Advertisement

European Archives of Paediatric Dentistry

, Volume 15, Issue 6, pp 421–428 | Cite as

Clinical recommendations for management of mesiodens and unerupted permanent maxillary central incisors

  • E. AyersEmail author
  • D. Kennedy
  • C. Wiebe
Original Scientific Article

Abstract

Background

Un-erupted maxillary incisors may result secondary to supernumerary teeth. Despite the removal of such mesiodentes, orthodontic traction of a permanent un-erupted maxillary incisor may be required.

Review

The literature regarding the impacted maxillary central incisor(s) was reviewed and all pertinent publications on the subject assessed. The review specifically relative to mesiodentes, surgical exposure and orthodontic management was interpreted together with the clinical experience of a number of the authors’ cases. From this analysis a set of recommendations was developed.

Recommendations

(1) A sufficient arch space has to be ensured or orthodontically created for permanent maxillary central incisor(s). (2) Early surgical extraction of a mesiodens or mesiodentes (ideally before 7 years of age), with simultaneous closed surgical exposure of the permanent impacted maxillary incisor with bonding of an attachment with gold chain. (3) Re-evaluation after 2–3 months to assess for any natural eruption of the maxillary central incisor. (4) Application of orthodontic traction in the event of non-eruption.

Conclusion

Early diagnosis of the presence of mesiodentes is imperative. Appropriate surgical and/or orthodontic traction is often indicated with regular post-surgical follow-up assessments.

Keywords

Mesiodens Supernumerary Surgical exposure Surgical uncovering 

References

  1. Alacam A, Bani M. Mesiodens as a risk factor in treatment of trauma cases. Dent Traumatol. 2009;25:25–31.CrossRefGoogle Scholar
  2. Becker A. Early treatment for impacted maxillary central incisors. Am J Orthod Dentofacial Orthop. 2002;121:586–7.PubMedCrossRefGoogle Scholar
  3. Becker A, Brin I, Ben-Bassat Y, Zilberman Y, Chaushu S. Closed-eruption surgical technique for impacted maxillary incisors: a postorthodontic periodontal evaluation. Am J Orthod Dentofacial Orthop. 2002;122(1):9–14.PubMedCrossRefGoogle Scholar
  4. Becker A, Casap N, Chaushu S. Conventional wisdom and the surgical exposure of impacted teeth. Orthod Craniofacial Res. 2009;12:82–93.CrossRefGoogle Scholar
  5. Becker A, Chaushu G, Chaushu S. Analysis of failure in the treatment of impacted maxillary canines. Am J Orthod Dentofacial Orthop. 2010;137(6):743–54.PubMedCrossRefGoogle Scholar
  6. Becker A, Chaushu S. Palatally impacted canines: the case for closed surgical exposure and immediate orthodontic traction. Am J Orthod Dentofacial Orthop. 2013;143(4):451–9.PubMedCrossRefGoogle Scholar
  7. Bedoya M, Park JH. A review of the diagnosis and management of impacted maxillary canines. J Am Dent Assoc. 2009;140(12):1485–93.PubMedCrossRefGoogle Scholar
  8. Bryan RAE, Cole BOI, Welbury RR. Retrospective analysis of factors influencing the eruption of delayed permanent incisors after supernumerary tooth removal. Eur J Paediatr Dent. 2005;6(2):84–9.PubMedGoogle Scholar
  9. Chaushu S, Becker A, Zeltser R, et al. Patients’ perception of recovery after exposure of impacted teeth: a comparison of closed- versus open-eruption techniques. J Oral Maxillofac Surg. 2005;63:323–9.PubMedCrossRefGoogle Scholar
  10. Chaushu S, Brin I, Ben-Bassat Y, Zilberman Y, Becker A. Periodontal status following surgical-orthodontic alignment of impacted central incisors with an open-eruption technique. Eur J Orthod. 2003a;25(6):579–84.PubMedCrossRefGoogle Scholar
  11. Chaushu S, Dykstein N, Yocheved BB, Becker A. Periodontal status of impacted maxillary incisors uncovered by 2 different surgical techniques. J Oral Maxillofac Surg. 2009;67:120–4.PubMedCrossRefGoogle Scholar
  12. Chaushu S, Zilberman Y, Becker A. Maxillary incisor impaction and its relationship to canine displacement. Am J Orthod Dentofacial Orthop. 2003b;124(2):144–50.PubMedCrossRefGoogle Scholar
  13. Coccia M, Brooks S, Webb T, et al. X-linked cataract and nance-horan syndrome are allelic disorders. Human Mol Genet. 2009;18(14):2643–55.CrossRefGoogle Scholar
  14. Fowler P. Limitations of the panoramic radiograph’s focal trough: a case report. NZ Dent J. 1991;87(389):92–3.Google Scholar
  15. Howard RD. The unerupted incisor. A study of the postoperative eruptive history of incisors delayed in their eruption by supernumerary teeth. Dent Pract Dent Rec. 1967;17(9):332–41.PubMedGoogle Scholar
  16. Jacoby H. The ballista spring system for impacted teeth. Am J Orthod. 1979;75(2):143–51.PubMedCrossRefGoogle Scholar
  17. Kennedy D. Autogenous tooth transplants for the pediatric dental patient: report of three cases. Pediatr Dent. 2013;35(4):E113–9.Google Scholar
  18. Khambete N, Kumar R, Risbud M, Kale L, Sodhi S. Dentigerous cyst associated with an impacted mesiodens: report of 2 cases. Imaging Sci Dent. 2012;42:255–60.PubMedCentralPubMedCrossRefGoogle Scholar
  19. Khandelwal VN, Nayak AU, Naveen RB, et al. Prevalence of mesiodens among six-to seventeen year old school going children of indore. J Indian Soc Pedod Prev Dent. 2011;29(4):288–93.PubMedCrossRefGoogle Scholar
  20. Kornhauser S, Abed Y, Harari D, Becker A. The resolution of palatally impacted canines using palatal–occlusal force from a buccal auxiliary. Am J Orthod Dentofacial Orthop. 1996;110(5):528–34.PubMedCrossRefGoogle Scholar
  21. Malmgren B. Ridge preservation/decoronation. Pediatr Dent. 2013;35(2):164–9.PubMedGoogle Scholar
  22. Mason C, Azam N, Holt RD, Rule DC. A retrospective study of unerupted maxillary incisors associated with supernumerary teeth. Br J Oral Maxillofac Surg. 2000;38(1):62–5.PubMedCrossRefGoogle Scholar
  23. Matteson SR, Lupton CR, Morrison WS. Effect of panoramic focal trough topography on radiographic imaging of supernumerary teeth in the anterior region. J Oral Maxillofac Surg. 1982;40(5):318–9.PubMedCrossRefGoogle Scholar
  24. Mukhopadhyay S. Mesiodens: a clinical and radiographic study in children. J Indian Soc Pedod Prev Dent. 2011;1(29):34–8.CrossRefGoogle Scholar
  25. Omer RSM, Anthonappa RP, King NM. Determination of the optimum time for surgical removal of unerupted anterior supernumerary teeth. Pediatr Dent. 2010;32(1):14–20.PubMedGoogle Scholar
  26. Patchett CL, Crawford PJ, Cameron AC, Stephens CD. The management of supernumerary teeth in childhood–a retrospective study of practice in Bristol Dental Hospital, England and Westmead Dental Hospital, Sydney, Australia. Int J Paediatr Dent. 2001;11(4):259–65.PubMedCrossRefGoogle Scholar
  27. Pavoni C, Franchi L, Giuseppina L, Baccetti T, Cozza P. Management of impacted incisors following surgery to remove obstacles to eruption: a prospective clinical trial. Pediatr Dent. 2013;35(4):364–8.PubMedGoogle Scholar
  28. Pinho T, Neves M, Alves C. Impacted maxillary central incisor: surgical exposure and orthodontic treatment. Am J Orthod Dentofacial Orthop. 2011;140(2):256–65.PubMedCrossRefGoogle Scholar
  29. Rajab LD, Hamdan AM. Supernumerary teeth: review of the literature and survey of 152 cases. Int J Paed Dent. 2002;12:244–54.CrossRefGoogle Scholar
  30. Russell K, Folwarczna M. Mesiodens—diagnosis and management of a common supernumerary tooth. J Can Dent Assoc. 2003;69(6):362–6.PubMedGoogle Scholar
  31. Schmidt AD, Kokich VG. Periodontal response to early uncovering, autonomous eruption, and orthodontic alignment of palatally impacted maxillary canines. Am J Orthod Dentofacial Orthop. 2007;131(4):449–55.PubMedCrossRefGoogle Scholar
  32. Toureno L, Park JH, Cederberg R, Hwang EH, Shin JW. Identification of supernumerary teeth in 2D and 3D: review of literature and a proposal. J Dent Educ. 2013;77(1):43–50.PubMedGoogle Scholar
  33. Varnarsdall RL, Corn H. Soft-tissue management of labially positioned unerupted teeth. Am J Orthod. 1977;72:53–64.CrossRefGoogle Scholar
  34. Vermette ME, Kokich VG, Kennedy DB. Uncovering labially impacted teeth: apically positioned flap and closed-eruption techniques. Angle Orthod. 1995;65(1):23–32.PubMedGoogle Scholar
  35. Winter G, Geddes M. Oral manifestations of chondroectodermal dysplasia (Ellis-van Creveld syndrome). Report of a case. Br Dent J. 1967;122(3):103–7.PubMedGoogle Scholar
  36. Witsenburg B, Boering G. Eruption of impacted permanent upper incisors after removal of supernumerary teeth. Int J Oral Surg. 1981;10(6):423–31.PubMedCrossRefGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2014

Authors and Affiliations

  1. 1.Faculty of DentistryUniversity of British ColumbiaVancouverCanada
  2. 2.Faculty of DentistryUniversity of British ColumbiaCalgaryCanada

Personalised recommendations