Impacted Mesiodens Research Articles

Orthodontic-Surgical Management of Triple Impacted Mesiodens and Maxillary Incisors - A Case Report

Abstract Rationale: Mesiodens are supernumerary teeth located in the pre-maxilla between the two central incisors with a prevalence rate of 0.15–1.9%. An impacted mesiodens may cause delayed eruption of permanent incisors, ectopic eruption, pathological disturbances and malalignment of teeth. Patient Concerns: The patient complained of missing upper front teeth associated with pain in the same region for two weeks. Diagnosis: Upon clinical and radiographic examination, it was diagnosed as triple impacted mesiodens with impacted permanent maxillary central incisors. Treatment: The clinicians in the study approached the issue by surgical removal of the impacted mesiodens and orthodontic treatment for extrusion of the impacted permanent maxillary central incisors. Outcomes: The patient was relieved of the pre-operative concerns and followed up regularly for the eruption of permanent maxillary central incisors. Take-away Lessons: The authors advocate the importance of timely diagnosis and proper management of such rare pathologies.

Surgical Management of Palatally Impacted Mesiodens in a Pediatric Patient: A Case Report

Supernumerary teeth are additional teeth or tooth-like structures that can develop either erupted or unerupted, beyond the normal complement of 20 primary teeth and 32 permanent teeth. A mesiodens is a specific type of supernumerary tooth located in the midline between the two central incisors. The presence of these extra teeth can lead to various clinical complications. This paper presents a case involving a palatally positioned, impacted mesiodens that was associated with an unerupted permanent left maxillary central incisor. Surgical removal of the mesiodens was performed, resulting in the successful eruption of the permanent incisor.

Effects of single unilaterally impacted mesiodens on maxillary central incisors: A 3D quantitative assessment based on cone-beam computed tomography.

Mesiodens usually lead to the malposition and abnormal morphology of maxillary central incisors. To evaluate the detrimental effects of single unilaterally impacted mesiodens on the three-dimensional positions and morphology of the maxillary central incisor using cone-beam computed tomographic (CBCT) examinations. A total of 321 patients aged 5-17 years with single unilaterally impacted mesiodens were included and divided into two groups: mixed dentition group (5-10 years) and early permanent dentition group (11-17 years). CBCT data for these patients were retrospectively analyzed to compare the inclination, rotation, angulation, and morphology of maxillary central incisors between the affected and contralateral control sides. The morphology, orientation, and spatial location of mesiodens were also assessed. Central incisors on the affected side showed significant palatal crown inclination, shorter root, shorter tooth, and greater crown-to-root ratio in both groups, whereas significant mesial crown angulation was only observed in the mixed dentition group. Impacted mesiodentes result in the displacement and impaired root development of central incisors, strongly suggesting timely clinical management of these abnormal teeth, such as the early removal of mesiodens and orthodontic treatments.

Mesiodens: the most common case of hyperdontia – presentation of radiological cases

Mesiodens is the most common case of supernumerary teeth. It is a very usual developmental abnormality of permanent dentition, either accompanied or not by painful symptomatology and other pathological findings. Mesiodens are often detected by chance, through patients' radiological examination for other reasons. So, radiology and its methods assist in the radiographic estimation of a mesiodens. The purpose of this study is to present the valuable contribution of oral radiology in detecting asymptomatic mesiodens and determining their exact position. Four radiological cases have been chosen for this study. The four patients belong to different age groups (29, 9, 64 and 71 years old accordingly) and are of both genders. Each one came to the School of Dentistry for different dental treatments. Three different radiological technoques of oral radiology have been applied for their examination, namely periapical, panoramic and cone-beam computed tomography radiographs. In all cases, the mesiodens were impacted and asymptomatic, thus detected by chance through the conducted radiographic evaluation. In case of mesiodens, radiology contributes significantly in determining the tooth's characteristics, as in most cases the mesiodens is impacted. All eadiographic methodologies presented in this studyare essential not only for the diagnosis, but also for the surgical management of mesiodens. In case of prosthodontic treatment in edentulous patients, orthodontic treatment or at the presence of pathological findings, the impacted mesiodens should be extracted, Otherwise, the decision depends on the clinical and radiological findings.

Different approaches and type of anaesthesia required for the extraction of inverted mesiodens: A case series with review of literature

Supernumerary teeth are additional teeth or toothlike structures that have erupted or remained unerupted in addition to the 20 deciduous teeth and 32 permanent teeth. The size, form, and number of teeth can all vary. It is the most frequent type of supernumerary tooth, and it is generally found between the top two central incisors, which may be impacted or erupted. CBCT pictures were collected to properly diagnose the form and location of the mesiodens. Their presence can cause a range of clinical issues. The current report discusses a rare example of palatally positioned, inverted, and impacted mesiodens discovered during a malocclusion radiographic evaluation. It seeks to demonstrate early detection, planning, and the proper method, allowing the teeth and neighbouring teeth to be preserved.

Management of a rotated upper central incisor associated with impacted supernumerary tooth

supernumerary teeth are often found in the maxilla, the extra teeth may be tuberculate, conical, or supplementary or like odontome in shape. The maxillary central incisor region contains mesiodens, a conical kind of supernumerary teeth that maybe unerupted. The adjacent maxillary incisors may rotate, unerupt, or misalign if mesiodens are present.We discuss a case of rotation of the maxillary central incisor with impacted mesiodens in this article, where treatment included surgical removal of impacted mesiodens and orthodontic alignment with 2X4 appliance.

Image segmentation of impacted mesiodens using deep learning.

This study aimed to evaluate the performance of deep learning algorithms for the classification and segmentation of impacted mesiodens in pediatric panoramic radiographs. A total of 850 panoramic radiographs of pediatric patients (aged 3-9 years) was included in this study. The U-Net semantic segmentation algorithm was applied for the detection and segmentation of mesiodens in the upper anterior region. For enhancement of the algorithm, pre-trained ResNet models were applied to the encoding path. The segmentation performance of the algorithm was tested using the Jaccard index and Dice coefficient. The diagnostic accuracy, precision, recall, F1-score and time to diagnosis of the algorithms were compared with those of human expert groups using the test dataset. Cohen's kappa statistics were compared between the model and human groups. The segmentation model exhibited a high Jaccard index and Dice coefficient (>90%). In mesiodens diagnosis, the trained model achieved 91-92% accuracy and a 94-95% F1-score, which were comparable with human expert group results (96%). The diagnostic duration of the deep learning model was 7.5 seconds, which was significantly faster in mesiodens detection compared to human groups. The agreement between the deep learning model and human experts is moderate (Cohen's kappa = 0.767). The proposed deep learning algorithm showed good segmentation performance and approached the performance of human experts in the diagnosis of mesiodens, with a significantly faster diagnosis time.

Removal of nasally impacted mesiodens by maxillary vestibular transnasal approach

The mesiodens is rarely associated with the nasal floor. Several surgical techniques exist for the removal of nasally impacted mesiodens. This case report presents a 13-year-old male who had uneventful surgical extraction of nasally impacted asymptomatic mesiodens using a maxillary transnasal subperiosteal approach via a modified LeFort I vestibular incision. This novel technique, which requires surgical experience and expertise, is recommended due to optimal surgical access, resulting in reduced surgical time and less bone removal with a decreased risk of damage to the adjacent structures.

The Enigma of a Massive Lesion Invading the Maxillary Sinus: A Case Report

Radicular cyst is a periapical inflammatory lesion mandatorily associated with a non-vital tooth which usually manifests as an asymptomatic slow growing painless swelling. The present case reported to the Department of Oral and Maxillofacial Surgery Chhattisgarh Dental College and Research Institute with an unusual presentation of an infected radicular cyst of maxilla invading the maxillary sinus. This case report highlights the advancing capability of an infected radicular cyst involving maxillary sinus its systematic treatment planning and execution. The cystic lesion covered the entire right maxilla and anteriors on the left side while involving maxillary sinus. It was surgically treated with enucleation and removal of inflamed sinus lining along with extraction of involved teeth and impacted mesiodens. The surgical site healed completely along with resolution of symptoms. A six month post-op radiograph revealed good bone healing.nbsp

Performance comparison of three deep learning models for impacted mesiodens detection on periapical radiographs

This study aimed to develop deep learning models that automatically detect impacted mesiodens on periapical radiographs of primary and mixed dentition using the YOLOv3, RetinaNet, and EfficientDet-D3 algorithms and to compare their performance. Periapical radiographs of 600 pediatric patients (age range, 3–13 years) with mesiodens were used as a training and validation dataset. Deep learning models based on the YOLOv3, RetinaNet, and EfficientDet-D3 algorithms for detecting mesiodens were developed, and each model was trained 300 times using training (540 images) and validation datasets (60 images). The performance of each model was evaluated based on accuracy, sensitivity, and specificity using 120 test images (60 periapical radiographs with mesiodens and 60 periapical radiographs without mesiodens). The accuracy of the YOLOv3, RetinaNet, and EfficientDet-D3 models was 97.5%, 98.3%, and 99.2%, respectively. The sensitivity was 100% for both the YOLOv3 and RetinaNet models and 98.3% for the EfficientDet-D3 model. The specificity was 100%, 96.7%, and 95.0% for the EfficientDet-D3, RetinaNet, and YOLOv3 models, respectively. The proposed models using three deep learning algorithms to detect mesiodens on periapical radiographs showed good performance. The EfficientDet-D3 model showed the highest accuracy for detecting mesiodens on periapical radiographs.

Infected dentigerous cyst on a totally impacted mesiodens

Dentigerous cyst is a developmental odontogenic cyst which originates through alterations of reduced enamel epithelium in an unerupted tooth or a developing tooth bud. These cysts rarely associate with supernumerary teeth. Supernumerary teeth accounts for 5% of all dentigerous cysts. The most common supernumerary teeth are mesiodens. The case study aimed to present a rare case of infected dentigerous cyst on a totally impacted mesiodens. This case report describes a rare case of infected dentigerous cyst associated with mesiodens in a 33 year old female who presented with a slow growing swelling in the palatal. Dentigerous cyst was treated with cyst enucleation with extraction of the mesiodens. Mesiodens should be diagnosed at the earliest possible time and its management should be conducted to prevent development of dentigerous cyst and damage to adjacent teeth and vital structures.

Evaluation of the surgical approach based on impacted position and direction of mesiodens

ObjectiveThis study aimed to reveal the relationship between the approach of extraction and the position of the mesiodens by systematic classification. MethodsThis retrospective study included patients with impacted mesiodens that required computed tomography for extraction. The direction, sagittal and axial position, eruption from the nasal floor, surrounding bone thickness, surgical approach, and anesthesia type for the impacted mesiodens were analyzed. Mesiodens were classified into three groups (V: vertical position, H: horizontal position, and D: direction), and each group was classified into three subgroups (V1, 2, 3; H1, 2, 3; D1, 2, 3). ResultsA total of 169 impacted mesiodens were included in this study. The palatal approach was the most common (151 teeth, 89.3%), followed by the labial approach (11 teeth, 6.5%) and nasal floor approach (6 teeth, 3.6%). The bone thickness from the mesiodens to the palatal surface were significantly shorter in palatal far region of nasopalatine duct (H3) than in palatal near region (H2) (P < 0.05). In vertical high position (V3), the percentage of the palatal approach in H3 (87.5%) was higher than that in H2 (71.4%). Additionally, 15 teeth erupting from the nasal floor wherein four were extracted by the nasal floor approach in H2 but only one tooth in H3. ConclusionsEven at higher positions, mesiodens located in the palatal far region tended to be extracted by the palatal approach because of the thin bone thickness.

Dense-in-dente in mesiodense: Report of a rare duet

Dens invaginatus is a developmental anomaly resulting from invagination of a portion of crown (enamel organ) during odontogenesis. Mesiodens is a supernumerary tooth present in the midline of maxilla between two central incisors. Very few cases of Dens invaginatus have been reported in a mesiodense. Through this article we are presenting a rare case of dens invaginatus occurring in a bulbous mesiodense in a 19 year old boy along with an additional adjacent supernumerary tooth, and a review of literature regarding the same. The patient had presented with complains of unaesthetic appearance. The clinical, radiologic and histologic examination revealed presence of Dens invaginatus Type II. The literature search showed that co-existence of dens invaginatus in a supernumerary tooth is a rare occurrence. As per the available literature, 12 such cases have been reported out of which three have been reported in impacted mesiodens and 3 cases of occurrence of dens invaginatus in mesiodentes.

A multidisciplinary approach toward the replacement of missing maxillary anterior teeth using impacted mesiodens as abutment via “reverse endodontic treatment”

A multidisciplinary approach toward the replacement of missing maxillary anterior teeth using impacted mesiodens as abutment via “reverse endodontic treatment”

English

Supernumeraries erupting in ectopic regions are one of the commonly found anomalies of orofacial region.1 The mesiodens, being located between the maxillary central incisors is the most common supernumerary tooth.2,3 But impacted mesiodens erupting into nasal cavity is a rare finding. We are detailing an instance of an inverted impacted mesiodens in the nasopalatine canal of an adult patient with encroachment on the nasal floor diagnosed as an incidental finding in panoramic radiograph. Intranasal tooth in adults is reported rare in the literature. Although surgical removal is advised generally on diagnosis of impacted mesiodens, we stress the importance of periodic monitoring of such cases which adds significantly to the patient wellbeing, function and aesthetics. There are few published case reports and most of the cases reported in the literature are in children which prompt for immediate removal upon its recognition. A supernumerary tooth that erupts ectopically into the nasal cavity is referred to as an intranasal tooth. Its occurrence rate is low with only 0.1 to 1 % people being affected from the community.4 The aetiology of intranasal tooth stays undefined. Supernumerary teeth may develop from the region of the nasal cavity as a result of a damage caused by an injury, rhinogenic maxillary sinusitis, a dental disease, oral blisters, obstructed path of dental eruption, and disruption of developmental tissue in the palatine gap.4 The potential complications that can arise due to nasal eruption of tooth are perforation of nasal septum, naso-oral fistula and aspergillosis4. The probable dental complications include midline diastema (17.6 %), late eruption of the permanent incisors (38.8 %), axial rotation of the permanent incisors (16.4 %), root resorption of the neighbouring teeth (4.7 %),5 cyst formation, 6 and infection.1 A team approach with inclusion of disciplines in medicine and dentistry is necessary for planning and execution of an appropriate treatment method in order to prevent complications related to inadvertent surgical entry into vital structures.

A rare case report of dentigerous cyst associated with an impacted mesiodens

A rare case report of dentigerous cyst associated with an impacted mesiodens

An incidental radiographic finding of an inverted mesiodens — A case report with a comprehensive review

Supernumerary teeth (ST) are uncommon developmental disorders that can be seen in either of the dental arches. Mesiodens is the most common type of ST. The experience of observing one such case is reported along with a literature review. This article describes a clinical case of a 46-year-old female patient with an impacted inverted mesiodens that was diagnosed accidentally during the routine radiographic examination. The mesiodens was very close to the nasal floor. Advanced radiographic investigations (CBCT) was advised for locating the exact position of mesiodens. The patient was counselled regarding the potential complications of ST and was advised for the surgical removal of the mesiodens, but the patient denied the treatment as ST was not causing any immediate problem. Therefore, the patient is under the continuous follow-up to avoid any complications with the mesiodens. The present case focuses on the importance of careful clinical and radiographic assessment in the diagnosis of ST, especially when they are asymptomatic. Patients should be educated regarding the same with proper explanations of all the treatment options.

A rare case of a supernumerary tooth (mesiodens) in an Iron Age (2470 ± 35 bp) skeleton from Koziegłowy (Poland)

AbstractAlthough supernumerary teeth are well documented clinically, they are uncommon in contemporary and historical populations. The most common form of supernumerary tooth is the mesiodens. Despite radiological studies of historical dental materials, cases of mesiodens are rarely found. This paper presents the first case of a mesiodens in archeological material from Poland, belonging to an adult male from Koziegłowy (Poland). The remains were dated to about 2470 ± 35 bp, one of the oldest set of remains in Europe. The presence of a mesiodens was confirmed with computed tomography. The fully impacted mesiodens is located in the alveolar bone palatally and above the central incisors. Its longitudinal axis is almost parallel to the horizontal plane. A mesiodens may be associated with certain congenital disorders. However, our case appears to be idiopathic. The mesiodens had not caused any complications involving the central or lateral incisors, such as root resorption, eruption disorders, cyst, rotation or inclination of the incisors, except for a small midline diastema. The described case contributes to our knowledge of orthodontic anomalies in historical populations.

Impacted supernumerary teeth along with the presence of impacted maxillary central incisors

Impaction of maxillary central incisors is not a common scenario seen in dental practice, and its treatment is often found to be challenging for a clinician as they are esthetically important. Parents are mostly apprehensive when the front teeth of their kids are missing. The causes for the impaction of maxillary central incisors are many, and one of the reasons is supernumerary teeth. A mesiodens is one common type which is a malformed, peg-like tooth that occurs between the maxillary central incisors. A bilateral tuberculate supernumerary tooth is a rare occurrence in the anterior premaxillary region, and if they occur, they fail to erupt into the oral cavity. They often cause impaction of the maxillary central incisors. This unique case report throws light on a rare case of palatally placed; tuberculate bilaterally impacted mesiodens along with impacted maxillary central incisors and its treatment procedures.

An effective mesiodens extraction method involving an intraoral approach through the nasal floor bone

AbstractA mesiodens is a supernumerary tooth located in the maxillary central region, frequently found in an inverted, impacted position, which can cause delayed or ectopic eruption of the permanent incisors. Unerupted supernumerary teeth are typically removed by the traditional palatal or labial approach. However, the traditional approach may induce injury to the adjacent root or damage the surrounding soft tissue because a deeply impacted mesiodens requires excessive bone removal in the anterior maxilla. The aim of the present study was to introduce an effective tooth extraction method involving an intraoral approach through the floor bone of the nasal cavity.