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LETTER TO EDITOR
Year : 2012  |  Volume : 1  |  Issue : 3  |  Page : 216-217

Periodontal defect associated with an inverted mesiodens


Department of Periodontology,Kanti Devi Dental College and Hospital,Delhi-Agra National Highway # 2,Uttar Pradesh, India

Date of Web Publication3-Jan-2013

Correspondence Address:
Srinivas Sulugodu Ramachandra
Department of Periodontics,Kanti Devi Dental College and Hospital,Delhi-Agra National Highway # 2,Mathura, P.O. Chhatikhara - 281 006,Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9626.105397

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How to cite this article:
Saurabh L, Ramachandra SS, Jithendra K D. Periodontal defect associated with an inverted mesiodens. Eur J Gen Dent 2012;1:216-7

How to cite this URL:
Saurabh L, Ramachandra SS, Jithendra K D. Periodontal defect associated with an inverted mesiodens. Eur J Gen Dent [serial online] 2012 [cited 2019 Apr 24];1:216-7. Available from: http://www.ejgd.org/text.asp?2012/1/3/216/105397

Sir,

Mesiodens refers to an unerupted supernumerary tooth in the midline of the maxilla, between the central incisors, and the term was coined by Bolk in 1917. [1] A study on mesiodens in children revealed a prevalence of around 0.8% (0.15-1.9%). [1] Majority of the mesiodens (62.8%) were vertically aligned. Inverted and horizontal positions were observed in 30.8% and 6.4% of the cases. Most of the mesiodens (53.8%) were impacted, and were associated with complications, and only 26.9% were asymptomatic. [1] Cause of inversion of the mesiodens has been postulated to be due to the contact of the incisal edge of the crown of the mesiodens by the apex of the root of the erupting right maxillary central incisor tooth. [2]

A 60-year-old male patient reported to the Department of Periodontics with the complaint of pain in relation to the maxillary left central incisor. On clinical examination, a deep periodontal pocket was noticed on the mesial side of the maxillary left central incisor [Figure 1]. Swelling over the maxillary midline area just near the labial frenum [arrow in [Figure 1]] and Grade I mobility was also noticed. Intraoral periapical radiograph showed bone loss along the involved tooth and a radio-opacity between the roots of the two central incisors [Figure 2]. On a closer analysis, this radio-opacity was diagnosed as an impacted and inverted mesiodens. The radiolucency was ill defined and without cortication, ruling out the possibility of a cyst. The patient was referred to the Department of Oral Surgery for removal of the inverted mesiodens. A treatment plan comprising of flap surgery with bone grafts was formulated to save the maxillary left central incisor.
Figure 1: Clinical image showing deep periodontal pocket between the two maxillary central incisiors. The arrow shows the swelling over the maxillary midline area just near the labial frenum

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Figure 2: Intraoral periapical radiograph showing the inverted mesiodens and bone loss along the root of the maxillary left central incisor

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Periodontal bone loss associated with impacted inverted mesiodens has not been reported so far. Established complications associated with mesiodens include interference with the eruption and alignment of the adjacent teeth, delayed or non-eruption of the maxillary incisors, radicular resorption and dentigerous cyst formation. [1] Clinical management of mesiodens could be confusing about whether and when they should be surgically removed, or whether they should be retained and followed-up radiographically. [3] Early detection and diagnosis of this anomaly is critical. Early removal of the mesiodens may not be the only treatment option; however, when pathological changes or interference with the normal teeth are diagnosed, removal should be performed. [3]

 
  References Top

1.Mukhopadhyay S. Mesiodens: A clinical and radiographic study in children. J Indian Soc Pedod Prev Dent 2011;29:34-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Atasu M, Orguneser A. Inverted impaction of a mesiodens: A case report. J Clin Pediatr Dent 1999;23:143-5.  Back to cited text no. 2
    
3.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. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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