Search

A mesiodens is often diagnosed coincidentally during a radiological examination. However, a mesiodens may also be diagnosed in relation to a clinically identified central diastema and an eruption disturbance, or a rotation of a central incisor. In this study of a group of 162 children and adolescents varying in age from 4 to 18 years, with a mesiodens, the frequency of position abnormalities, diastemas, and eruption disturbances of the maxillary frontal teeth was registered retrospectively. One or more of these complications was diagnosed in 72% of the patients. Usually, removal of the mesiodens in children and adolescents results in spontaneous recovery of the complications. Early diagnosis and early treatment are therefore important.

In patients with single missing teeth, a standard treatment plan does not exist. The treatment plan depends on the age and the facial profile, the malocclusion, the interdigitation, the available space, the amount of bone, the shape, color, and the level of the gingiva of the neighbouring teeth. Closing or opening the diastema should be considered. A diagnostic set-up of the final occlusion can provide more insight into the final result that can be expected from the treatment modalities. Orthodontic closure of the diastema is preferable, but not always feasible or desirable and compensatory extractions may be necessary. In children, auto-transplantation is an option. In adults with a sufficient amount of bone the placement of an implant may be the treatment of choice. Frequently, preimplantological bone augmentation is necessary because otherwise prosthodontic replacement is the only solution.

The orthodontic treatment of patients with missing incisors should be directed to avoid prosthetic solutions. Specific rules have to be applied for the closure of spaces due to missing teeth to reduce the occurrence of papillae retraction and to place the substituting teeth in such a position that their crowns can be built up to look like the ones they replace. To realize these goals the mesiodistal angulations should deviate from the standard ones, a proper distribution of crown width should be achieved and finally a permanent retention with a palatally bonded thin multi-stranded wire should be installed in most cases.