Supranumerary Teeth-Mesiodens

Southern georgia Oral Surgery-Statesbor, Ga. and Hinesville, Ga.
Oral Surgeon-Roger Myers DMD

What are Supernumerary Teeth ?

By definition, supernumerary teeth are extra teeth, whish are typically malformed and diminutive compared to normal dentition. It is more common in the midline region of the upper or lower jaw;  Most frequently found in the region of the upper central incisors; Therefore, the occurrence rate in the mandible region is quite infrequent. The most common type of supernumerary tooth as indicated is mesiodens. Mesiodens may occur as single, multiple, unilateral or bilateral. In some syndromes, mesiodens may present as a part of the symptoms; however, this condition might be seen in normal individuals. It seems that positive family history is one of the predisposing factors .
Extra teeth have a lot of names! They are classified based upon where they are located and what they look like.
If an extra tooth is shaped like another "normal" tooth, it is called a supplemental tooth. If it is not shaped like a normal tooth, then it is known as a rudimentary tooth. Rudimental teeth are then classified based on what they look like:

• Conical Rudimentary Teeth look small or peg-shaped.
• Tuberculate Rudimentary Teeth appear to be barrel-shaped and have more than one cusp.
• Molariform Rudimentary Teeth look similar to premolar or molar teeth, but not enough to be called a supplemental tooth.

Mesiodentes are the most common supernumerary teeth, occurring in 0.15% to 1.9% of the population. Given this high frequency, the general dentist should be knowledgeable about the signs and symptoms of mesiodentes and appropriate treatment. The cause of mesiodentes is not fully understood, although 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. It is therefore important for the clinician to diagnose a mesiodens early in development to allow for optimal yet minimal treatment.

Treatment options may include surgical extraction of the mesiodens. If the permanent teeth do not erupt in a reasonable period after the extraction, surgical exposure and orthodontic treatment may be required to ensure eruption and proper alignment of the teeth. In some instances, fixed orthodontic therapy is also required to create sufficient arch space before eruption and alignment of the incisor(s). Early diagnosis allows the most appropriate treatment, often reducing the extent of surgery, orthodontic treatment and possible complications. This paper outlines the causes and modes of presentation of mesiodentes, and presents guidelines for diagnosis and management of nonsyndromic mesiodentes.