Maxillary impacted mesiodentes in unusual positions: Two case reports

Mesiodens are the most common supernumerary teeth, but rare anatomical variants such as multiple formations or ectopic eruption into the nasal cavity are scarcely reported. Their management remains controversial, particularly in asymptomatic patients.

We present two exceptional cases. The first involves a 56-year-old male with two fully developed, conical mesiodens located palatally between the central incisors, discovered incidentally and managed conservatively. The second case concerns a 16-year-old male with a mesiodens protruding into the nasal cavity, detected due to delayed eruption of the upper central incisors. In both cases, patients were asymptomatic, and a watchful waiting strategy with clinical and radiological follow-up was chosen.

Cone bean computer tomography (CBCT) played a crucial role in diagnosis and treatment planning, allowing for detailed assessment of root development, anatomical relationships, and exclusion of complications. Literature supports surgical extraction in symptomatic cases; however, a conservative approach may be safe and appropriate in selected asymptomatic patients.

These cases highlight the importance of individualized, patient-centered decision-making in managing rare mesiodens presentations. Conservative management combined with CBCT-based monitoring can be a viable alternative to surgery when clinical symptoms are absent.