Supernumerary teeth are defined as any teeth in excess of normal number. Mesiodens is a supernumerary tooth, in the central region of premaxilla between two central incisors. Dens invaginatus is a developmental anomaly resulting from invagination in the surface of tooth crown before calcification has occurred. Radiographically, it is observed as infolding of a radioopaque ribbon like structure, with equal density as enamel, extending from cingulum into a root canal and sometimes reaching the root apex. This paper aims to present a rare association of dens invaginatus with two mesiodentes in a child causing the eruption disturbance and unaesthetic appearance in anterior maxilla.
Supernumerary teeth or hyperdontia is defined as excess number of teeth as compared to the normal dental formula [
Dens invaginatus is a rare malformation of teeth showing a broad spectrum of morphological variation [
Association of dens invaginatus with mesiodens is a very rare phenomenon. Extensive Pubmed search revealed only five case reports published in literature till date [
A 13-years-old child reported with complaint of abnormally erupted tooth in maxillary anterior region (Figure
Clinical picture showing horizontal partial eruption on mesiodens.
Clinical picture showing the lateral aspects of mesiodens.
Radiographically examination revealed unerupted left central incisor. Two supernumerary teeth were found in maxillary central incisor region. One of the supernumerary teeth was partially erupted in left central incisor region in horizontal manner and the other was impacted. Root appeared to be incomplete (Figure
Panoramic view showing the two mesiodens in the anterior region of maxilla with unerupted left central incisor.
Extracted mesiodentes were unusual (Figures
Lingual aspect of both mesiodens showing the dens invaginatus.
Labial aspect of mesiodens showing the dilaceration and indentation on crown of mesiodens.
Postoperative X-ray showing incomplete root formation of mesiodens.
Supernumerary teeth are developmental disturbances occurring during the odontogenesis resulting in the formation of teeth in excess of the normal number. Mesiodens refers to supernumerary tooth in the premaxilla between the two central incisor and these are more common in the permanent dentition than in primary dentition [
Mesiodentes can be classified on basis of their occurrence in permanent dentition (rudimentary) and according to their morphology as conical, tuberculate, molariform, or supplemental. Most commonly mesiodens presents in conical shape. Tuberculate mesiodentes are barrel shaped with several cusp or tubercles and have incomplete roots or abnormal root formation. They rarely erupt into the oral cavity. The rare form is molariform mesiodens. Supplemental mesiodens resembles natural teeth in both size and shapes are usually seen at end of tooth series. Supplemental maxillary incisors are much less common than conical or tuberculate supernumerary teeth in an anterior maxilla. Supplementary lateral incisor is more common than supplemental central incisor [
Dens invaginatus is a developmental malformation resulting from invagination of the tooth crown or root before calcification has occurred [
Oehlers classification is most commonly used for the dens invaginatus [ Type 1: an enamel lined minor form occurs in the crown of the tooth and not extending beyond the cemento enamel junction. Type 2: an enamel lined form which invades the root but remains confined as blind sac. It may or may not communicate with dental pulp. Type 3: a form which penetrates through the root perforating at the apical area showing a second foramen in the apical or in the periodontal area. There is no immediate communication with the pulp. In the present case both mesiodentes had a blind sac extending to pulp and dividing it without communicating.
This anomaly occurs frequently in lateral incisors followed by central incisor, premolars canines, and molars [
Various complications might occur as a result of the presence of supernumerary teeth and dens invaginatus. Delayed eruption, crowding, spacing, impaction, diastema, cystic lesion, root resorption, and so forth are complications associated with supernumerary teeth. The dens invaginatus in dens in dente allows entry of irritants into an area which is separated from pulpal tissue by only a thin layer of enamel and dentine and presents a predisposition for development of caries. Pulpal necrosis, abscess formation, cyst, and internal resorption are other complications [
Supernumerary teeth either can be managed by removal, endodontic treatment or can be monitored without its removal [
To conclude as mesiodentes are associated with various complications, early diagnosis and treatment are very important to prevent physiological, esthetics, and functional problems especially in children.