Home | About Us | Current Issue | Archives | Search | Instructions | Subscription | Feedback | e-Alerts | Login 
Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
 Users Online: 29  
 
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size


 
  Table of Contents    
ORIGINAL ARTICLE
Year : 2011  |  Volume : 29  |  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 Publication23-Apr-2011

Correspondence Address:
S Mukhopadhyay
18/1C Diamond City (N), 68 Jessor Road, PO Nagerbazar, Kolkata - 700 055, West Bengal
India
Login to access the Email id


DOI: 10.4103/0970-4388.79928

PMID: 21521916

Get Permissions

 

   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

How to cite this URL:
Mukhopadhyay S. Mesiodens: A clinical and radiographic study in children. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2014 Dec 19];29:34-8. Available from: http://www.jisppd.com/text.asp?2011/29/1/34/79928



   Introduction Top


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. [1] Supernumerary tooth in the primary dentition is a less common finding, with one-fifth of this seen in the permanent dentition. [2] 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. [1],[3] Supernumerary teeth may occur as a single isolated anomaly or in association with syndromes like cleft lip and palate, Downs syndromes, Cleidocranial dysplasia, etc. [4]

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. [5] Mesiodens account for 80% of all supernumerary teeth. [6] On the basis of its morphology, mesiodens can be classified as conical, supplemental and tuberculate type. [3],[7]

A mesiodens may erupt normally, stay impacted, appear inverted or take a horizontal position. [1] 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. [2],[3],[4],[6],[7],[8],[9]

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 Top


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 Top


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.
Table 1: Distribution of mesiodens by sex


Click here to view
Figure 1: Distribution of mesiodens according to age group

Click here to view


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].
Table 2: Type of mesiodens


Click here to view
Figure 2: Intraoral periapical radiograph showing conical mesiodens

Click here to view
Figure 3: Supplemental mesiodens

Click here to view
Figure 4: Tuberculate mesiodens

Click here to view


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].
Table 3: Sagittal position of mesiodens


Click here to view


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].
Table 4: Orientation of mesiodens


Click here to view
Table 5: Eruption status of mesiodens


Click here to view
Table 6: Distribution of mesiodens by number


Click here to view
Table 7: Complications caused by mesiodens


Click here to view
Figure 5: Intraoral periapical radiograph showing inverted mesiodens

Click here to view
Figure 6: Intraoral periapical radiograph showing mesiodens in transverse and vertical directions

Click here to view



   Discussion Top


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. [6] Its prevalence ranges between 0.15 and 1.9% in different populations studied. [2] 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. [9] 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. [1],[4],[6],[10] Huang et al. found the sex ratio as 2.5:1 in favor of boys. [11] 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. [3],[7] 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. [12] A supplemental mesiodens is more frequent in primary dentition. It resembles the tooth of the normal series and rarely remains unerupted. [3] 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. [13]

Liu, Gunduz et al. found that 46% and 55.2% of the supernumerary teeth had a normal (vertical) position axis. [1],[9] 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. [1],[2] 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. [9],[11],[13]

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. [2],[3],[4],[6],[7],[8],[9],[14] 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. [2],[7] 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. [2] According to Mitchell and Benett's observation, 70% of the permanent teeth included in their study sample erupted spontaneously following extraction of the mesiodens. [15] 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. [1] Another treatment approach calls for late extraction of mesiodens when the adjacent permanent incisors have completed their root formation. [10],[15] 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. [10] 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 Top


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.

 
   References Top

1.Liu JF. Characteristics of premaxillary supernumerary teeth: A survey of 112 cases. ASDC J dent child 1995;62:262-5.   Back to cited text no. 1
    
2.Russel KA, Folwarczna MA. Mesiodens-diagnosis and management of a common supernumerary tooth. J can dent Assoc 2003;69:362-6.  Back to cited text no. 2
    
3.Garvey MT, Barry HJ, Blake M. Supernumerary teeth -an overview of classification, diagnosis and management. J can Dent Assoc 1999;65:612-6.  Back to cited text no. 3
    
4.Zhu JF, Marcushamer M, King DL, Henry RJ. Supernumerary and congenitally absent teeth: A literature review . J clin pediatr Dent 1996;20:87-95.  Back to cited text no. 4
    
5.Sykaras SN. Mesiodens in primary and permanent dentitions. Report of a case. Oral Surg Oral Med Oral Pathol 1975;39:870-4.  Back to cited text no. 5
    
6.Ferrĕs-PadrŏE, Prats-Armengol J, Ferrĕs -Amat E. A descriptive study of 113 unerupted supernumerary teeth in 79 pediatric patients in Barcelona. Med Oral Patol oral cir Bucal 2009;14:E146-52.  Back to cited text no. 6
    
7.Primosch RE. Anterior supernumerary teeth -assessment and surgical intervation in children. Pediatr Dent 1981;3:204-15.  Back to cited text no. 7
    
8.Leco - Berrocal MI, Martin -Morales JF, Martinez-González JM. An observational study of the frequency of supernumerary teeth in a population of 2000 patients. Med Oral Patol Oral cir Bucal 2007;12:E134-8.  Back to cited text no. 8
    
9.Gündüz K, Celenk P, Zengin Z, Sümer P. Mesiodens: A radiographic study in children. J oral Science 2008;50:287-91.  Back to cited text no. 9
    
10.Fenández-Montenegro P, Valmaseda - Castellón E, Beruni AytésL, Gay Escoda C. Retrospective study of 145 supernumerary teeth. Med Oral Patol Oral cir Bucal 2006;11:E339-44.  Back to cited text no. 10
    
11.Huang WH, T Sai TP, Su HL. Mesiodens in the primary dentition stage: A radiographic study. ASDC J Dent child 1992;59:186-9.  Back to cited text no. 11
    
12.Foster TD , Taylor GS. Characteristics of supernumerary teeth in the upper central incisor region. Dent Pract Dent Rec 1969;20:8-12.  Back to cited text no. 12
    
13.Kim SG, Lee SH. Mesiodens: A clinical and radiographic study .ASDC J Dent child 2003;70:58-60.  Back to cited text no. 13
    
14.Von Arx T. Anterior maxillary supernumerary teeth: A clinical and radiographic study. Aust Dent J 1992;37:189-95.  Back to cited text no. 14
    
15.Mitchell L, Bennett TG. Supernumerary teeth causing delayed eruption -a retrospective study. Br J Orthod 1992;19:41-6.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


This article has been cited by
1 The Effect of Early Removal of Mesiodens for the Correction of Central Incisor Rotation
Jueun Lee,Youngjin Kim,Hyunjung Kim,Soonhyeun Nam
THE JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY. 2014; 41(1): 64
[Pubmed]
2 Micro- and nanoscale structures of mesiodens dentin: Combined study of FTIR and SAXS/WAXS techniques
Ozlem Marti Akgun,Sevgi Haman Bayari,Semra Ide,Günseli Guven Polat,Ilghar Orujalipoor Kalkhoran
Microscopy Research and Technique. 2014; : n/a
[Pubmed]
3 Bilateral Mesiodens in Monozygotic Twins: 3D Diagnostic and Management
Carla Vecchione Gurgel,Ana Lídia Soares Cota,Tatiana Yuriko Kobayashi,Salete Moura Bonifácio Silva,Maria Aparecida Andrade Moreira Machado,Daniela Rios,Daniela Gamba Garib,Thais Marchini Oliveira
Case Reports in Dentistry. 2013; 2013: 1
[Pubmed]
4 Three-Dimensional Evaluation of Impacted Mesiodens Using Dental Cone-Beam Computed Tomography in Korean Children and Adolescents
Sang-Duk Kim,Sang-Ho Lee,Nan-Young Lee,Sang-Yun Jeon
THE JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY. 2013; 40(3): 149
[Pubmed]
5 Characteristics of premaxillary supernumerary teeth in primary and mixed dentitions: a retrospective analysis of 212 cases
Madiraju G. Shekhar
Journal of Investigative and Clinical Dentistry. 2012; 3(3): 221
[Pubmed]
6 Maxillary incisor impaction caused by a supernumerary tooth (mesiodens), an interdisciplinary approach to management [Zatrzymanie ze{ogonek
Strzałkowska, A. and Rózalska, A.
Dental and Medical Problems. 2012; 49(3): 450-457
[Pubmed]
7 Quantitative localization of impacted mesiodens using panoramic and periapical radiographs
Choi, H.-M. and Han, J.-W. and Park, I.-W.P. and Baik, J.-S. and Seo, H.-W. and Lee, J.-H. and Par, H.-W.
Imaging Science in Dentistry. 2011; 41(2): 63-69
[Pubmed]
8 Nonsyndromic double mesiodentes- hidden lambs among normal flock!
Gharote, H.P., Nair, P.P., Thomas, S., Prasad R, G., Singh, S.
BMJ Case Reports. 2011;
[Pubmed]
9 Quantitative localization of impacted mesiodens using panoramic and periapical radiographs
Hang-Moon Choi,Jin-Woo Han,In-Woo Park,Jee-Seon Baik,Hyun-Woo Seo,Joo-Hyun Lee,Ho-Won Park
Imaging Science in Dentistry. 2011; 41(2): 63
[Pubmed]



 

Top
Print this article  Email this article
 

    

 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (1,075 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed13660    
    Printed186    
    Emailed8    
    PDF Downloaded792    
    Comments [Add]    
    Cited by others 9    

Recommend this journal


Contact us | Sitemap | Advertise | What's New | Copyright and Disclaimer 
 © 2005 - Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Medknow 
Online since 1st May '05