Mesiodens

Mesiodens is a supernumerary tooth located in the maxillary central incisor region, typically positioned between or near the two permanent central incisors. It is the most common type of supernumerary tooth and occurs more often in the upper jaw than the lower jaw. Prevalence estimates vary, but mesiodentes are found in a minority of the population, with reports ranging roughly from around 0.1% to a few percent; there is some suggestion of a male predominance in certain studies.

Morphology and localization vary. Mesiodens can be conical (peg-shaped), tuberculate (barrel-shaped with multiple cusps), or supplemental (resembling a normal incisor). The most common form is conical. They are usually located at or near the midline between the maxillary central incisors and may be vertically oriented, tilted, or inverted.

Diagnosis often arises during routine dental exam or when eruption disturbances occur. Radiographs are essential: panoramic radiographs are standard, with periapical or occlusal views used for precise localization. Cone-beam computed tomography may be employed for complex cases to aid surgical planning.

Clinical implications include delayed eruption or failure of eruption of the permanent central incisors, crowding, midline diastema, and potential root resorption of adjacent teeth. Rare complications include the development of dentigerous or other odontogenic cysts.

Management depends on the tooth’s effect on eruption and alignment. If asymptomatic and not affecting eruption, observation may be appropriate. If eruption is disturbed or aesthetic concerns are present, surgical removal is indicated, typically around ages 6 to 7 to facilitate natural eruption of the central incisors. Orthodontic assessment is often recommended after extraction to guide proper alignment. Etiology is linked to dental lamina hyperactivity, with genetic factors likely contributing; the exact cause remains multifactorial.