mesiodens in the deciduous dentition a case in deciduous dentition ambika et al 101 to the eruption...

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    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


    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


    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

    Annals of

    Dental Research

    Annals of Dental Research (2013) Vol 2 Suppl 1: 98-101

    Mind Reader Publications: All Rights Reserved

    Gupta Ambikaa, Gupta Charu

    b, Singh Harneet

    b, Dhariwal Richa


    Copyright: 2012 Ambika et al. This is an open-access article distributed under the terms of the

    Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction

    in any medium, provided the original author and source are credited.


  • Mesiodens in deciduous dentition Ambika et al



    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-


    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



    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 Gardeners

    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


    to the eruption of permanent central incisors.

    [13] Sometimes, the esthetic demands of the

    patient may also necessitate its removal.


    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


    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:


    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;


    5. Stafne EC. Supernumerary teeth. Dental

    Cosmos 1932; 74: 653-9.

    6. Brook AH. A unifying aetiological



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