Clinical recommendations for management of mesiodens and unerupted permanent maxillary central incisors

Un-erupted maxillary incisors may result secondary to supernumerary teeth. Despite the removal of such mesiodentes, orthodontic traction of a permanent un-erupted maxillary incisor may be required.

The literature regarding the impacted maxillary central incisor(s) was reviewed and all pertinent publications on the subject assessed. The review specifically relative to mesiodentes, surgical exposure and orthodontic management was interpreted together with the clinical experience of a number of the authors' cases. From this analysis a set of recommendations was developed.

(1) A sufficient arch space has to be ensured or orthodontically created for permanent maxillary central incisor(s). (2) Early surgical extraction of a mesiodens or mesiodentes (ideally before 7 years of age), with simultaneous closed surgical exposure of the permanent impacted maxillary incisor with bonding of an attachment with gold chain. (3) Re-evaluation after 2-3 months to assess for any natural eruption of the maxillary central incisor. (4) Application of orthodontic traction in the event of non-eruption.

Early diagnosis of the presence of mesiodentes is imperative. Appropriate surgical and/or orthodontic traction is often indicated with regular post-surgical follow-up assessments.