Mesiodens is a supernumerary tooth located in the midline between the two central incisors. It often results in malocclusion, aesthetic issues, or possible cyst formation if left untreated. Although its etiology is unknown, genetic and environmental factors have been suggested as possible causes. The most significant concern with Mesiodens is altered or delayed eruption of permanent central incisors. Hence, early removal during mixed dentition stage is recommended. In patients where the central incisors have erupted normally and there are no symptoms, close monitoring is an acceptable approach with annual x-rays.
Mesiodens most commonly develop in the palatal aspect of the central incisors. For accurate localization, a cone beam CT (CBCT) scan is required. The technique for its removal involves a small incision in the palatal aspect of central incisors and a conservative gum tissue flap. The mesiodens can often be removed with micro-elevators using minimally-invasive techniques. The gum tissue is then stabilized with dissolvable sutures. There is generally minimal discomfort, no swelling, with rapid healing.