Download Mesiodens: Etiology, Diagnosis and Treatment: A

BAOJ Dentistry
Lucas Penalva PM, et al., BAOJ Dentistry 2015, 1: 1
1: 002
Review Article
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review
Lucas Penalva PM1, Perez-Albacete Martinez C1*, Ramírez Fernandez MP1, Mate Sánchez De Val JE1, Calvo Guirado JL1
Universidad Catolica San Antonio de Murcia (UCAM) Murcia, Spain
1
Abstract
Background
The presence of supernumerary teeth, between the two central
incisors, known under the term mesiodens, is one of the most
common developmental problems in children. It represents 5080% of supernumerary, with its higher frequency in the maxilla and
men 2:1. Most of the mesiodens have a single root, it has conical
crowns or triangle, is heteromorphic. The etiology of mesiodens is
unclear; the best theory is hyperactivity of the dental lamina. These
teeth can cause different disorders such as malposition of adjacent
teeth, anomalous eruption, and delayed eruption of permanent
maxillary central incisor interincisal diastema and cyst formation.
Objective
The aim of this work was to make a literature review of the different
oral aspects involving mesiodens.
Material and methods
To make the literature review, we used different database for finding
articles related to mesiodens. Of the total of articles we founded,
those which did not fulfill the inclusion criteria were discarded.
Conclusions
Mesiodens is the most common supernumerary tooth observed
more in men than in women 2:1. It can cause pathological
conditions so an early diagnosis with panoramic radiography,
complete with occlusal or periapical at different angles, besides
a clinical diagnosis is recommended. The treatment of choice is
extraction supernumerary, this will depend on their morphology,
position, the potential effect on teeth and surrounding structures,
and patient age.
Keywords: Diagnosis; Etiology; Mesiodens; Supernumerary Teeth;
Treatment
Introduction
Or hyperdontia supernumerary teeth is the increased number of
normal dental formula, twenty deciduous and permanent thirty-two
[1-5]. The most common type of supernumerary teeth according to
Alberti et al. [6] in 1,577 children was the mesiodens representing
83% of the 0.38% of supernumerary teeth; the proportion of males:
females was 2: 1, the most common age was 9 years old and the
most common location maxilla in its previous zone.
Mesiodens named for Bolk [7] features appear in the midline distal
jaw between 11 and distal 21, representing 80% of all supernumerary
teeth.
BAOJ Dentistry, an open access journal
Its orientation can occur at all levels of space and erupt only 25%
of cases usually interincisal mouth and via palatal level, in 75% of
cases occur retained without rash [8].
Etiology
There are several theories to explain what time or what embryological
formation is generated:
For hyperactivity of embryonic epithelial cells, tooth germ cells
are equal, but some can differentiate into invaginations that would
result in new dental tissues, either from the dental lamina, either
at the time that the tooth bud is separated from the dental lamina,
being attached to this by the dentis gubernaculum, from this new
tooth buds may originate either by overactivity of the outer layer
sheath Hertwing or from epithelial remains of Malassez.
For split the dental follicle, the theory of dichotomy, some factors
such as trauma, evolutionary mutations, can cause accidental
follicle division into two or more fragments, according to the
theory of atavism, with few defenders, it is mesiodens the third
incisor primates would be a phylogenetic reversal [9].
Supernumerary teeth may be associated with some syndromes, such
as Fabry’s syndrome, cherubism, Apert syndrome, cleidocranial
dysplasia or Crouzon disease, cleft lip, cleft palate, Gardner
syndrome and other as hereditary fibromatosis , associated with
hearing loss and supernumerary teeth [10] however, the appearance
of a mesiodens can occur in individuals with no syndrome.
Epidemiology
Fernandez et al. found that the prevalence of supernumerary teeth
is between 0.5 and 3.8% in the permanent dentition and between
0.35 and 0.6% in the temporary dentition. The most frequent group
was the mesiodens (46.9%) [11].
*Corresponding author: Perez-Albacete Martinez C, International
Dentistry Research Cathedra, Universidad Católica San Antonio de
Murcia (UCAM) Murcia, Spain, E-mail: [email protected]
Rec Date: jULY 31, 2015, Acc Date: August 20, 2015, Pub Date: August
24, 2015.
Citation: Lucas Penalva PM, Perez-Albacete Martinez C, Ramírez
Fernandez MP, Mate Sánchez De Val JE, Calvo Guirado JL (2015)
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review.
BAOJ Dentistry 1: 002.
Copyright: © 2015 Lucas Penalva PM, et al. This is an open-access
article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source
are credited.
Volume 1; Issue 1; 002
Citation: Lucas Penalva PM, Perez-Albacete Martinez C, Ramírez Fernandez MP, Mate Sánchez De Val JE, Calvo Guirado JL (2015)
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review. BAOJ Dentistry 1: 002.
Its frequency in the Caucasian population varies between 0.15 and
1% predominance of males in a 2 to 1 in the permanent dentition
[12,13].
[2,8,14,17,25,26].
When the rash is done through the nasal floor completely, they
are called “nasal prongs” manifesting itself as a local tumor that
causes nasal deformity, with airway obstruction, headache or other
facial pain, epistaxis, rhinorrhea and purulent rhinitis erupts with
speed and is quickly visible, also it has great mobility and is easily
removable [14-16].
Early Diagnosis
Clinic
Mesiodens show great variety in size [2,17,18] and forms [1,19,2022]. They can imitate the way of normal teeth (eumorphic), or have
an unusual morphology (heteromorphic) as:
Conical or peg teeth: size smaller than normal teeth, with conical
crown and a rudimentary whole root. It is the most common form.
Tuberculate tooth: smaller than normal tooth crown and root
tubers is unique, incomplete, thick and curved.
Infundibular tooth: tooth similar to normal size but with
invaginations inward at the crown, giving it look like a funnel.
Molariform tooth: shaped molar or premolar and incomplete root
formation.
Delayed eruption of a permanent tooth more than six months and
the dental mal-positioning can be the first clinical manifestation of
a supernumerary tooth [23].
Complications
Inclusion of permanent teeth: often cause deformation of the
buccal or lingual / palatal surface of alveolar process, with the
prolongation of the presence of primary teeth. It is the most
common complication [1,24,19,25,16-18,26,31].
Dental Mal-Positioning: In the incisal region, crowding or
malposition we will investigate the existence of a mesiodens. The
most common is the torsoversión and lip movement [25,26].
Diastema: The presence of diastema advisable to perform a
radiographic examination to rule out mesiodens included, in which
case it should be removed when the patient is still in the growth
phase and may close the interproximal space without orthodontic
treatment [1,16,17,19,24,27,28,32,33].
Abnormal Eruptions: Can erupt into atypical locations away
from the dental arch, such as the eruption into the nostrils and
into the maxillary sinus, leading to a private clinic in pain, airway
obstruction and infection [2,8,15,24,34].
Page 2 of 5
Functional And Aesthetic Problems: Caused by malposition
involved mesiodens.
Clinical examination: Mesiodens diagnosis is based on clinical
and radiographic findings.
By inspection, we can see that erupted mesiodens those found in
the oral cavity; also do a presumptive diagnosis in cases where we
observe a delay in the eruption of the maxillary central incisors,
bad position of teeth, diastema etc. Palpation inform us about the
situation and whether there mesiodens accessible to the touch
[8,35] pericoronal cysts.
Radiological examination: It provides data on the shape, number,
location and relations with adjacent structures. To find the location
of the supernumerary tooth occlusal radiographs and periapical
radiographs with different horizontal angles [1,32,36,25,3740] are used. It is also necessary to rule out a panoramic
radiography supernumerary teeth without clinical signs, as most of
supernumerary teeth are asymptomatic [10]. When in doubt you
can make a Cone Beam CT, showing the exact location in the 3
planes.
Differential diagnosis: Heteromorphic supernumerary teeth
should preferably be differentiated from odontoma. Both may
even coexist, as in Gardner’s syndrome. The compound odontoma
frequently located between the anterior teeth [29-31].
Supernumerary teeth may also be confused with other injuries
that occur with radiopacity, as cementomas, cysts, tumors
(cementoblastoma, adenomatoid odontogenic tumor) and retained
deciduous teeth [41,42].
Treatment
The inverted teeth can migrate and this makes it advisable to
develop cysts extraction invested mesiodens is essential extracting
tuberous forms early for the central incisor erupts in an acceptable
time, and causing much more frequently than the delay in conical
eruption of the incisors.
However, unless a conical mesiodens cause malposition, central
incisor crowding or other problems, you can be left in place as it is
located above and away from the erupted teeth [43].
There are two streams to the moment of extraction of a
mesiodens:
Cyst Formation: The follicle of an enclosed tooth can be the
source of a dentigerous or follicular cyst, up to 6% of cases [3]. The
dentigerous cyst can become infected, suffer histological changes, or
even become an ameloblastoma or intracystic carcinoma [25,29-31].
Early Tooth Extraction: Performed before 6 years. Its aim is to
prevent future orthodontic problems and the need for complicated
surgical procedures. It has a better prognosis than the extraction
late. Its disadvantages are the risk of damaging the roots of the
permanent incisors, psychological difficulties for the child to
tolerate surgery, and finally that this surgery may ultimately prove
unnecessary, because sometimes just erupting without affecting
the permanent teeth.
Rhizolysis and Periodontal Lesions: Compression on the
roots of adjacent teeth retained by the supernumerary tooth
Late Tooth Extraction: Performed at 8-10 years after complete root
formation of permanent incisors. The risk of damaging the apex of
Pulp Pathology: Forming a cavity, or the existence of a root
resorption, they can induce the full range of pulp pathology [2,8].
BAOJ Dentistry, an open access journal
Volume 1; Issue 1; 002
Citation: Lucas Penalva PM, Perez-Albacete Martinez C, Ramírez Fernandez MP, Mate Sánchez De Val JE, Calvo Guirado JL (2015)
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review. BAOJ Dentistry 1: 002.
permanent teeth is less than making early extraction, at this time
the child is better prepared to face surgery. Thus authors like Koch
et al. [44], advised late only perform extraction and extraction in
early symptomatic cases of supernumerary teeth. The drawback is
the increased risk of lack of space, requiring more aggressive in
that case and complicated orthodontic and surgical treatment.
Most permanent incisors included because of a mesiodens,
approximately 75% erupt spontaneously after the supernumerary
tooth is extracted [2,36]. Then we must control the eruption of
the central incisors erupted not waiting at least six months, and
checking that there is sufficient space in the dental arch so that they
can be located [2,45].
If we find that there is no spontaneous eruption of the incisors
we perform surgical exposure of them [16,21] and orthodontic
traction using brackets attached directly to the labial surface of the
incisor [46].
Objective
The aim of this review was to conduct a comprehensive literature
review of the existing literature on the etiology, epidemiology,
symptoms, diagnosis and treatment of mesiodens.
Method and Results
The database used for making the literature review included
PubMed, LILACS, EMBASE, Google Scholar, MedLinePlus,
Cochrane and Dialnet.
The key words used for making the search at the different database
were “Mesiodens” OR “supernumerary teeth” [All Fields] AND
“treatment” OR, “etiology” OR “clinic” OR “orthodontic treatment”
OR “management” OR, “prevalence” OR, the following keywords
were used “case” OR “orthodontic” OR “radiographic” OR
“extraction” OR “radiographic” OR “review” [All Fields].
The inclusion criteria for the different articles searched for making
this research work were: original articles or literature reviews from
January 1981 until January 2015 that were written in English,
Spanish, Italian, French, German or Portugueses.
Articles which the main topic was not mesiodens it etiology,
diagnosis, clinical aspects or treatment were discarded; also articles
which we cannot get the full text or articles in which mesiodens
or related aspects of it were superficially mentioned along the
manuscripts.
After using inclusion and exclusion criteria, we used a total of
55 articles for making a literature review of the different aspects
involving mesiodens.
Discussion
Studies have shown that the formation of supernumerary tooth
is due to an epithelial overactivity, but there is disagreement as to
what training from or what embryological point is generated [9].
Mesiodens may be single or multiply, Hernandez et al. [47] refer
cases of double mesiodens in children. Gündüz et al. [48] collected
69 cases of patients who had a mesiodens 53 (76.8%) and 16 patients
BAOJ Dentistry, an open access journal
Page 3 of 5
two (23.1%). Salcido et al. [49] found 36 cases with mesiodens:
only 31 (86.1%) and 5 double (13.9%). Ferres Padro et al. [50] they
found in 42 cases mesiodens: only 36 (45.6%), 4 double (5.1%) and
2 mesiodens more than three (2.5%).
Fernandez et al. [51] performed 145 supernumerary extraction
in 102 patients. Mesiodens was the most frequent: 46.9% of the
patients had. Also it was for Salcido et al. [49], who reviewed to
2,245 patients and found 102 supernumerary teeth in 72 patients,
36 of whom presented. Ferrés Padro et al. [50] conducted the
extraction of 113 unerupted supernumerary teeth in 79 pediatric
patients. Mesiodens was the most frequent supernumerary teeth
(53.2% of patients), with a total amount of 42.
The panoramic radiograph performed as control visit tells us the
presence of supernumerary teeth without clinical signs exist, since a
high percentage are asymptomatic. Studies like those of Fernandez
et al. [51] and Gündüz et al. [48], who extracted mesiodens 68
and 85 respectively, show that in 39.7% of cases the first study and
22.3% in the second were asymptomatic.
At other times cause complications. Fernandez et al. [51] found
that 51.5% of the 68 had been extracted mesiodens inclusion of
permanent teeth, 7.4% and diastema tooth malposition, and in a
case of a follicular cyst formation. Gündüz et al. [48] reported that
38.8% of the 85 occurred mesiodens extracted delayed eruption of
permanent incisors in interincisal diastema 17.6%, 16.4% change in
the position of the permanent incisors erupted and 4.7% resorption
of adjacent teeth.
Besides orthopantomography in some cases we must complete the
radiological study with a periapical, occlusal, lateral skull X-ray
or CT scan to determine the exact location and relationship to
adjacent structures, prior to any extraction [38-40].
Mesiodens are 80% of all supernumerary teeth according Danalli
[1] as a result of the measurement from distal to the distal 11 to
21, while the percentage found by Bolk ranges from 45-66%, with
those diagnosed in the midline [7]. In a study of a total of 36 they
were diagnosed mesiodens mesiodens in 30 patients (average of 1.2
per patient mesiodens), corresponding to 1.5% of the total sample.
Prevalence was similar to that described in studies by Hurlen and
Humerfelt [52] (1.4%) and Salcido-Garcia et al. [49] (1.6%), and is
very close to the observed average frequency for prevalence values ​​
collected (1.67%).
Raymundo et al. [53] anomalies observed in the number of teeth in
the permanent dentition in 909 patients aged 6-12. The prevalence
of supernumerary teeth was 2.2%, mostly located in the anterior
area; the mesiodens was the most common supernumerary teeth
(78.4%).
Gorse et al. [54] 329 surgical procedures performed between
2002 and 2009 for diagnosis of retained parts odontomas
supernumeraries and found 110 cases of supernumerary teeth
(57.3%) in the anterior maxilla (87.3%), the range the most
common age 6-11 years (82.7%).
The management of supernumerary teeth depends on the type and
Volume 1; Issue 1; 002
Citation: Lucas Penalva PM, Perez-Albacete Martinez C, Ramírez Fernandez MP, Mate Sánchez De Val JE, Calvo Guirado JL (2015)
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review. BAOJ Dentistry 1: 002.
tooth position. Mesiodens removal is often indicated in certain
situations, such as delayed eruption, displacement of adjacent
organs or orthodontic interference [55]. Early extraction mesiodens
has a better prognosis [56].
In the primary dentition it is usually not indicated mesiodens
extraction for the high risk of displacing or damaging the
development of the permanent incisors. In the mixed dentition,
there are two trends in the treatment best suited to perform the
extraction time: early removal (before the radicular formation
of permanent incisors) and late (after completion of the root
formation) [20]. Its removal allows early, in most cases, the
spontaneous eruption of the incisors affected, preventing associated
complications and other more complex subsequent treatments.
Conclusions
With the limits of this review concerning to mesiodens, we can
concluded that: Mesiodens is the most common supernumerary
tooth observed more in men than in women 2: 1. The most common
form of presentation is conoide, erupting only 25% of the time and
located palatal to the central incisors. It can cause pathological
conditions so an early diagnosis with panoramic radiography,
complete with occlusal or periapical at different angles, besides a
clinical diagnosis is recommended.
The treatment of choice is extraction supernumerary, this will
depend on their morphology, position, the potential effect on teeth
and surrounding structures, and patient age.
References
1. Ranalli DN, Buzzato JF, Baum TW, Murphy SM (1988) Long term
interdisciplinary management of multiple mesiodens and delayed
eruption: report of a case. J Dent Child 55: 376-380.
2. Primosch RE (1981) Anterior supernumerary teeth-assessment and
surgical intervention in children. Pediatric Dent 3: 204-215.
3. Stafne EC (1987) Diagnóstico radiológico en odontología. Buenos
Aires: Ed. Médica Panamericana.p. 271-272.
4. Trull Gimbernat JM, Bachiller LA, Balaguer E, Vall-Llosera Riera J, Gay
Escoda C (1994) Supernumerarios simples no sindrómicos: descripción
de un caso. Avances en Odontoestomatología 10: 89-93.
5. Penarrocha MA, Penarrocha M, Larrazabal C, Minguez I (2003) Dientes
supernumerarios: consideraciones quirúrgicas y ortodoncicas.
Archivos de Odontoestom atologia 19(4): 263-272.
6. Alberti G, Mondani PM, Parodi V (2006) Eruption of supernumerary
permanent teeth in a sample of urban primary school population in
Genova, Italy. Eur J Paediatric Dent 7: 89-92.
7. Bolk L (1917) Die uberzahlingen obereren incisiven des menschen.
Dtsch Mschr Zahnheilk 35:185.
8. Escoda GC, Micas MM, Tost EA, Albiol GJ (2004) Otras inclusiones
dentarias. Mesiodens y otros dientes supernumerarios. Dientes
temporales supernumerarios. Dientes temporales incluidos. En: Gay
Escoda C, Aytés Berini L, editores. Tratado de Cirugía Bucal. Tomo I.
1.ª ed. Madrid: Ergon 497- 534.
9. Fleury J, Deboets D, Assaad C, Maffre N, Caillot M (1984) Dents
surpenuméraires. Rev. Stomatol. Chir. Maxillofac 85:142-150.
BAOJ Dentistry, an open access journal
Page 4 of 5
10. Jensen B, Kreiborg S (1990) Development of the dentition in
cleidocranial displasia. J Oral Pathol Med 19:89-93.
11. Fernández Montenegro P, Balmaceda Castellón E, Berini Aytés L, Gay
Escoda C (2006) Estudio retrospectivo de 145 dientes supernumerarios.
Med Oral Pato Oral Cir Bucal 11:339-344.
12. 11-7 Backman B, Wahlin YB (2001) Variations in number and
morphology of permanent teeth in 7-year-old Swedish children. Int
J Paediatr Dent 11.
13. Alencar M., Duarte D, Cury P, Bonecker M (2005) Lower mesiodens:
report of an inusual case. J Clin Pediatr Dent 29:353-6.
14. Von-Arx T (1992) Anterior maxillary supernumerary teeth: a clinical
and radiographic study. Aust Dent J 37:189-95.
15. Wood GD, MacKenzie Y (1987)A dentonasal deformity. Oral Surg Oral
Med Oral Pathol 63:656-7.
16. Thoma KH, Gorlin RJ, Goldman HM (1973) Patología Oral. Barcelona:
Salvat p 48-50.
17. Yoon K, Martin J. Davis (2008) Impacted Maxillary Anterior
Supernumerary Teeth A Survey of Forty-Two Cases. N Y State Dent
J 8:24-9.
18. Contreras M, Alejos E, Buenechea R, Berini L, Gay Escoda C (1995)
Mesiodens molariformes: a propósito de un caso. An Odontoestomato
Gl3:103-5.
19. Carver DD, Peterson S, Lee B (1990) Bilateral inverted supernumerary
teeth. Oral Surg Oral Med Oral Pathol 70:127.
20. Canut, J.A (1998) Ortodoncia Clínica Barcelona, Espana: Ed. Salvat p
123-45.
21. Howe GL (1987) Cirugía Bucal Menor. México: Ed. El Manual Moderno
p 244-57.
22. Chadwick SM, Kilpatrick NM (1993) Late development of
supernumerary teeth: a report of two cases. lnt J Pediatr Dent 3: 205-10.
23. Berrone S, Defabianis P, Gallesio C (1989) Valutazione clinico-chirurgica
delle anomalie dentaire in sovrannumero. Minerva Stomatol 38:261268.
24. Laskin DM (1988) Cirugía Bucal y Maxilofacial. Buenos Aires: Ed.
Médica Panamericana p 356-358.
25. Kessler HP, Krant RA (1989) Oentigerous cyst associated with an
impactad mesiodens. Gen Dent 37:47-49.
26. Henry RJ, Post AC (1989) A labially positioned mesiodens: case report.
Pediatr Dent 11(1): 59-63.
27. Bassigny F (1990) Les défauts d’éruption des incisivas centrales
supérieures: causes connues et meconnues. Rev Orthop Dentofaciale
24: 83-89.
28. Nik-Hussein NN (1990) Supernumerary teeth in the premaxillary
region: its effects on the eruption and occlusion of the permanent
incisors. Aust Orthod J 11(4):247-250.
29. Archer WH (1975) Oral and Maxillofacial Surgery. 5th ed Philadelphia:
WB Saunders 524-705.
30. Kruger GO (1984) Tratado de cirugía bucal. 4ª edición. México:
Interamericana. p 329-331.
31. Zuolanck JW, Spotis TM (1985) Supernumerary mandibular premolars:
reports of cases. J Am Dent Assoc 110:721-723.
Volume 1; Issue 1; 002
Citation: Lucas Penalva PM, Perez-Albacete Martinez C, Ramírez Fernandez MP, Mate Sánchez De Val JE, Calvo Guirado JL (2015)
Mesiodens: Etiology, Diagnosis and Treatment: A Literature Review. BAOJ Dentistry 1: 002.
32. Huang WH, Tsai TP, Su HL (1992) Mesiodens in the primary dentition
stage: a radiographic study. J Dent Child 59:186-189.
33. Gregg TA, Kinirons MJ (1991) The effect of the position and orientation
of unerupted premaxillary supernumerary teeth on eruption and
displacement of permenent incisors. lnt Paediatr Dent 1:3-7.
34. Sinha V, Sinha S, Tyarg BP, Raizada RM, Chaturvedi W, et al. (1994)
supernumerary teeth presenting as misal teeth. lndian Pediatr
31:1564-1565.
35. Carton A (1987) Mirror image dental anomalies in identical twins. Br
Dent J 162(5):193-194.
36. Tatel FS (2003) Reshaping a mesiodens. Pediatric Dent 25:585-586.
37. Deplagne H (1984) Les dróles de kystes fissuraires et un curieux
mésiodens. Rev Stomatol Chir Maxillofac 85:32-34.
38. Houston WJB, Tulley WJ (1986) Manual de Ortodoncia. México: DF: El
Manual Moderno. P 245-248.
39. Ferguson JW, Evans RL, Cheng LH (1992) Diagnostic accuracy and
observer perfomance in the diagnosis of abnormalities in the anterior
maxilla: a comparison of panoramic with intraoral radiography. Br
Dent J 173(8): 265-271.
40. Hurst RV (1991) Panoramic surveys and the missing mesiodens. J Clin
Orthod 25(5): 304-306.
41. Gallas MM, García A (2000) retention of permanent incisors by
mesiodens: a family affair. Br Dent J 188:63-64.
42. Contreras Somoza MF, Salinas Noyola A, Sáez Martínez S, Sellet LG
(2007) Signos de dientes supernumerarios. Rev Op Dent Endod 5: 210.
43. Högström A, Andersson L (1987) Complications related to surgical
removal of anterior supernumerary teeth in children. J Dent Child
54:341-343.
44. Koch H, Schwarts O, Klausen B (1986) Indications for surgical removal
of supernumerary teeth in the premaxilla. Int J Oral Maxillofac Surg
15:273-281.
Page 5 of 5
46. Tatum RC, Fraga A, Saini R, Tatum BM (1983) Mesiodens and
supernumerary central incisors: early diagnosis and treatment to
avoid extensiva orthodontic treatment. Two cases. Compend Cont
Educ Dent 4:271-8.
47. Hernández M, Ferreira LP (2009) Mesiodens múltiples sin antecedentes
sindrómicos: a propósito de dos casos. J Am Dent Assoc (ed. esp.)
4(3): 140-144.
48. Gündüz K, Celenk P, Zengin Z, Sümer P (2008) Mesiodens: a
radiographic study in children. J Oral Sci 50:287-91.
49. Salcido-García JF, Ledesma Montes C, Hernández Flores F, Pérez D,
Garcés Ortiz M (2004) Frecuencia de dientes supernumerarios en una
población mexicana. Med Oral Patol Oral Cir Bucal 9:403-409.
50. Ferrés-Padró E, Prats Armengol J, Ferrés Amat E (2009) A descriptive
study of 113 unerupted supernumerary teeth in 79 pediatric patients
in Barcelona. Med Oral Patol Oral Cir Bucal 14:146-52.
51. Fernández Montenegro P, Balmaceda Castellón E, Berini Aytés L, Gay
Escoda C (2006) Estudio retrospectivo de 145 dientes supernumerarios.
Med Oral Patol Oral Cir Bucal 11:240-5.
52. Hurlen B, Humerfelt D (1985) Characteristics of premaxillary
hyperodontia. A radiographic study. Acta Odontol Scand 43(2): 75-81.
53. Raymundo CA (2006) Prevalencia de anomalías en el número de
dientes en dentición permanente en ninos de 6 -12 anos atendidos
en La Clinica Central de La Facultad de Estomatologia de la UPCH
[Tesis bachiller]. Lima, Perú: UPCH.
54. Aliaga R. (2010) Frecuencia y distribución de intervenciones quirúrgicas
de dientes supernumerarios odontomas y dientes incluidos en
odontopediatria. Clínica de postgrado – Servicio de 20(4).
55. Russell KA, Folwarczna MA (2003) Mesiodens--diagnosis and
management of a common supernumerary tooth. J Can Dent Assoc
69(6): 362-366.
56. Cawson RA (1984) Essentials of dental surgery and pathology.
Edinburgh: Churchill Livingstone 172-178.
45. Ochoa Grijalba JF, Kuster CG (1993) Supernumerary teeth removal
and orthodontic tooth repositioning: a case report. J Clin Pediatr Dent
17:95-98.
BAOJ Dentistry, an open access journal
Volume 1; Issue 1; 002