Extraction of an impacted supernumerary mesiodens tooth in a child: a clinical case report

Abstract

Mesiodens are supernumerary teeth located between the central incisors, close to the midline; Generally, they have a conical shape, can be impacted, and cause aesthetic-functional imbalance of the stomatognathic system. It is essential to emphasize that early diagnosis, through clinical and complementary exams, provides an optimized therapeutic strategy. The aims of the present study were to report a clinical case on strategies used to delimit the surgical opportunity as well as operative procedures performed in the presence of impacted mesiodens in a child patient. An 11-year-old female patient presented to the dental clinic for evaluation of a mesiodens-type supernumerary tooth. During the clinical examination, no areas of swelling were evident that would indicate the presence of the supernumerary. During the complementary examination, carried out using a panoramic x-ray in semi-open occlusion and ConeBeam® computed tomography, a supernumerary tooth of the mesiodens type can be seen impacted between the roots of the permanent maxillary central incisors. The mesiodens had an intimate relationship with the superior cortex of the nasopalatine canal, promoting luminal stenosis and an intimate relationship with the floor of the nasal fossa. Exodontia was chosen as a therapeutic strategy. Management strategies were reinforced until the surgical procedure session. The patient and legal guardian received post-operative guidance, were monitored for 15 days after the procedure, and were informed of the importance of monitoring until complete rhizogenesis of the permanent maxillary central incisors. In conclusion, it is highlighted that the surgical opportunity needs to be well-defined.