Received: September 30, 2025. | Accepted: November 6, 2025. | Published online: May 7, 2026
Surgical removal of mesiodens, a case series
Extracción quirúrgica de mesiodens, una serie de casos
José Eduardo Orellana-Centeno Instituto de Investigación Sobre Salud Pública, Licenciatura en Odontología, Miahuatlán de Porfirio Díaz, Oaxaca, México. | Universidad Autónoma Benito Juárez de Oaxaca, Facultad de Odontología, Oaxaca de Juárez, Oaxaca, México.
http://orcid.org/0000-0002-9518-7319
Mauricio Orellana Centeno Facultad de Odontología, San Luis Potosí, S.L.P., México. | Universidad Autónoma Benito Juárez de Oaxaca, Facultad de Odontología, Oaxaca de Juárez, Oaxaca, México. http://orcid.org/0000-0003-3374-9766
Verónica Morales Castillo Instituto Mexicano del Seguro Social, HGZ No. 09, Rioverde, San Luis Potosí, México. http://orcid.org/0009-0005-4488-421X
Javier Leyva Díaz
Universidad Autónoma Benito Juárez de Oaxaca, Facultad de Odontología, Oaxaca de Juárez, Oaxaca, México. http://orcid.org/0009-0002-8541-8176
Enrique Antonio Martínez Martínez Universidad Autónoma Benito Juárez de Oaxaca, Facultad de Odontología, Oaxaca de Juárez, Oaxaca, México.
Alfonso Acevedo Mascarúa
Universidad Autónoma Benito Juárez de Oaxaca, Facultad de Odontología, Oaxaca de Juárez, Oaxaca, México.
ABSTRACT:
Introduction: Dental anomalies are congenital malformations of the tissues of the tooth that can range from alterations in number, eruption, location, size and shape to structural abnormalities. Among the alterations in number we find the supernumerary tooth, defined as a tooth formed in excessive number.
Case Report: Two paediatric patients presented for consultation between June and August 2022 at the dentistry clinic of the Universidad de la Sierra Sur (UNSIS). On clinical and radiographic examination, the presence of a supernumerary tooth located in the palate between the upper central incisors (dental organ 11 and 21) was observed. Results: The mesiodens type supernumerary teeth were extracted with a surgical technique using a surgical motor and with a favourable operative and postoperative outcome for the patient. Conclusions: Among the supernumerary teeth, the most common is the mesiodens. Early detection, diagnosis and management is important in order to avoid abnormal development of the patient's dental occlusion and aesthetics.
Introducción: Las anomalías dentarias son malformaciones congénitas de los tejidos del diente que pueden presentarse desde alteraciones en número, erupción, localización, tamaño y forma hasta anormalidades estructurales. Dentro de las alteraciones en número encontramos al diente supernumerario, se define como aquel diente formado en número excesivo. Reporte de Caso Se presentaron dos pacientes pediátricos a consulta en el periodo de junio a agosto del 2022 a la clínica de odontología de la Universidad de la Sierra Sur (UNSIS) pacientes pediátricos que a la exploración clínica y radiográfica se observó la presencia de un diente supernumerario ubicados en el paladar, entre los incisivos centrales superiores (órgano dentario 11 y 21). Resultados: Los dientes supernumerarios tipo mesiodens fueron extraídos con técnica quirúrgica utilizando motor quirúrgico y teniendo un operatorio y postoperatorio favorable para el paciente. Conclusiones: Dentro de los dientes supernumerarios el más común es el mesiodens, es importante se detección, diagnóstico y manejo temprano esto para evitar un desarrollo anormal de la oclusión dental y estética del paciente.
CITACIÓN: Orellana-Centeno JE, Orellana Centeno M, Morales Castillo V, Leyva Díaz J, Martínez Martinez EA, & Acevedo Mascarúa A. Surgical removal of mesiodens, a case series. J Oral Res. 2026; 15(1):4-14. https://doi.org/10.17126/joralres.2026.002
INTRODUCTION
Dental anomalies are congenital malformations of the tooth tissues that may involve changes in number, eruption, location, size, or shape, as well as structural abnormalities.1 Among the numerical anomalies is the supernumerary tooth, or hyperdontia, defined as the presence of an excessive number of teeth or an additional tooth in the normal dentition, whether deciduous or permanent.2 Its prevalence has been reported to range from 0.3% to 0.8% in deciduous teeth and from 1.5% to 3.5% in permanent teeth.3 It is more prevalent in Asian populations, whereas in Latin American populations —such as the population examined in this study— the prevalence of mesiodens is 1.7%.4 It is also more frequent in men than in women, with a ratio of approximately 2:1. Additionally, it occurs more commonly in the maxilla and is rare in the mandible.5
The etiology of supernumerary teeth is still not clearly defined. Although several theories have been proposed and the condition has been studied extensively, its precise cause remains uncertain. Suggested explanations include dental follicle dichotomy, phylogenetic factors, genetic influences, and the most widely accepted theory, which attributes the anomaly to hyperactivity of the dental lamina during early stages of development. In this context, several molecular signaling pathways involved in dental morphogenesis —such as BMP, FGF, Wnt, and Shh— may be affected. Increased signaling of the latter two pathways in the dental epithelium has been shown to lead to the formation of supernumerary teeth in animal models.6,7 Alterations in these genes, which regulate early developmental processes, could therefore promote the formation of supernumerary teeth.8
Most supernumerary teeth are asymptomatic and, therefore, detected only during clinical and radiographic examinations. Radiographic diagnosis can be made using periapical, occlusal, orthopantomographic (panoramic), lateral cephalometric radiographs, or cone-beam computed tomography (CBCT).9 Supernumerary teeth are classified according to their number, location, eruption status, and morphology.
- Number: Isolated (most frequent) or Multiple (usually associated with a syndrome and may be related to cleidocranial dysplasia, Down syndrome, Fabry–Anderson syndrome, Hallermann–Streiff syndrome, Gardner syndrome, Treacher–Collins syndrome, Rothmund–Thomson syndrome, or cleft lip and palate).10
- Location: Unilateral (found in 76% to 86% of cases, typically in the canine and molar region; where mesiodens have a reported prevalence of 0.15% to 1.9%) or Bilateral (less frequent, occurring in 12% to 23% of cases).10
- Eruption: Classified into three categories: erupted, embedded, and impacted. The most common situation is complete embedding, with only about 25% of supernumerary teeth erupting. Occasionally, these teeth may follow an abnormal eruptive path and adopt an ectopic position, with a risk of eruption into the nasal cavity.10
- Morphology: Four forms have been described: conical (peg-shaped, most common), tuberculate (barrel-shaped), supplemental (similar in shape to adjacent teeth), and rudimentary-dysmorphic (small, often conical shape).10
Among supernumerary teeth, the most common type is the mesiodens. It is typically located between the maxillary central incisors and may be single, unilateral or bilateral, erupted or impacted, and oriented vertically, horizontally, or in an inverted position. According to Shafer et al.,11 mesiodens account for more than 50% of all supernumerary teeth.
Mesiodens can present in these different forms:
a) Rudimentary (the most common, typically conical in shape); b) Eumorphic (resembling the shape of normal teeth); and c) Heteromorphic (with atypical morphology).12
A thorough intraoral examination is essential, as a protuberance may occasionally be observed on the buccal or palatal mucosa.13 The radiographs commonly used to determine the palatal or buccal position of a mesiodens include occlusal radiographs and periapical radiographs taken with different horizontal angulations, following Clark’s technique, which applies the principle of parallax or the buccal object rule.14
Complications associated with the presence of a mesiodens include:
a) Displacement, rotation, or interference with normal tooth eruption; b) Delayed eruption of the permanent maxillary central incisors; c) Root resorption or abnormal root formation; and d) Effects on adjacent vital structures, such as perforation of the nasopalatine canal or nasal floor, or the development of cysts.15
The exact criteria for planning the treatment of mesiodens remain unclear. The decision is made by the dentist based on the patient's age and the characteristics of the mesiodens.16 The aim of this study is to describe the surgical removal of mesiodens in a series of cases.
CASE REPORT
Clinical Case 01
An asymptomatic patient attended the dental clinic of the Universidad de la Sierra Sur (UNSIS) on June 21, 2022. The patient was an 8-year-old male attending for a routine dental examination. A clinical history was obtained, and panoramic, periapical, and occlusal radiographs were taken. He had no relevant pathological or non-pathological history. Following the clinical and radiographic evaluation, he was diagnosed with crowding in the anterior segment of the maxilla and a dental anomaly —specifically, a supernumerary tooth of the mesiodens type. His mother was informed of the diagnosis and the proposed treatment plan, and she accepted and signed the informed consent form.
The supernumerary tooth was located on the palatal side between the upper central incisors (teeth 11 and 21), causing an alteration in their position. It presented the following characteristics: isolated, single, rudimentary–dysmorphic in sha-pe and impacted, (Figure 1).
Auxiliary examinations were performed using periapical and occlusal radiographs, which confirmed the diagnosis. (Figure 2)
Following diagnosis and authorization from the patient’s mother, the oral cavity and the area to be treated were cleaned and disinfected. Topical anesthesia was applied, and local anesthesia was administered by infiltration from the upper right canine (53) to the upper left canine (63), as well as palatally at the incisive papilla, using two cartridges of FD 2% lidocaine HCl with epinephrine (FD Zeyco, Laboratorio Zeyco S.A. de C.V., Zapopan, Jalisco, Mexico). A sulcular incision was then made from the upper right canine to the upper left canine using a No. 3 scalpel handle and a No. 12 blade, creating an enveloping flap. Using a curette, the mucoperiosteal flap was raised, exposing part of the mesiodens. An osteotomy was performed to fully expose the tooth. Careful luxation was carried out to avoid damage to the surrounding tissues and to facilitate extraction, using constant irrigation with saline solution. The supernumerary tooth was then extracted (Figure 3).
Finally, the area was sutured with a resorbable suture (Vicryl 4-0). Posto-perative instructions were provided, including an antibiotic (amoxicillin–clavulanic acid 500 mg tablets for 7 days) and an analgesic (ibuprofen 400 mg tablets for 3 days). The patient was advised to drink plenty of water and rest during the first few days. Postoperative appointments were scheduled to clinically monitor progress.
Clinical Case 02
A 6-year-old female patient attended a check-up at the dental clinic of the Universidad de la Sierra Sur (UNSIS) on August 11, 2022. A medical history was taken, and panoramic, periapical, and occlusal radiographs were obtained. She presented with no relevant medical or non-medical history. Following the clinical and radiographic examination, she was diagnosed with a deep bite and two dental anomalies: a supernumerary mesiodens in the anterior maxillary segment and two geminated teeth (71 and 72). Her mother was informed of the diagnosis and treatment plan, and she accepted and signed the informed consent form. A clinical examination of the patient was performed (Figure 4).
The supernumerary tooth was located on the palate, between the upper central incisors (teeth 11 and 21), causing an alteration in the position of these teeth. It displayed the following characteristics: isolated, single, rudimentary, dysmorphic, and impacted. A fused tooth (teeth 71 and 72) was also observed (Figure 5).
Following diagnosis and with the mother's consent, the oral cavity and treatment area were prepared using aseptic and antiseptic techniques. Topical anesthesia was applied, followed by infiltration anesthesia from the upper right canine (53) to the upper left canine (63), as well as palatally at the incisive papilla, using two cartridges of 2% lidocaine FD with HCl and epinephrine (FD Zeyco, Laboratorio Zeyco S.A. de C.V., Zapopan, Jalisco, Mexico). A sulcular incision was then made from the upper right canine to the upper left canine using a No. 3 scalpel handle and a No. 12 scalpel blade, creating an enveloping flap. The mucoperiosteal flap was elevated with a curette, enabling visualization of a portion of the mesiodens. An osteo-tomy was performed with a Surgic Ap surgical motor (NSK Nippon Seiko KK, Tokyo, Japan) to fully expose the tooth. Careful luxation was carried out under constant saline irrigation to avoid damage to the surrounding tissues and facilitate extraction. The supernumerary tooth was then extracted, (Figure 6).
The area was subsequently sutured with resorbable sutures (Vicryl 4-0). Anesthesia for the extraction of the fused tooth was administered using the lower dental technique. After applying topical anesthesia, one cartridge of 2% lidocaine FD with HCl and epinephrine (FD Zeyco, Laboratorio Zeyco S.A. de C.V., Zapopan, Jalisco, Mexico) was used. Luxation and avulsion of the fused tooth were performed with 151SK forceps. Once the tooth was removed, the site was sutured with resorbable sutures (Vicryl 4-0). Postoperative instructions were provided, including an antibiotic (amoxicillin with clavulanic acid, 500 mg tablets for 7 days) and an analgesic (ibuprofen, 400 mg tablets for 3 days). The patient was advised to drink plenty of water and rest during the first few days. Postoperative appointments were scheduled to clinically monitor treatment progress (Figure 6).
DISCUSIÓN
Two cases of patients with mesiodens supernumerary teeth were presented, both involving individuals without associated syndromes or relevant medical histories. In both cases, the mesiodens were located in the anterior segment of the maxilla and had gone undetected. The lack of symptoms meant that neither condition prompted a consultation, and both were discovered incidentally during routine examinations.
In the first case, the patient presented with mixed dentition, and the mesiodens was extracted due to its potential for occlusal complications. In the second case, the patient exhibited predominantly deciduous dentition and an additional dental anomaly: a geminated tooth in the mandible. Neither patient presented with any syndrome associated with the oral pathologies observed.
The etiology of mesiodens remains unknown. Several theories have been proposed, including atavism (evolutionary regression leading to three central incisors), germ dichotomy (division of the dental follicle into two), genetic factors (autosomal dominant or recessive inheritance, or associations with the X chromosome), alterations in organogenesis, hyperactivity of the dental lamina, and associations with certain syndromes (such as Down syndrome, Gardner syndrome, and cleidocranial dysplasia), as well as systemic conditions (such as cleft lip and palate). A combination of environmental and genetic factors has also been suggested.17 Dental diagnosis should be based on a thorough clinical and radiographic examination to detect swelling, malpositioned teeth, crowding, spacing, or chronological alterations in the eruption process.18
A 3D digital positioning guide can provide clinicians with detailed patient information during the surgical procedure. This information allows for appropriate assessment of risks and planning of the surgical approach, including incision design, surgical fenestration, and the angle and depth of the operation. In their study, Aji et al.,18 developed a surgical plan using 3D digital templates to accurately extract impacted supernumerary teeth with minimally invasive techniques, even in complex locations such as the lingual side of the mandible.
Management of supernumerary teeth depends on their type and location, as well as their functional, aesthetic, and other impacts on the deciduous or permanent dentition. Immediate extraction is indicated in cases involving delayed or inhibited eruption, displacement of adjacent teeth, interference with orthodontic appliances, the presence of a pathological condition, or spontaneous eruption of the supernumerary tooth.20
According to Stafne et al.,21 6% of impacted supernumerary teeth are associated with dentigerous cysts, which can cause bone destruction as they continue to grow, become infected, undergo histological changes, and, in exceptional cases, become malignant. In the case of mesiodens supernumerary teeth, two extraction approaches are described: (a) Early extraction, performed before the formation of the permanent incisor roots, and (b) Late extraction, carried out after root formation. Some authors recommend performing the extraction during early mixed dentition, corresponding to the first type. This report presents one case of each approach. Although the surgical procedure itself does not differ, it is important to note that extraction at an earlier stage may reduce the need for future orthodontic treatment.22
CONCLUSIONS
These cases demonstrate that mesiodens in children may remain asymptomatic and be detected only during routine examinations. Early identification is important to prevent potential occlusal complications. In both cases, surgical extraction of the mesiodens resulted in a successful resolution without complications.
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CONFLICT OF INTERESTS
The authors declare that there are no conflicting interests.
Los autores declaran que no existen conflictos de intereses.
ETHICS APPROVAL
Informed consent was provided by the patient for the publication of this case report.
El paciente dio su consentimiento informado para la publicación de este caso clínico.
FUNDING
Self-financing.
Autofinanciado.
AUTHORS’ CONTRIBUTIONS
José Eduardo Orellana-Centeno: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project management; Software; Validation; Visualization; Drafting; Revision and editing. |Mauricio Orellana Centeno: Conceptualization; Investigation; Validation; Revision and editing. | Verónica Morales Castillo: Conceptualization; Data curation; Investigation; Validation; Drafting; Revision and editing. | Javier Leyva Díaz: Conceptualization; Investigation; Validation; Revision and editing. | Enrique Martínez Martínez: Conceptualization; Investigation; Validation; Revision and editing. | Alfonso Acevedo Mascarúa: Conceptualization; Investigation; Validation; Revision and editing.
José Eduardo Orellana-Centeno: Conceptualización; Curación de datos; Análisis formal; Investigación; Metodología; Gestión de proyectos; Software; Validación; Visualización; Redacción; Revisión y edición.|Mauricio Orellana Centeno: Conceptualización; Investigación; Validación; Revisión y edición. | Verónica Morales Castillo: Conceptualización; Curación de datos; Investigación; Validación; Redacción; Revisión y edición. |Javier Leyva Díaz: Conceptualización; Investigación; Validación; Revisión y edición. | Enrique Martínez Martínez: Conceptualización; Investigación; Validación; Revisión y edición. | Alfonso Acevedo Mascarúa: Conceptualización; Investigación; Validación; Revisión y edición.
ACKNOWLEDGEMENTS
None.
No es necesario.
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Todas las declaraciones expresadas en este artículo son responsabilidad exclusiva de los autores y no necesariamente representan las del editor, los editores y los revisores. Todas las declaraciones expresadas en este artículo son responsabilidad exclusiva de los autores y no representan necesariamente las de la editorial, los editores ni los revisores.
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