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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 87-90

A rare case report of dual mesiodens


Department of Pedodontics and Preventive Dentistry, D. Y. Patil Deemed to be University, School of Dentistry, Navi Mumbai, Maharashtra, India

Date of Submission26-Nov-2019
Date of Acceptance19-Mar-2020
Date of Web Publication08-Jul-2020

Correspondence Address:
Dr. Rupinder Bhatia
Department of Pedodontics and Preventive Dentistry, D. Y. Patil Deemed to be University, School of Dentistry, Nerul, Navi Mumbai, Maharashtra
India
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DOI: 10.4103/srmjrds.srmjrds_83_19

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  Abstract 

Supernumerary teeth, a developmental anomaly when compared to the normal dentition, are characterized by the presence of an extra tooth or teeth. The most common supernumerary teeth are the mesiodens which is located in the middle region of the premaxilla, between the two central incisors. Its' prevalence differs between different racial groups, and in the population of India, it varies from 0.3% to 3.8%, with a ratio of 2:

Keywords: Mesiodens, mesiodentes, supernumerary teeth


How to cite this article:
Parampill A, Rastogi R, Bhatia R. A rare case report of dual mesiodens. SRM J Res Dent Sci 2020;11:87-90

How to cite this URL:
Parampill A, Rastogi R, Bhatia R. A rare case report of dual mesiodens. SRM J Res Dent Sci [serial online] 2020 [cited 2020 Aug 12];11:87-90. Available from: http://www.srmjrds.in/text.asp?2020/11/2/87/289172


  Introduction Top


A supernumerary tooth is an extra tooth when compared to the normal dentition. It was first reported between AD 23 and 79. It presents more in the maxilla than the mandible. Most common type of supernumerary teeth is mesiodens. According to Mosby's Medical Dictionary, “Mesiodens is defined as a supernumerary erupted or an unerupted tooth that develops between two maxillary central incisors.” Balk in 1917 coined the term mesiodens to imply an extra tooth presents between the two central incisors. Delay in eruption and displacement or spacing of permanent incisors can be indicative of the presence of a mesiodens.[1]

About 0.1%–3.6% is the prevalence rate of supernumerary teeth with a 2:1 male predilection over female, of which one-third of these cases are of mesiodens. The occurrence rate is 0.1%–3.6% (permanent dentition) when compared to 0.02%–1.9% (primary dentition).[2]

Mesiodens could be in either of the positions – unilateral, bilateral, or inverted. Mesiodens have a fundamental morphology of a conical crown that is smaller in size than the adjoining normal teeth and at times mimic a more natural tooth shape.[3] Canoglu et al. 2009 stated that the roots of mesiodens are totally formed, which may be either curved or globular. About 20% of all mesiodentes erupt spontaneously into the oral cavity. Hatab et al. 1994 stated that mesiodens are diagnosed during routine radiographic examination as they remain impacted and asymptomatic for a prolonged duration.[3] The objective of this case report is to explain a case of fully erupted, conical, double meisodens in an 8.5-year-old asyndromatic male patient along with a high frenal attachment.


  Case Report Top


An 8.5-year-old boy reported to the department of pedodontics and preventive dentistry complaining of misaligned teeth in the upper front region of the jaw which lead to unpleasing facial appearance. Medical and past dental history was noncontributory. He was a healthy patient with no association to any syndrome. He had no familial history of the same. On oral examination, the patient was in his mixed dentition period and along with that, there were two conical mesiodentes present in the anterior region of the maxilla in the middle of the two central incisors [Figure 1]a and [Figure 1]b. This resulted in the distal rotation of 21 and 11 was labially placed when compared to 21. There was no interference with occlusion and a healthy gingiva was seen. An orthopantomogram was taken to evaluate the status and growth of the mesiodens and also to rule out the existence of any other impacted supernumerary teeth [Figure 2]. The radiograph revealed that dual conical mesiodens with entirely developed roots present in the middle of two maxillary permanent central incisors. Furthermore, it was noticed that the patient had a high frenal attachment. Hence, the treatment plan was to extract the mesiodens under local anesthesia [Figure 3] and to conduct a frenectomy using a diode laser. The patient was recalled post extraction after 1 week. There was uneventful healing. Frenectomy procedure was carried out 4 months after the extraction [Figure 4]. The patient was recalled after 1 week [Figure 5].
Figure 1:(a) Preoperative picture (labial view). (b) Preoperative picture (occlusal view)

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Figure 2: Orthopantomogram

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Figure 3: Extracted mesiodentes

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Figure 4: Frenectomy completed

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Figure 5: Recall after 1 week showing healing

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  Discussion Top


Mesiodens is a frequent type of supernumerary tooth that appears in the maxillary midline. However, very little literature is available on double supernumerary teeth or mesiodentes, as they do not occur frequently with a prevalence of 0.1%–1.9%, and a rare case of triple mesiodens has also been reported by Laws 1979.[4],[5] The mesiodens occurs as an autosomal dominant pattern with incomplete penetration. Although mesiodens may be familial in nature, it does not follow a simple Mendelian pattern. They may also occur in alongside other developmental abnormalities or syndromic conditions such as cleft lip and palate, Down's syndrome, cleidocranial dysostosis, and Gardner's syndrome.[4] In our present case, the patient presented with double mesiodens but did not have a familial history of mesiodens nor was associated with any syndromic conditions.

Anthonappa[6] suggested that males are predominantly affected more than females (3.1:1). In a case series by Rana,[7] they found that the patients who had reported with mesiodentes were all male, again suggestive of male predilection. In the present case report, the patient was a male child in his mixed dentition.

In most cases of mesiodentes, they are usually placed palatally to the central incisors and rarely placed labially. They erupt spontaneously in the oral cavity.[4] In the present case, the mesiodens erupted spontaneously in the oral cavity and was placed slight palatally in between the two central incisors.

Morphologically, mesiodens may be eumorphic (resembling natural teeth) or dysmorphic (conical, tuberculate, or molariform). The eruption of the central incisors is not affected by the presence of conical mesiodens, but it can cause the displacement of the crown, root, or the whole tooth. Mesiodentes usually cause the rotation of the permanent incisors, which were seen in the case reports by Asha,[1] Krishnamurthy et al.,[3] and Singaraju[4] In the present case, the associated mesiodentes were conical, caused labial displacement of the right permanent central incisor, and distal rotation of the left permanent central incisor.

A clinical intervention is usually required in cases of mesiodentes as they affect the eruption and position of the adjacent teeth. They are managed by either conservative method or extraction. Khatri[8] stated that extraction can be of three types, i.e., immediate, early-before the root formation of permanent incisors, or late-after the root formation of central incisor. Yaguü-Garciía[9] favored early extraction to prevent complications but was discouraged by as it stood a chance of inducing damage to the developing permanent incisors during extraction.[10] Normal eruptive forces of the tooth allow it to spontaneously erupt, help in proper alignment, and can also reduce extensive orthodontic treatment, which can be achieved if mesiodentes are extracted in early mixed dentition stage. Schwartzet al.[11] suggested that if the supernumerary teeth are left untreated have the tendency to resorb and disappear on its' own. Rajab[2] stated that if the mesiodens are symptomless and do not cause any problems to the adjacent teeth, it can be kept in place and observed periodically. In the current case, considering the age of the child, the eruption status of the maxillary central incisor as well as the unaesthetic appearance, the extraction of the mesiodentes was carried out. This would help in providing realigning of the malocclusion to some extent and reducing the treatment time for orthodontic therapy.

Frenal abnormalities are present in the lingual or maxillary labial frenum. The presence of a high frenal attachment in the maxilla can cause a diastema of the dentition and eruption disturbance of the central incisors. Laser therapy is well accepted by the children and parents due to its minimal invasiveness. For soft-tissue removal, erbium, chromium: yttrium–scandium–gallium–garnet, erbium-doped yttrium aluminium garnet, diode, and neodymium-doped yttrium aluminium garnet lasers are used.[12] In the present case, the patient had a high frenal attachment which would present a challenge in the orthodontic therapy after extraction of the mesiodentes, so a frenectomy was performed using a diode laser.


  Conclusion Top


This is a case report on a rare finding of mesiodentes in the maxillary arch which had caused malocclusion and esthetic problems to the patient. Mesiodens are a common anomaly which pediatric dentists come across. However, a double mesiodens is rare. Early diagnosis clinically with the help of radiographs is important for minimal complications and better prognosis. Extraction is the choice of treatment in mixed dentition as it allows a spontaneous alignment of adjacent teeth to some extent and reduces the time of orthodontic therapy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Asha ML. Twin mesiodens: A case report. Int J Adv Health Sci 2015;2:18.  Back to cited text no. 1
    
2.
Rajab LD. Supernumerary teeth: Review of the literature and a survey of 152 cases. Int J Paediatr Dent 2002;12:244.  Back to cited text no. 2
    
3.
Krishnamurthy NH, Unnikrishnan S, Thimmegowda U, Thomas J. Fully erupted twin mesiodens: A case report. Int J Curr Res 2017;9:52667.  Back to cited text no. 3
    
4.
Singaraju GS. Floral double mesiodentes: A rare case report. J Nat Sci Bio Med 2016;6:229.  Back to cited text no. 4
    
5.
Laws TF. Triple mesiodentes. J Am Dent Assoc 1979;99:483.  Back to cited text no. 5
    
6.
Anthonappa RP. Characteristics of 283 supernumerary teeth in Southern Chinese children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e48.  Back to cited text no. 6
    
7.
Rana SS. Double mesiodens in mixed dentition period: Report of 3 cases. SRM J Res Dent Sci 2018;9:125.  Back to cited text no. 7
  [Full text]  
8.
Khatri MP. Overview of mesiodens: A review. Int J Pharm Biosci 2014;5:526.  Back to cited text no. 8
    
9.
Srinivasan S, Nandlal B. Palatally erupted twin maxillary mesiodens: A case report. Int J Adv Res 2017;5:440.  Back to cited text no. 9
    
10.
Yaguüe-Garciía J. Multiple supernumerary teeth not associated with complex syndromes: A retrospective study. Med Oral Patol Oral Cir Bucal 2009;14:331.  Back to cited text no. 10
    
11.
Schwartz KH. Indications for surgical removal of supernumerary teeth in the premaxilla. Int J Oral Maxillofac Surg 1986;15:273.  Back to cited text no. 11
    
12.
Nazemisalman B. Types of lasers and their application in pediatric dentistry. J Lasers Med Sci 2015;6:96.  Back to cited text no. 12
    


    Figures

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



 

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