Surgical Removal of an Impacted Palatal Mesiodens Prior to Orthodontic Treatment: A Case Report

An impacted mesiodens is the most common type of supernumerary tooth and may interfere with the eruption, alignment, and orthodontic movement of permanent maxillary incisors. Accurate localization is essential for safe surgical planning and minimizing damage to adjacent anatomical structures. This case report describes the diagnosis and surgical management of a palatally impacted mesiodens in a 14-year-old male patient referred for orthodontic treatment because of dental crowding and malalignment. Routine panoramic radiography revealed an impacted supernumerary tooth in the anterior maxilla, and cone-beam computed tomography (CBCT) was subsequently performed to determine its precise three-dimensional position. CBCT demonstrated the mesiodens located palatal to the root of the maxillary right central incisor. Following discussion with the patient's parent and informed consent, surgical extraction was performed under local anesthesia using a palatal envelope flap. The impacted tooth was successfully exposed, carefully removed, and the surgical site was irrigated and closed with 3-0 chromic gut sutures. The procedure was completed without complications, and postoperative healing was uneventful, allowing the patient to proceed with orthodontic treatment. This case highlights the importance of CBCT-guided surgical planning and timely removal of an impacted mesiodens before orthodontic therapy to facilitate predictable treatment outcomes while preserving adjacent structures.