98
Abstract
Unicystic ameloblastoma is believed to be less aggressive than the
solid or multicystic ameloblastomas. This report is a rare case of
unicystic ameloblastoma of the maxilla that was treated by
enucleation under suspicion of a dentigerous cyst related to
impacted premolar. The neoplastic nature of the lesion became
evident only when the enucleated material was available for
histological examination. With this report, the authors illustrate the
importance and complexity of differential diagnosis of lesions with
a cystic aspect in the anterior region of the maxilla. Relevant
diagnostic problems and choice of treatment of unicystic
ameloblastoma are presented along with a review of the literature.
Annals of Dental Research (2013) 2 Suppl 1, 98-101
Keywords:
Ameloblastoma, Enucleation, Unicystic, Intraosseous, Multicystic
Correspondence to
Dr. Ambika Gupta M.D.S.
Department of Oral Medicine and Radiology,
Government Dental College,
Rohtak, Haryana, India
Email: [email protected]
Phone number: +91 1262 212648
Article Info
Received: 24 December 2012
Revised: 09 February 2013
Accepted: 23 February 2013
a Assistant Professor
b Demonstrator
Department of Oral Medicine and
Radiology, Post Graduate Institute of
Dental Sciences, Rohtak, Haryana, India
c Dental Surgeon, Health Department
Mohindergarh, Haryana, India.
Mesiodens in the Deciduous Dentition – A Case Report
Case Report
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Annals of Dental Research (2013) Vol 2 Suppl 1: 98-101
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Gupta Ambikaa, Gupta Charu
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b, Dhariwal Richa
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Mesiodens in deciduous dentition Ambika et al
99
Introduction
A supernumerary tooth is an
additional entity to the normal series and is
seen in all the quadrants of the jaw. [1] It may
or may not be morphologically similar to the
teeth of group to which it belongs i.e. molars,
premolars or the anterior tooth. A
supernumerary tooth may be present unilateral
or bilateral, there may be a single tooth or
multiple teeth, erupted or impacted and in one
or both the jaws. The ratio of occurrence of
supernumerary tooth in maxilla to mandible is
8:1 while the most common site in the maxilla
is premaxillary region. [2]
A supernumerary tooth present in the midline
of the maxilla between the two central incisors
is termed as ‘mesiodens’. [3] These teeth are
usually small with a cone- shaped crown and a
short root. [2] The incidence of mesiodens in
permanent dentition ranges from 0.15-3.8%
whereas in deciduous dentition ranges from 0-
1.9%.
Case report
A six year old boy reported to the
Department of Oral Medicine and Radiology
of Government Dental College and Hospital,
Rohtak with the chief complaint of mobile
upper front tooth. There was pain associated
with tooth number 61. The medical and family
history was insignificant. On extraoral
examination, no abnormality was detected. On
intraoral examination, a full complement of
primary dentition was seen in good oral health
with mobile right upper cental incisor.
However, a conical ‘mesiodens’ was observed
between the two primary central incisors
placed slightly palatally in the midline. (Fig
1,2) Intraoral periapical radiograph showed the
presence of permanent central incisors apical
to the primary incisors and an erupted
mesiodens with a conical crown and single
short root. (Fig 3) The roots of primary
incisors were resorbed which caused the
mobility of right primary cental incisor.
The patient was referred to the Department of
Pedodontics where 61 was extracted under
local anesthesia along with the mesiodens.The
patient is kept under observation for
uneventful eruption of permanent incisors.
Figure 1: Intra oral view showing a conical
shaped mesiodens between the two deciduous
central incisors.
Figure 2: Intra oral view showing incisal aspect
of the mesiodens and labially inclined 61.
Ambika et al Mesiodens in deciduous dentition
100
Discussion
The etiology of supernumerary tooth
is unknown and is not well understood. Several
theories have been put forward which suggests
a role of hyperactivity of dental lamina,
dichotomy, atavistic tendency, and hereditary
factors. [4-6] These teeth may also be a part of
various disorders such as cleft lip and palate,
cleidocranial dysplasia or Gardener’s
syndrome. [7] While there may be a genetic
influence, this does not follow a simple
Mendelian pattern. [8] Supernumerary teeth
occur with much less frequency in deciduous
dentition. When such teeth are present, they
often go undiagnosed due to similarity with
their normal counterpart. [9] These teeth may
also be mistaken for germination and fusion.
[9] The frequency of eruption of primary
supernumerary is much higher than the
permanent supernumerary (73% vs 25%). This
may be due to the presence of diastema in
deciduous dentition. Almost 35-50% of the
deciduous supernumerary teeth are followed
by permanent supernumeraries in the same
location. [6]
There is little evidence in the dental literature
about the presence of mesiodens in the primary
dentition. These conical shaped supernumerary
teeth have certain characteristics like location
in maxillary midline, palatal eruption, eruption
during early childhood, may cause
displacement of incisors or delay their
eruption. [10] This case report presents a rare
finding of mesiodens in the primary dentition.
The clinical significance of mesiodens lies in
the fact, that these teeth may impede eruption
of the central incisors (26-52%), cause
displacement or rotation of permanent teeth
(28-63%) or cyst formation (4-9%). [7,11,12]
They may also be associated with crowding of
the affected area , abnormal diastema or
premature space closure , dilacerations of roots
of developing permanent teeth or eruption into
the nasal cavity. The abnormal eruption of
mesiodens may cause occlusal disturbances.
These teeth may also be an aesthetic problem
for the child.
The best modality to evaluate mesiodens is a
maxillary anterior occlusal radiograph. The
management depends upon the position and
the complications caused by such teeth.
Extraction of erupted mesiodens is indicated if
the tooth is causing displacement or resorption
of adjacent teeth, causing occlusal interference
or is associated with any pathology. In our
case, the erupted mesiodens caused the rotation
of crown of 51 and posed the risk for
interference in the proper eruption of
permanent central incisors. Therefore, the
extraction of the mesiodens was planned. The
appropriate time for surgical removal of
mesiodens is at 5-6 years of age i.e. just prior
Figure 3: Intraoral periapical radiograph of
maxillary anterior region
Mesiodens in deciduous dentition Ambika et al
101
to the eruption of permanent central incisors.
[13] Sometimes, the esthetic demands of the
patient may also necessitate its removal.
Conclusion:
The occurrence of mesiodens in
primary dentition is extremely rare. When
these teeth are present, they may become a
matter of concern for the parents as well as the
clinician. Early diagnosis and prompt
intervention are necessary to prevent any
further complications
References
1. Shafer WG, Hine MK, Levy BM: A
textbook of Oral Pathology 5th Edition,
Elsevier, 2007 : 64.
2. Prabhu NT, Rebeca J, Munshi AK.
Mesiodens in the primary dentition- a case
report. J Indian Soc Pedo Prev Dent 1998; 16:
93-5.
3. Ray D, Sarkar S, Das G. Erupted maxillary
conical mesiodens in deciduous dentition in a
Bengali girl-a case report. J. Indian Soc Pedo
Prev Dent 2005; 23: 153-5.
4. Grahen H, Granath L. Numerical variation
in primary dentition and their correlation with
the permanent dentition. Odontal Rev 1961;
21:348-57.
5. Stafne EC. Supernumerary teeth. Dental
Cosmos 1932; 74: 653-9.
6. Brook AH. A unifying aetiological
explanation for abnormalities of human tooth
number and size. Arch Oral Biol 1984; 29:373-
8.
7. Foster T D: A textbook of orthodontics.
Oxford: Blackwell Scientific Publications
1982: 145-149.
8. Roberts A, Barlow ST, Collard MM,
Hunter ML. An unusual distribution of
supplemental teeth in primary dentition. Int J
Paediatr Dent. 2005; 15: 464-7.
9. Humerfelt D, Hurnel B, Humerfelt S.
Hyperdontia in children below four years of
age -A radiographic study. J Dent child 1985;
52 : 121-4.
10. Hattab FN, Yassin OM, Rawashdeh MA.
Supernumerary teeth: Report of three cases
and review of the literature. J Dent Child 1994;
61: 382-393.
11. Mitchell L. Supernumerary teeth. Dent
Update 1989; 16: 65-9.
12. Ziberman Y, Malron M, Shteyer A.
Assessment of 100 children in Jerusalem with
supernumerary teeth in the pre maxillary
region. J Dent Child 1992; 59 : 44-7.
13. Braham LR, Morris ME: Textbook of
Pediatric Dentistry. 2nd Edn CBS publishers
and distributors 1990: 99-415.
Citation : Gupta A, Gupta C, Singh H, Dhariwal R.
Mesiodens in the Deciduous Dentition – A Case Report.
Annals of Dental Research 2013; 2 Suppl 1: 98-101.