A labially positioned mesiodens and its repositioning as a missing central incisor

Hyperdontia is an increased number of teeth within the dental arches. This is of particular interest to pediatric dentists who commonly make the initial diagnosis. Most often a large portion of these teeth is completely embedded or impacted within the jaws and can be viewed only radiographically. Hyperdontia can occur on virtually every tooth-bearing surface. However, the most frequent is the mesiodens, in the anterior maxillary region. Anterior maxillary teeth are one of the most important features contributing to aesthetics of an individual. Missing anterior teeth can cause undue psychological stress in children, during their growing years. Most of the literature available show that the mesiodens are situated on the palatal aspect of the permanent incisors. Their treatment frequently involves an early recognition, extraction through a traditional palatal technique and guiding the associated permanent tooth to its original position. The purpose of this article is to enlighten the clinician of the need of deviating from the traditional approach of early extraction in particular situations and to conserve the mesiodens if favorable as an alternative treatment to a malformed permanent tooth, which may fail to erupt. This report describes a successful multidisciplinary approach to treatment of a unerrupted, labially placed mesiodens in conjunction with a dilacerated and impacted permanent tooth, in a child with a missing left central incisor. Treatment consisted of localizing and confirming the placement of the mesiodens to be labial, surgically exposing the crown of the mesiodens through a labial surgical approach, orthodontically guiding it to the position of the missing central incisor, extracting the malformed permanent incisor, and restoring the mesiodens to the required anatomy with composites, to establish aesthetics and function of the affected region.