|Year : 2011 | Volume
| Issue : 1 | Page : 34-38
Mesiodens: A clinical and radiographic study in children
Department of Pedodontics, North Bengal Dental College, PO Sushruthanagar, Dist: Darjeeling, West Bengal, India
|Date of Web Publication||23-Apr-2011|
18/1C Diamond City (N), 68 Jessor Road, PO Nagerbazar, Kolkata - 700 055, West Bengal
| Abstract|| |
Background: A mesiodens is a supernumerary tooth located in the palatal midline between the two maxillary central incisors. The overall prevalence varies between 0.15 and 1.9%. The present study aimed to evaluate the epidemiological characteristics of mesiodens in the pediatric population. Materials and Methods: A longitudinal prospective study was carried out in 7932 children to determine the prevalence of mesiodens. The following data were also recorded: age, sex, shape, sagittal position, orientation, eruption status, number and complications caused by mesiodens. Results: The prevalence of mesiodens in the present study was 0.8%. The sex ratio was 1.78:1, favoring boys. The majority of mesiodens (67.9%) were conical in shape, followed by the supplemental (17.9) and tuberculate (14.1%) types. 71.8% of the mesiodens were palatally placed, 25.6% erupted on the arch and 2.6% were labially positioned. A majority of the mesiodens (62.8%) were vertically aligned. Inverted and horizontal positions were observed in 30.8% and 6.4% of the cases. Most of the mesiodens (53.8%) were impacted, and 14 children had two mesiodens. Most of the mesiodens were associated with complications, and only 26.9% were asymptomatic. Conclusions: The prevalence of mesiodens was 0.8% .Conical shape, palatal position and vertical orientation were common characteristic observations in the study.
Keywords: Epidemiology, mesiodens, prevalence, pediatric population
|How to cite this article:|
Mukhopadhyay S. Mesiodens: A clinical and radiographic study in children. J Indian Soc Pedod Prev Dent 2011;29:34-8
| Introduction|| |
A supernumerary tooth is a developmental anomaly of number characterized by the presence of tooth in addition to the normal series. The prevalence varies between 0.3 and 3.8% of the population.  Supernumerary tooth in the primary dentition is a less common finding, with one-fifth of this seen in the permanent dentition.  The etiology of supernumerary tooth is not known. Over the years, various theories have been suggested, which include dichotomy of the tooth bud, hyperactivity of the dental lamina and a combination of genetic and environmental factors. , Supernumerary teeth may occur as a single isolated anomaly or in association with syndromes like cleft lip and palate, Downs syndromes, Cleidocranial dysplasia, etc. 
While supernumerary tooth may be found in any region of the dental arch, the most common site is the palatal midline between the two maxillary central incisors, where it is termed as mesiodens.  Mesiodens account for 80% of all supernumerary teeth.  On the basis of its morphology, mesiodens can be classified as conical, supplemental and tuberculate type. ,
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. ,,,,,,
The presence of mesiodens is best diagnosed by clinical and radiographic examinations. The objective of the present study was to determine the frequency of mesiodens along with other epidemiological characteristics.
| Materials and Methods|| |
A longitudinal prospective study was carried out in 7932 subjects (4138 boys and 3794 girls) of the pediatric age group, ranging in age from 4 to 14 years, who attended the Department of Pedodontics, North Bengal Dental College. Selection criteria of the samples include patient who had no history of previous extraction or tooth loss due to trauma. Patients diagnosed with any syndrome were excluded from the study. Only those patients were included who visited the hospital for treatment of caries, gingival disease, tooth fracture, malocclusion or routine check up during the period of October 2007-October 2009. Ethical committee clearance was obtained from the concerned authority. Mesiodens was recorded following clinical and radiographic examinations. Radiographic examinations include periapical radiograph of the premaxillary area and anterior maxillary occlusal radiograph. The presence of supernumerary tooth, unerupted or erupted. in the palatal midline between the two maxillary central incisors was termed as mesiodens. In addition to the prevalence, the following information about the mesiodens was also recorded: age, gender, number, morphology, sagittal position, orientation, eruption status and complications associated with it. The data obtained were subjected to statistical analysis.
| Results|| |
A total of 64 patients were diagnosed as having mesiodens from 7932 samples of the pediatric age group (4-14 years). The prevalence rate was 0.8%. The majority of the cases were detected between 7, 8 and 9 years of age [Figure 1]. The total number of mesiodens diagnosed was 78 from 64 patients, of which 41 were boys and 23 were girls. The sex ratio was 1.78:1, favoring boys [Table 1]. The number of mesiodens per patient was 1.21.
Among the 78 mesiodens, conical shape was the most common type, accounting for 67.9% of the total sample [Table 2], [Figure 2]. The other two types were supplemental and tuberculate [Figure 3] and [Figure 4].
Regarding the sagittal position of the mesiodens, the majority of them were palatally placed (71.8%), whereas 25.6% and 2.5% were positioned on the arch and labial to the arch, respectively [Table 3].
Of the 78 mesiodens, 62.8% was in a vertical position, 30.7% was in an inverted position and 6.4% was in a transverse position [Table 4], [Figure 5] and [Figure 6]. Thirty-six mesiodens (46.1%) were erupted and the remaining 53.9% of the cases were unerupted [Table 5]. Fifty patients were found with single mesiodens and 14 patients with two mesiodens. None of the subjects had three or more mesiodens [Table 6]. Complications caused by mesiodens were axial rotation (33.33%), noneruption of incisors (23.1%) and diastema (16.67%) [Table 7].
|Figure 6: Intraoral periapical radiograph showing mesiodens in transverse and vertical directions|
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| Discussion|| |
Supernumerary teeth are developmental anomalies of number observed during routine dental examination. Although both dentitions are affected, a higher incidence of the anomaly is noted in the permanent dentition. The lateral incisor is the most frequently observed supernumerary tooth in primary dentition whereas in permanent dentition, mesiodens prevails.  Its prevalence ranges between 0.15 and 1.9% in different populations studied.  In the present study, the prevalence observed was 0.8%. This is in accordance with the values reported in the literature.
In the present study, the group compromised of the pediatric population, with the maximum incidence reported between 7 and 9 years of age. This result coincides with the one reported by other authors.  This observation may be due to the fact that maxillary permanent central incisors erupt at this age. Radiological examination of noneruption or axial rotation of the upper central incisors or diastema might reveal the presence of mesiodens.
The present study showed that supernumerary teeth were more frequently seen in boys than in girls, the ratio being 1.78:1. Most studies have reported that the sex ratio was 2:1, favoring boys. ,,, Huang et al. found the sex ratio as 2.5:1 in favor of boys.  The data observed in the present study was slightly inferior to the result reported in the literature. Supernumerary teeth in primary dentition are noted with an almost even gender distribution. The gender variation may be attributed to the differences in sampling size and racial group examined.
Mesiodens can be classified into conical, supplemental and tuberculate type according to its morphology. Conical mesiodens is usually peg shaped, develops with root formation ahead of or at an equivalent stage to that of the central incisor. , Tuberculate or multicusped mesiodens is more common in permanent dentition and usually remain unerupted. Their root formation is delayed compared with that of the adjacent teeth. Tuberculate mesiodens often interferes with the eruption of incisors.  A supplemental mesiodens is more frequent in primary dentition. It resembles the tooth of the normal series and rarely remains unerupted.  In the present study, conical shape was found in a majority of the cases (67.9%). The results of this study were similar to those described by Kim and Lee. 
Liu, Gunduz et al. found that 46% and 55.2% of the supernumerary teeth had a normal (vertical) position axis. , In this study, 62.8% of all mesiodens were oriented normally. Thus, in comparison with similar studies, higher frequencies of vertically aligned mesiodens were observed in the present study.
It is reported that three-fourth of all mesiodens remain unerupted, and are discovered accidentally during radiological examination of the premaxillary area. , Inverted and transversely aligned mesiodens never erupt into the oral cavity. In the present series, 46.1% of the cases were erupted.
In this study, presence of only one mesiodens occurred in 78.1% of the cases and in two in 21.9% of the cases. None of the samples had three or more mesiodens. These findings support the result of other studies. ,,
Mesiodens is capable of causing a variety of complications like interference with the eruption and alignment of the adjacent teeth, delayed or noneruption of maxillary incisors, radicular resorption and dentigerous cyst formation. ,,,,,,, In the present series, complications observed were noneruption of maxillary incisors, axial rotation or displacement and diastema. Radicular resorption of adjacent teeth or dentigerous cyst were not observed in the present study. This is probably due to the fact that these complications occur in long-standing cases. The present study involved only the pediatric population.
Various authors have reported that mesiodens can delay or prevent eruption of central incisors in 26-52% of the cases and displacement or rotation of the adjacent teeth in 28-63% of the cases. , These results support the findings of the present study.
A thorough clinical and radiological examination dictates management of mesiodens. Russel and others recommended extraction of mesiodens in the early mixed dentition stage for better alignment of teeth and minimizing the need for orthodontic treatment.  According to Mitchell and Benett's observation, 70% of the permanent teeth included in their study sample erupted spontaneously following extraction of the mesiodens.  Some authors believe that the best time for removal of mesiodens is 8-9 years of age when the upper incisors erupt. At this age, behavior of a child is much easier to manage and the type of anesthesia required can be less invasive.  Another treatment approach calls for late extraction of mesiodens when the adjacent permanent incisors have completed their root formation. , However, if the mesiodens remains asymptomatic or when there is an increased risk of damaging the developing permanent incisors, surgery should be avoided and a periodic follow-up is necessary.  The role of the pedodontist in management of a case of mesiodens is important because the earlier the detection, the minimal are the future complications and the better is the prognosis.
| Conclusion|| |
The prevalence of mesiodens in the pediatric population was 0.8%. The sex ratio was 1.78:1, favoring boys. In the present study, the majority of the mesiodens were conical in shape and located palatal to the central incisors. Position axis of most of the mesiodens was vertical. 53.8% of the cases were unerupted, which was lower than the percentage reported by many studies. Only 14 children (21.9%) had two mesiodens.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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