Mesiodens in the Deciduous Dentition A Case in deciduous dentition Ambika et al 101 to the eruption of ... supernumerary teeth in the pre maxillary region. J Dent Child 1992; 59 :

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<ul><li><p>98 </p><p>Abstract </p><p>Unicystic ameloblastoma is believed to be less aggressive than the </p><p>solid or multicystic ameloblastomas. This report is a rare case of </p><p>unicystic ameloblastoma of the maxilla that was treated by </p><p>enucleation under suspicion of a dentigerous cyst related to </p><p>impacted premolar. The neoplastic nature of the lesion became </p><p>evident only when the enucleated material was available for </p><p>histological examination. With this report, the authors illustrate the </p><p>importance and complexity of differential diagnosis of lesions with </p><p>a cystic aspect in the anterior region of the maxilla. Relevant </p><p>diagnostic problems and choice of treatment of unicystic </p><p>ameloblastoma are presented along with a review of the literature. </p><p>Annals of Dental Research (2013) 2 Suppl 1, 98-101 </p><p>Keywords: </p><p>Ameloblastoma, Enucleation, Unicystic, Intraosseous, Multicystic </p><p>Correspondence to </p><p>Dr. Ambika Gupta M.D.S. </p><p>Department of Oral Medicine and Radiology, </p><p>Government Dental College, </p><p>Rohtak, Haryana, India </p><p>Email: </p><p>Phone number: +91 1262 212648 </p><p>Article Info </p><p>Received: 24 December 2012 </p><p>Revised: 09 February 2013 </p><p>Accepted: 23 February 2013 </p><p>a Assistant Professor </p><p>b Demonstrator </p><p>Department of Oral Medicine and </p><p>Radiology, Post Graduate Institute of </p><p>Dental Sciences, Rohtak, Haryana, India </p><p>c Dental Surgeon, Health Department </p><p>Mohindergarh, Haryana, India. </p><p>Mesiodens in the Deciduous Dentition A Case Report </p><p>Case Report </p><p>Annals of </p><p>Dental Research </p><p> </p><p>Annals of Dental Research (2013) Vol 2 Suppl 1: 98-101 </p><p> Mind Reader Publications: All Rights Reserved </p><p>Gupta Ambikaa, Gupta Charu</p><p>b, Singh Harneet</p><p>b, Dhariwal Richa</p><p>c </p><p>Copyright: 2012 Ambika et al. This is an open-access article distributed under the terms of the </p><p>Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction </p><p>in any medium, provided the original author and source are credited. </p><p>mailto:drambika79@rediffmail.com</p></li><li><p>Mesiodens in deciduous dentition Ambika et al </p><p>99 </p><p>Introduction </p><p> A supernumerary tooth is an </p><p>additional entity to the normal series and is </p><p>seen in all the quadrants of the jaw. [1] It may </p><p>or may not be morphologically similar to the </p><p>teeth of group to which it belongs i.e. molars, </p><p>premolars or the anterior tooth. A </p><p>supernumerary tooth may be present unilateral </p><p>or bilateral, there may be a single tooth or </p><p>multiple teeth, erupted or impacted and in one </p><p>or both the jaws. The ratio of occurrence of </p><p>supernumerary tooth in maxilla to mandible is </p><p>8:1 while the most common site in the maxilla </p><p>is premaxillary region. [2] </p><p>A supernumerary tooth present in the midline </p><p>of the maxilla between the two central incisors </p><p>is termed as mesiodens. [3] These teeth are </p><p>usually small with a cone- shaped crown and a </p><p>short root. [2] The incidence of mesiodens in </p><p>permanent dentition ranges from 0.15-3.8% </p><p>whereas in deciduous dentition ranges from 0-</p><p>1.9%. </p><p>Case report </p><p> A six year old boy reported to the </p><p>Department of Oral Medicine and Radiology </p><p>of Government Dental College and Hospital, </p><p>Rohtak with the chief complaint of mobile </p><p>upper front tooth. There was pain associated </p><p>with tooth number 61. The medical and family </p><p>history was insignificant. On extraoral </p><p>examination, no abnormality was detected. On </p><p>intraoral examination, a full complement of </p><p>primary dentition was seen in good oral health </p><p>with mobile right upper cental incisor. </p><p>However, a conical mesiodens was observed </p><p>between the two primary central incisors </p><p>placed slightly palatally in the midline. (Fig </p><p>1,2) Intraoral periapical radiograph showed the </p><p>presence of permanent central incisors apical </p><p>to the primary incisors and an erupted </p><p>mesiodens with a conical crown and single </p><p>short root. (Fig 3) The roots of primary </p><p>incisors were resorbed which caused the </p><p>mobility of right primary cental incisor. </p><p>The patient was referred to the Department of </p><p>Pedodontics where 61 was extracted under </p><p>local anesthesia along with the mesiodens.The </p><p>patient is kept under observation for </p><p>uneventful eruption of permanent incisors. </p><p>Figure 1: Intra oral view showing a conical </p><p>shaped mesiodens between the two deciduous </p><p>central incisors. </p><p>Figure 2: Intra oral view showing incisal aspect </p><p>of the mesiodens and labially inclined 61. </p></li><li><p>Ambika et al Mesiodens in deciduous dentition </p><p>100 </p><p>Discussion </p><p> The etiology of supernumerary tooth </p><p>is unknown and is not well understood. Several </p><p>theories have been put forward which suggests </p><p>a role of hyperactivity of dental lamina, </p><p>dichotomy, atavistic tendency, and hereditary </p><p>factors. [4-6] These teeth may also be a part of </p><p>various disorders such as cleft lip and palate, </p><p>cleidocranial dysplasia or Gardeners </p><p>syndrome. [7] While there may be a genetic </p><p>influence, this does not follow a simple </p><p>Mendelian pattern. [8] Supernumerary teeth </p><p>occur with much less frequency in deciduous </p><p>dentition. When such teeth are present, they </p><p>often go undiagnosed due to similarity with </p><p>their normal counterpart. [9] These teeth may </p><p>also be mistaken for germination and fusion. </p><p>[9] The frequency of eruption of primary </p><p>supernumerary is much higher than the </p><p>permanent supernumerary (73% vs 25%). This </p><p>may be due to the presence of diastema in </p><p>deciduous dentition. Almost 35-50% of the </p><p>deciduous supernumerary teeth are followed </p><p>by permanent supernumeraries in the same </p><p>location. [6] </p><p>There is little evidence in the dental literature </p><p>about the presence of mesiodens in the primary </p><p>dentition. These conical shaped supernumerary </p><p>teeth have certain characteristics like location </p><p>in maxillary midline, palatal eruption, eruption </p><p>during early childhood, may cause </p><p>displacement of incisors or delay their </p><p>eruption. [10] This case report presents a rare </p><p>finding of mesiodens in the primary dentition. </p><p> The clinical significance of mesiodens lies in </p><p>the fact, that these teeth may impede eruption </p><p>of the central incisors (26-52%), cause </p><p>displacement or rotation of permanent teeth </p><p>(28-63%) or cyst formation (4-9%). [7,11,12] </p><p>They may also be associated with crowding of </p><p>the affected area , abnormal diastema or </p><p>premature space closure , dilacerations of roots </p><p>of developing permanent teeth or eruption into </p><p>the nasal cavity. The abnormal eruption of </p><p>mesiodens may cause occlusal disturbances. </p><p>These teeth may also be an aesthetic problem </p><p>for the child. </p><p>The best modality to evaluate mesiodens is a </p><p>maxillary anterior occlusal radiograph. The </p><p>management depends upon the position and </p><p>the complications caused by such teeth. </p><p>Extraction of erupted mesiodens is indicated if </p><p>the tooth is causing displacement or resorption </p><p>of adjacent teeth, causing occlusal interference </p><p>or is associated with any pathology. In our </p><p>case, the erupted mesiodens caused the rotation </p><p>of crown of 51 and posed the risk for </p><p>interference in the proper eruption of </p><p>permanent central incisors. Therefore, the </p><p>extraction of the mesiodens was planned. The </p><p>appropriate time for surgical removal of </p><p>mesiodens is at 5-6 years of age i.e. just prior </p><p>Figure 3: Intraoral periapical radiograph of </p><p>maxillary anterior region </p></li><li><p>Mesiodens in deciduous dentition Ambika et al </p><p>101 </p><p>to the eruption of permanent central incisors. </p><p>[13] Sometimes, the esthetic demands of the </p><p>patient may also necessitate its removal. </p><p>Conclusion: </p><p> The occurrence of mesiodens in </p><p>primary dentition is extremely rare. When </p><p>these teeth are present, they may become a </p><p>matter of concern for the parents as well as the </p><p>clinician. Early diagnosis and prompt </p><p>intervention are necessary to prevent any </p><p>further complications </p><p>References </p><p>1. Shafer WG, Hine MK, Levy BM: A </p><p>textbook of Oral Pathology 5th Edition, </p><p>Elsevier, 2007 : 64. </p><p>2. Prabhu NT, Rebeca J, Munshi AK. </p><p>Mesiodens in the primary dentition- a case </p><p>report. J Indian Soc Pedo Prev Dent 1998; 16: </p><p>93-5. </p><p>3. Ray D, Sarkar S, Das G. Erupted maxillary </p><p>conical mesiodens in deciduous dentition in a </p><p>Bengali girl-a case report. J. Indian Soc Pedo </p><p>Prev Dent 2005; 23: 153-5. </p><p>4. Grahen H, Granath L. Numerical variation </p><p>in primary dentition and their correlation with </p><p>the permanent dentition. Odontal Rev 1961; </p><p>21:348-57. </p><p>5. Stafne EC. Supernumerary teeth. Dental </p><p>Cosmos 1932; 74: 653-9. </p><p>6. Brook AH. A unifying aetiological </p><p>explanation for abnormalities of human tooth </p><p>number and size. Arch Oral Biol 1984; 29:373-</p><p>8. </p><p>7. Foster T D: A textbook of orthodontics. </p><p>Oxford: Blackwell Scientific Publications </p><p>1982: 145-149. </p><p>8. Roberts A, Barlow ST, Collard MM, </p><p>Hunter ML. An unusual distribution of </p><p>supplemental teeth in primary dentition. Int J </p><p>Paediatr Dent. 2005; 15: 464-7. </p><p>9. Humerfelt D, Hurnel B, Humerfelt S. </p><p>Hyperdontia in children below four years of </p><p>age -A radiographic study. J Dent child 1985; </p><p>52 : 121-4. </p><p>10. Hattab FN, Yassin OM, Rawashdeh MA. </p><p>Supernumerary teeth: Report of three cases </p><p>and review of the literature. J Dent Child 1994; </p><p>61: 382-393. </p><p>11. Mitchell L. Supernumerary teeth. Dent </p><p>Update 1989; 16: 65-9. </p><p>12. Ziberman Y, Malron M, Shteyer A. </p><p>Assessment of 100 children in Jerusalem with </p><p>supernumerary teeth in the pre maxillary </p><p>region. J Dent Child 1992; 59 : 44-7. </p><p>13. Braham LR, Morris ME: Textbook of </p><p>Pediatric Dentistry. 2nd Edn CBS publishers </p><p>and distributors 1990: 99-415. </p><p>Citation : Gupta A, Gupta C, Singh H, Dhariwal R. </p><p>Mesiodens in the Deciduous Dentition A Case Report. </p><p>Annals of Dental Research 2013; 2 Suppl 1: 98-101. </p></li></ul>