mesiodentes

Mesiodentes are a type of supernumerary tooth located in the maxillary midline, between the two central incisors. They are the most common form of supernumerary teeth and can be erupted or impacted. Mesiodentes are often small and may be conical in shape, but they can also be tuberculate or resemble a normal incisor (supplemental). They typically occur in the permanent dentition and may be single or, less commonly, multiple. They frequently accompany eruption disturbances or midline spacing changes.

The exact cause of mesiodentes is not fully understood and is considered multifactorial, with genetic predisposition and local factors such as aberrant activity of the dental lamina thought to play roles. They are sometimes associated with certain syndromes, including cleidocranial dysostosis and Gardner syndrome, but most cases occur in individuals without systemic disease.

Clinically, mesiodentes may be asymptomatic and found on routine radiographs, or they may present with delayed eruption of the maxillary central incisors, crowding, or a midline diastema. Diagnosis relies on clinical examination and imaging, typically panoramic radiographs; cone-beam computed tomography can help localize a tooth before treatment.

Management depends on symptoms and eruption status. Indications for extraction include interference with eruption of the central incisors, crowding, displacement of adjacent teeth, or development of a potential cyst. Timing generally aims to facilitate proper eruption of the adjacent teeth, often during the mixed dentition period, and may involve subsequent orthodontic treatment to align the incisors. If the mesiodens is asymptomatic and not affecting eruption, some clinicians may opt for observation, though extraction is commonly performed to prevent future complications.

Prognosis after removal is typically favorable, with many patients achieving normal eruption and alignment of the incisors; occasional complications include persistent diastema or the need for orthodontic treatment.