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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 6  |  Issue : 4  |  Page : 237-239

Cone beam computed tomographic evaluation of impacted mesiodens and central incisor as sequelae of trauma: A short case report


1 Department of Oral Medicine and Radiology, College of Dentistry, Aljouf University, Sakakah, Aljouf, Saudi Arabia
2 Department of Pedodontics, College of Dentistry, Aljouf University, Sakakah, Aljouf, Saudi Arabia
3 Department of Orthodontics, College of Dentistry, Aljouf University, Sakakah, Aljouf, Saudi Arabia
4 Preventive Dentistry, College of Dentistry, Aljouf University, Sakakah, Aljouf, Saudi Arabia
5 Conservative Dentistry, College of Dentistry, Aljouf University, Sakakah, Aljouf, Saudi Arabia

Date of Web Publication12-Dec-2017

Correspondence Address:
Dr. Santosh R Patil
Department of Oral Medicine and Radiology, College of Dentistry, Aljouf University, Sakaka, Aljouf
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_42_17

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  Abstract 


A supernumerary tooth is a developmental anomaly characterized by the presence of an extra tooth in addition to the normal number of deciduous or permanent teeth. Mesiodens is one of the common supernumerary teeth presenting in the midline between the two central incisors. The presence of mesiodens may lead to numerous consequences such as disturbance of eruption, crowding, displacement, root resorption of adjacent teeth, and formation of a cyst. We report here cone beam computed tomographic evaluation of mesiodens and impacted incisor in a young boy.

Keywords: Dental anomaly, impaction, mesiodens, supernumerary tooth


How to cite this article:
Patil SR, Gudipaneni R, Kuraym Alenazi KK, Al-Zoubi IA, Rao KA, Ravi J, Iqbal A. Cone beam computed tomographic evaluation of impacted mesiodens and central incisor as sequelae of trauma: A short case report. Int J Health Allied Sci 2017;6:237-9

How to cite this URL:
Patil SR, Gudipaneni R, Kuraym Alenazi KK, Al-Zoubi IA, Rao KA, Ravi J, Iqbal A. Cone beam computed tomographic evaluation of impacted mesiodens and central incisor as sequelae of trauma: A short case report. Int J Health Allied Sci [serial online] 2017 [cited 2019 Oct 21];6:237-9. Available from: http://www.ijhas.in/text.asp?2017/6/4/237/220523




  Introduction Top


Supernumerary tooth is defined as extra tooth which presents as an additional to the normal number of teeth. Supernumerary tooth may be seen as erupted in the oral cavity or may be impacted, which will be diagnosed on routine radiographic examination. The prevalence of supernumerary tooth varies between 0.3% and 2.1%.[1] Supernumerary tooth has been reported to occur more commonly in males in comparison to females, and there are reports of racial variation. Supernumerary tooth can be seen in both the jaws but they are most frequently observed in the anterior segment of the upper jaw, followed by the premolar region of the lower arch.[2] The etiology of supernumerary teeth is not established till date, but hyperactivity of the dental lamina is the most commonly established etiological factor for the formation of the supernumerary tooth. Genetic and environmental circumstances are also known to be significant causative elements in the evolution of supernumerary tooth.[3]

Mesiodens is considered as a most common supernumerary tooth occurring between the upper central incisors. It may be erupted in the oral cavity and be asymptomatic or may be impacted leading to eruption disorders of related teeth, crowding, and displacement of adjacent teeth, root resorption, or formation of a cyst. The most frequently observed consequence of a mesiodens is delayed eruption of maxillary central incisors with or without diastema.[4]

Most of the patients with mesiodens were diagnosed amid routine clinical and radiographic evaluation. Precise location of impacted mesiodens and its effect on the adjacent structures are very important for diagnosis and treatment planning. Conventional radiographic methods such as periapical views, occlusal views, and panoramic radiographs play a significant role in the diagnosis of a mesiodens and complications resulting from it. However, all these mentioned views enable to locate the teeth in only two dimensions, and exact diagnosis and treatment plan cannot be carried out relying on these conventional radiographic methods. Cone beam computed tomography (CBCT) can provide three-dimensional (3D) image of an impacted mesiodens in axial, coronal, and sagittal plane along with the 3D reconstructed imaging, thus enabling the dental practitioner to locate the teeth and observe the related changes thereby plan for the best treatment option.[5] The present article features the benefits of CBCT which are found in the assessment of the morphological discrepancies and eruptive disorders affecting the permanent dentition, as sequelae to injury in their antecedents.


  Case Report Top


A 12-year-old boy was referred to College of Dentistry, AlJouf University, with complaint of noneruption of the permanent maxillary left incisor. Patient history revealed intrusive trauma to the deciduous anterior maxillary teeth that had led to their exfoliation due to an accident few years ago. No any systemic illness or any significant family history was noted. On intraoral examination, we noticed that a child had a mixed dentition, with clinically missing maxillary left central incisor. Few of the deciduous teeth showed physiologic mobility. Panoramic radiograph showed impacted maxillary left central incisor and a mesiodens coronally, which appeared to be blocking the eruption of the central incisor.

A cone beam CT scan using Cranex (SOREDEX, Tuusula, Finland), tube current, 6 mA; tube voltage of 65 kV; exposure time for 20 s at 50 Hz; inherent filtration, 1.8 mm Al; and total filtration of 2.7 mm Al was performed to evaluate the impacted mesiodens and central incisor and to facilitate a favorable treatment option. The 3D view from the CT scan revealed impacted maxillary left maxillary central incisor and a mesiodens which was in close adjacency to the crown of the impacted central incisor [Figure 1], [Figure 2], [Figure 3], [Figure 4]. The extraction of the mesiodens was carried to facilitate surgical exposure for orthodontic bonding, followed by extrusion of tooth, the impacted central incisor.
Figure 1: Coronal cone beam computed tomographic image showing impacted mesiodens and central incisors

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Figure 2: Sagittal cone beam computed tomographic image showing impacted mesiodens and central incisors

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Figure 3: A reformatted panoramic cone beam computed tomographic image demonstrating the mesiodens blocking the eruption of 21

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Figure 4: A three-dimensional reconstructed panoramic cone beam computed tomographic image shows spatial position of mesiodens and 21

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  Discussion Top


Supernumerary teeth are extra teeth which may occur in addition to the normal number of deciduous teeth and the permanent teeth in erupted or unerupted form. Supernumerary teeth may manifest as solitary, multiple, in unilateral, or at bilateral location and may be seen in the upper and the lower jaws.[6] According to Alberti, the mesiodens is the most common type of supernumerary tooth, and 25% of all mesiodens are reported to erupt in the oral cavity spontaneously. In general, they remain impacted and asymptomatic and are commonly discovered during the routine radiographic examination.[7]

Several studies have employed CBCT to diagnose supernumerary teeth more precisely and to overcome the constraints of conventional radiographic imaging. Nevertheless, there are multiple shortcomings of conventional CTs, such as metallic artifacts, compromised resolution, increased expenses, and increased radiation doses.[8] Hence, the conventional CT imaging is not preferred for routine imaging in the dentistry. CBCT can give enhanced information on the 3D relationship of mesiodens, adjacent teeth, and related soft tissues avoiding the superimpositions. Other advantages of CBCT include volumetric data acquisition with less time required for scanning, decreased motion artifact, beam limitation (reduced radiation, optimal field of view, higher resolution), and interactive display modes. CBCT technology has a substantial impact on maxillofacial imaging. It has been applied to diagnosis in all areas of dentistry and is now expanding into treatment applications, especially during implant therapy implant, endodontic treatments, maxillofacial trauma, craniofacial defects, jaw cysts, and tumors.[9]

The management of supernumerary tooth depends on their location, type, eruption status, and their effect on adjacent teeth. The dental practitioner should procure an explicit preoperative evaluation for opting the relevant treatment modality and thereby evading iatrogenic injuries to the adjacent teeth and soft tissues, particularly developing permanent tooth germs that are contiguous to supernumerary tooth in young individuals.[10]


  Conclusion Top


Supernumerary tooth, particularly the mesiodens, is one of the common dental anomalies seen in the routine dental practice. Impaction, crowding and diastema, ectopic or asymmetric, and delayed eruption of the central incisors should signal the dental surgeon regarding the probability of a mesiodens. Understanding the incidence nature and behavior of mesiodens is therefore compelling. CBCT should not be considered a replacement for panoramic or conventional projections but a complementary modality.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yen T, Chang P, Tsai AI, Chang Y. Evaluation of maxillary supernumerary teeth for pediatric dental patients by cone beam computed tomography. Taiwan J Oral Maxillofac Surg 2015;26:240-50.  Back to cited text no. 1
    
2.
Gündüz K, Celenk P, Zengin Z, Sümer P. Mesiodens: A radiographic study in children. J Oral Sci 2008;50:287-91.  Back to cited text no. 2
    
3.
Indira M, Dhull KS, Sujata R, Kumar PS, Devi Bm G. Molariform mesiodens in primary dentition: A case report. J Clin Diagn Res 2014;8:ZD33-5.  Back to cited text no. 3
    
4.
Nagaveni N, Shashikiran N, Reddy VS. Surgical management of palatal placed, inverted, dilacerated and impacted mesiodens. Int J Clin Pediatr Dent 2009;2:30-2.  Back to cited text no. 4
    
5.
Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC. Three-dimensional evaluations of supernumerary teeth using cone-beam computed tomography for 487 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:403-11.  Back to cited text no. 5
    
6.
Fernández Montenegro P, Valmaseda Castellón E, Berini Aytés L, Gay Escoda C. Retrospective study of 145 supernumerary teeth. Med Oral Patol Oral Cir Bucal 2006;11:E339-44.  Back to cited text no. 6
    
7.
Alberti G, Mondani PM, Parodi V. Eruption of supernumerary permanent teeth in a sample of urban primary school population in Genoa, Italy. Eur J Paediatr Dent 2006;7:89-92.  Back to cited text no. 7
    
8.
Omami M, Chokri A, Hentati H, Selmi J. Cone-beam computed tomography exploration and surgical management of palatal, inverted, and impacted mesiodens. Contemp Clin Dent 2015;6:S289-93.  Back to cited text no. 8
    
9.
Kim KD, Ruprecht A, Jeon KJ, Park CS. Personal computer-based three-dimensional computed tomographic images of the teeth for evaluating supernumerary or ectopically impacted teeth. Angle Orthod 2003;73:614-21.  Back to cited text no. 9
    
10.
Meighani G, Pakdaman A. Diagnosis and management of supernumerary (mesiodens): A review of the literature. J Dent (Tehran) 2010;7:41-9.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


This article has been cited by
1 Prevalence and Pattern of Impacted Canines in Najran, South Western Saudi Arabian Population
Bandar Alyami,Ramat Braimah,Saeed Alharieth
The Saudi Dental Journal. 2019;
[Pubmed] | [DOI]



 

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