Multidisciplinary Management of Severe Iatrogenic Injury to the Maxillary Incisors Following Mesiodens Extraction

Iatrogenic injury during mesiodens extraction may result in severe damage to adjacent teeth and supporting structures, particularly when adequate imaging and surgical planning are lacking. This case report describes the multidisciplinary management of extensive iatrogenic trauma involving the maxillary anterior teeth following surgical removal of a mesiodens. A 28-year-old woman presented with grade II mobility of the maxillary incisors (#12, #11, #21, and #22) six months after mesiodens extraction. Clinical and cone-beam computed tomography (CBCT) examinations revealed extensive root destruction and loss of supporting alveolar bone involving the teeth. A conservative tooth-preserving treatment approach was adopted, including root canal therapy with mineral trioxide aggregate obturation, surgical apicectomy, fiber-reinforced composite splinting, and definitive zirconia prosthetic rehabilitation. Clinical and radiographic follow-up at 12 months demonstrated satisfactory healing, reduction in mobility, and stable functional and esthetic outcomes. This case emphasizes the importance of CBCT-guided surgical planning and interdisciplinary management in preventing and successfully treating complex iatrogenic dental injuries.