437 - Multiple Mesiodens and Impacted Permanent Central Incisor - Clinical Case

Introduction: Supernumerary teeth are the dental anomalies that most often affect the deciduous and mixed dentition, with males being more affected than females by a ratio of 2:1. These occurrences are more frequent in the maxilla than in the mandible, with mesiodens standing out as the most common supernumerary tooth, located in the anterior midline of the maxilla. This clinical case describes a rare situation of multiple mesiodens.

Case Report: A 7-year-old male patient was referred to a university dental clinic for assessment of a supernumerary tooth. After an intraoral clinical examination, orthopantomography, periapical radiography and CBCT, two mesiodens were found: one impacted and inverted, and the other erupted. The planned treatment involved the extraction of teeth 51 and 62, simultaneously with the two mesiodens, and the ulectomy of tooth 21, performed under minimal inhalation sedation with a mixture of nitrous oxide and oxygen, in addition to local anesthesia. Before the procedure, the patient received antibiotic coverage and the post-operative period was uneventful. Clinical changes that may give rise to suspicion of the presence of mesiodens include an asymmetrical eruption pattern and delayed eruption of the upper incisors, retention of the deciduous incisors, ectopic eruption of an upper incisor or spontaneous eruption of mesiodens. Early diagnosis and appropriate treatment are crucial to prevent complications such as delay or loss of eruption potential of the permanent tooth, crowding, resorption of adjacent teeth, development of a dentigerous cyst, ossification of the pericoronal space and crown resorption.