiograph showing the position of the mesiodentes in relation to the rotated central and lateral incisors
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 | Figure 6: Extracted tuberculate mesiodens (left) and conical mesiodens (right)
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| Discussion | | |
Supernumerary teeth are developmental anomalies observed during routine dental examination. Although both dentitions are affected, a higher incidence of the anomaly is noted in the permanent dentition and predominantly in males.[5]
The presence of mesiodens is well documented in literature. However, the presence bilateral eruption of mesiodens at an early stage are less frequently reported because of infrequent detection by parents as the spacing frequently encountered after extraction of deciduous incisors are utilized to allow the supernumerary teeth to erupt with reasonable alignment.[6] In the present case, the bilateral mesiodentes were detected by the parents due to the abnormal shape of the teeth which led to an unesthetic smile in the child.
This case is unusual as the clinical presentation demonstrated a conical and tuberculate supernumerary teeth in the anterior maxilla in an asyndromic patient. Yusof observed and reviewed that multiple supernumerary teeth occurring in the absence of a syndrome occurred in the premolar region of the mandible and reported the anterior maxilla was an unusual site for this occurrence.[7] It has been reported that the tuberculate variety causes delayed eruption of the adjacent permanent teeth whereas the conical type caused a displacement.[1] In this case, it was radiographically detected that the conical mesiodens had rotated 11 and tuberculate mesiodens had deflected the path of eruption of 21 which could lead to an ectopic eruption of the tooth.
Several authors have stated varied opinions on the management of mesiodens, especially with regard to the timing of removal. Russel et al. recommended the extraction of mesiodens in the early mixed dentition stage for better alignment of teeth and minimizing the need for orthodontic treatment.[8] Rotberg recommended the removal of the supernumerary as soon as it has been discovered and ideally before the age of 5 years, so that root formation of the associated permanent incisors is incomplete.[9] Hogstrum and Andersson suggested two approaches in which the first approach involved removal of the supernumerary as soon as it has been diagnosed. This could create dental phobia in a young child and can also cause devitalization or deformation of adjacent teeth. The second approach involved, the supernumerary could be left until root development of the adjacent teeth is complete. The potential disadvantages associated with this plan include loss of eruptive force of adjacent teeth, loss of space, and crowding of the affected arch and also possible midline shifts.[10] In the present case, the timing for surgical removal of both mesiodens was prime as the roots of erupted supernumerary teeth had deleteriously altered the eruption pathways of both permanent maxillary central incisors.
Therefore, the authors emphasize on the use of routine radiographic procedures during the initial stages of the mixed dentition period to prevent complications enumerated above. Failure to identify or intercept the eruption of the supernumerary tooth would leave a deep psychological impact and future malocclusion in the child.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 9. | Rotberg S, Kopel HM. Early vs. late removal of mesiodens: A clinical study of 375 children. Compend Contin Educ Dent 1984;5:115-9. |
| 10. | Högström A, Andersson L. Complications related to surgical removal of anterior supernumerary teeth in children. ASDC J Dent Child 1987;54:341-3. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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