Rotated mesiodens in children. An immediate surgical removal or active monitoring?

Rotated mesiodentes impaction is a rare variant of dental anatomy which may cause a cluster of symptoms damaging nearby structures. Although some recommend a delayed approach, after the end of teeth development, it seems that an immediate surgical removal would be of great benefit for the patients involved.

QUESTION

Should a mesiodentes impaction in children with unknown trajectories and unpredicted development be operated upon its discovery?

ANSWER

Supernumerary teeth are more often encountered in the maxillary anterior region, while mesiodens is the most frequently diagnosed type. A prevalence ranging between 0.15% and 1.9%, with a predisposition toward male individuals, is reported. They usually remain impacted, having a blurred etiology attributed to a positive family history, or being a part of a syndrome. However, a case of mesiodentes, rotated 360‐degree complete inversion (Figure 1), should be considered even rarer. Such a case may cause a wide cluster of symptoms with a probable lesion of the local anatomy structures. Mesiodentes may follow an abnormal path of eruption into the nasal cavity or even take an ectopic position in the mouth. Additionally, a significant delay or ectopic or asymmetric eruption of the maxillary permanent incisors (malocclusion and diastema), dilaceration, dentigerous cyst formation, and infections may occur.1 The optimal time for a surgical intervention is debatable. Some have argued for an immediate removal after diagnosis, primarily in children and young adults, to avoid possible complications, while others have advocated for a delayed approach which could cause an iatrogenic damage to the developing adjacent teeth. We agree with Rotberg and Kopel, who, in 1984, supported that the earlier the mesiodens is removed, the less the complications would be.2

Figure 1

Mesiodentes, 11 y of age female patient, dental scan

CONFLICT OF INTEREST

None declared.

AUTHOR CONTRIBUTIONS

VT: involved in data collection and context design. GT: wrote the manuscript and designed the clinical image. AF: involved in manuscript review and final approval.