Mesiodentes

A mesiodent is an extra tooth in the maxillary anterior incisor region. Mesiodentes are the most common supernumerary teeth, occurring in 0.15% to 1.9% of the population. The etiology of mesiodens is unclear, but is twice prevalent in males (possibly an autosomal recessive gene), and there is a familial trait. Proliferation of the dental lamina and genetic factors have been implicated. Mesiodentes can cause delayed or ectopic eruption of the permanent incisors, which can further alter occlusion and appearance.

Mesiodens sometimes interfere with eruption of permanent teeth and cause other alignment problems with the existing teeth. Only a small portion of supernumerary teeth eventually erupts.

To prevent additional damage such as misalignment and delayed eruption of the permanent central incisors early intervention is suggested. Usually it is preferred to wait until the root of the central and the lateral teeth are completely formed before mesiodents are removed.

Mesiodens have been found in certain syndromes such as cleft lip and palate, cleidocranial dysostosis, and Gardner's syndrome. Supernumerary teeth in general have associations with Ehler-Danlos syndrome, Apert syndrome, and Down's syndrome as well.

The concerns associated with mesiodens are listed below and removal is often needed

1. Delayed eruption of permanent teeth

2. Cyst formation

3. Crowding

4. Diastemas

5. Resorption of the roots of adjacent teeth

6. Eruption of mesiodens  in to the nasal cavity..

Below see two cases that show the mesiodents erupting in to the nasal cavity.

 

 

 

Glubomaxillary cyst or Periapical cyst?

Globulomaxillary cyst has been considered to be a developmental cyst that arises from entrapped nonodontogenic epithelium in the globulomaxillary suture. In recent years existence and histogenesis of this lesion has been disputed. It had been argued that the anterior maxilla was formed by merging of growth centers rather than fusion of facial processes and therefore,  ectodermal entrapment was ruled out. Recent embryologic studies have demonstrated that Fusion of facial processes does occur, and epithelium is entrapped in areas that later will lie between the maxillary lateral incisors and canines. At the present Globumaxillary cyst has been removed from WHO classification of non odontogenic cyst and some argue that it needs to be reinstated as a developmental non odontogenic cyst.

 Below see a case which could potentially be argued both ways. 40 year old male presented with swelling of the space between maxillary left canine and lateral incisor. Patient had been treated with a root canal treatment years go on teeth #8, 9, and 10 and does not recall why. He denies history of trauma to the anterior maxilla.   Panoramic x ray disclosed  potentially an endodontic lesion in apex of #10 and cystic lesion that has resulted in root divergence in the area of tooth #10 and 11. Tooth #11 has tested vital and has been ruled out as a potential source of the lesion.   Pathology was consistent with both periapical lesion arising from tooth#10 and a non odontogenic cyst.

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BIlateral Mandibular swelling

34 year old female was referred from her dentist for mandibular swelling. Patient was complaining of lower jaw pain and swelling of 2 days duration and has been febrile for the past week. Health questionnaire was also negative for any systemic disease and patient claimed no past surgical history. Examination of the face was consistent with  lower facial swelling not extending beyond the lower mandibular border and skin was flushed and warm to palpation.  Bilateral mandibular body and chin and all lower teeth were tender to palpation and all lower teeth have plus 2 mobility. No decay was observed on any of the lower teeth.   Panoramic x-ray was taken and no odontogenic source for the infection was identified. Periodontal exam was also negative. A Cone beam CT was taken and a silicone mandibular implant was identified spanning from right mandibular body to the left. The  implant had resorbed the cortical bone.   Upon further questioning about past surgical history patient said she was embarrassed and did not disclosed the implant placement since her husband might find out!!
IV antibiotic was given and the implant was removed under general anesthesia.