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| CASE REPORT |
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| Year : 2021 | Volume
: 11
| Issue : 2 | Page : 128-131 |
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Solitary impacted supernumerary tooth nudging the nasal cavity
Charu Suri, Syed Afroz Ahmed, Sarah Samee, Satish Bramhe
Department of Oral Maxillofacial Pathology and Microbiology, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| Date of Submission | 11-Sep-2021 |
| Date of Decision | 28-Sep-2021 |
| Date of Acceptance | 30-Sep-2021 |
| Date of Web Publication | 11-Feb-2022 |
Correspondence Address:
Dr. Charu Suri
Department of Oral and Maxillofacial Pathology, Sri Sai College of Dental Surgery, Vikarabad, Telangana
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijohs.ijohs_27_21
Mesiodens is the most frequent type of supernumerary tooth, found in the central position of the upper or lower jaw. It presents in between the central incisors either erupted or impacted. Supernumerary teeth are developmental variations characterized by extra teeth besides the normal dentition. This condition is referred to as hyperdontia. The diagnosis of mesiodens is usually an accidental finding through a radiograph, which was intended for investigation of the neighboring teeth. Early diagnosis and prompt treatment are necessary for prevention of deleterious effects on the surrounding dentoalveolar structures. This case report describes the diagnosis and management of an undiagnosed inverted mesiodens along with a palatally impacted maxillary canine in a patient undergoing orthodontic treatment.
Keywords: Inverted, palatally impacted, supernumerary tooth
How to cite this article:
Suri C, Ahmed SA, Samee S, Bramhe S. Solitary impacted supernumerary tooth nudging the nasal cavity. Int J Oral Health Sci 2021;11:128-31 |
| Introduction | |  |
A supernumerary tooth is a developmental anomaly characterized by a greater number of teeth than the normal number.[1] The term mesiodens refers to a supernumerary tooth which presents in the midline of the maxilla/mandible, most commonly between the central incisors.[2] In 1917, Balk gave the term “mesiodens.”[3]
Mesiodens accounts for about 80% of all supernumerary teeth.[3] Its occurrence in deciduous dentition is quite in frequent amounting to 0.3%–0.8%,[4] while that in permanent dentition varies from 0.15% to 1.9%,[5] with a higher prevalence in males, and of 2:1 proportion. A dominant autosomal trait has been implicated, as well as X chromosome-linked inheritance, as it is more prevalent in the male population.[2]
Mesiodens may be of different shapes tuberculate, conical, odontome, or may closely resemble the normal tooth.[1] It can be erupted or unerupted. If it erupts, the mesiodens is located between upper central incisors or palatally placed.[6]
The consequences of an undiagnosed mesiodens could lead to a variety of complications ranging from delayed eruption, crowding, spacing, or impaction of permanent incisors.[7] The case being reported below shows some of the consequences due to delayed diagnosis.
| Case Report | | |
A 16-year-old male patient reported to a private clinic with a chief complaint of discomfort in his nose. The patient gave a past dental history of malocclusion for which he was undergoing an orthodontic treatment. Intraoral examination revealed a missing maxillary canine. Radiographs revealed an impacted left maxillary canine along with a tooth-like radiopacity between the maxillary central incisors approximating the nasal cavity [Figure 1]. His medical and family histories were not relevant and noncontributory. | Figure 1: Panoramic radiograph taken initially depicts a radiopacity approximating the nasal cavity and presents between the maxillary central incisors
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The patient was advised to undergo cone-beam computed tomography (CBCT) in order to get a better and closer view of the radiopacity. The following sections were most relevant – sagittal section of the left maxillary region [Figure 2] and three-dimensional image frontal view of the maxilla [Figure 3]. After careful evaluation of the CBCT scans, the clinicians confirmed the diagnosis of an inverted mesiodens for the radiopacity. | Figure 2: Occlusal and sagittal sections of cone-beam computed tomography which were used as a surgical guide in the removal of the mesiodens
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 | Figure 3: Frontal view of cone-beam computed tomography which shows the inverted position of mesiodens
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Management
The surgical approach was planned with the help of CBCT scans. The treatment plan included surgical extraction of the impacted mesiodens, carried out by raising a periapical flap in relation to the left maxillary incisors. Adequate amount of bone was removed using rotary cutting instruments after elevation of the flap [Figure 4]. The mesiodens was removed [Figure 5], and the extraction socket was checked for any pathological tissue. The flap was relocated, and sutures were placed for a week. This was followed up by an uneventful postoperative period. | Figure 4: Labial approach with the elevation of periapical flap and removal of adequate bone
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| Discussion | | |
Dental anomalies are common congenital deformities that can present either as a solitary finding or in concomitance with syndromes.[8] Anomalies in tooth number, compared to their normal number, may occur as an increased (hyperdontia) or reduced (hypodontia) number of teeth. Supernumerary tooth represents hyperdontia.[6]
The etiology involved in the development of the supernumerary teeth is unclear.[2] Various theories have been put forth to describe the occurrence of supernumerary teeth which are as follows:[9]
- The remnants of dental lamina become reactivated to develop into accessory dental organs
- Strongly supported in the literature is the hyperactivity theory, which proposes that supernumerary teeth are formed as a result of local, independent, conditioned hyperactivity of the dental lamina[4]
- Supernumerary teeth may develop from splitting of a single tooth bud (dichotomy of the tooth bud)[3]
- Genetics are also instrumental for the occurrence of supernumerary teeth, since they are commonly found in the relatives of affected individuals; however, inheritance pattern does not follow Mendelian principles.
Mesiodens occurs unilaterally, or bilaterally, while three or more supernumerary teeth are found rarely.[10] Mesiodens can be classified as (a) rudimentary – associated with permanent dentition and (b) supplemental – associated with permanent dentition. Based on their morphology, it can be (a) eumorphic – similar to a normal-sized central incisor and (b) dysmorphic – these have different shapes and sizes, and are categorized into conical, tuberculate, and molariform.[5]
The diagnosis of mesiodens approximating nasal cavity is made on the basis of clinical and radiographic findings. Clinically, an intranasal mesiodens can be visualized as a white mass in the nasal cavity although not in all cases. In this case, no such mass could be appreciated. Radiographically, the intranasal mesiodens appears as a radiopaque lesion with the same attenuation as that of the oral teeth.[11]
Early diagnosis and extraction of mesiodens has said to have a better prognosis.[12] The timing of mesiodens removal has always remained controversial,[13] as some studies support delayed intervention until the root development of the adjacent teeth is almost complete while other studies have proposed that mesiodens should be removed as soon as possible after the condition has been diagnosed in order to prevent the possible consequences.[13]
By advising for CBCT, which provides accurate three-dimensional information about the orientation of the mesiodens, sagittal positioning, and surrounding anatomic structures, the surgeon is able to rule out any risk of harming adjacent teeth during the surgery. All of these factors are of great significance when carrying out a pretreatment evaluation and creating a treatment plan.[13] A labial surgical approach was utilized which allowed increased visualization of the mesiodens and greater ease of removal.[14]
The main complications most commonly associated with mesiodens are delayed eruption of permanent incisors, midline diastema, rotation, or axial inclination of permanent incisors, and delayed eruption of adjacent teeth.[6]
| Conclusion | | |
Radiographic evaluation proved to be of great importance in the accidental detection of unerupted mesiodens in this case.[3] Hence, careful clinical and radiographic evaluations of every patient coming in with a complaint of malposed teeth should be done thoroughly, in order to detect the presence of supernumerary teeth.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 9. | Indira M, Dhull KS, Sujatha R, Kumar PP, Devi BG. Molariform mesiodens in primary dentition: A case report. J Clin Diagn Res 2014;8:ZD33-5. |
| 10. | Baranwal HC, Verma PK, Dwivedi CD, Srivastava R. Dentigerous cyst associated with an impacted maxillary mesiodens. Eur J Gen Dent 2012;1:50-3. [Full text] |
| 11. | Choudhury B, Das AK. Supernumerary tooth in the nasal cavity. MJAFI 2008;64:173-4. |
| 12. | Sachin M, Jayshri W, Dimpi S. Mesiodens: Etiology, diagnosis and management of a common supernumerary tooth: A literature review. Int J Curr Res 2017;9:45119-22. |
| 13. | Shih WY, Hsieh CY, Tsai TP. Clinical evaluation of the timing of mesiodens removal. J Chin Med Assoc 2016;79:345-50. |
| 14. | Henry RJ, Post AC. A labially positioned mesiodens: Case report. Pediatr Dent 1989;11:59-63. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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