Clinical evaluation of the timing of mesiodens removal

Background: Mesiodens is a common clinical finding among children and has a higher prevalence in Asian populations. The timing of the removal of mesiodens remains controversial. Clinical studies comparing early versus late removal are lacking. The aim of this retrospective study was to evaluate the frequency of clinical complications regarding the timing of childhood mesiodens removal and to explore the factors associated with complications following mesiodens removal.

Methods: In total, 384 Taiwanese children diagnosed with unerupted mesiodens who had attended the Pediatric Dentistry Department, Taipei Veteran General Hospital, Taipei, Taiwan from 2005 to 2012 were identified as potential participants. Among these patients, 105 children had received surgical odontectomy of the mesiodens under general anesthesia and had complete longitudinal clinical and radiographic follow-up records, including computed tomography (CT) evaluations; these patients were enrolled. The influence of age, the developmental stage of the adjacent permanent teeth, and the location of the mesiodens were explored regarding complications that were noted at the time of surgery, injury to the adjacent permanent teeth during surgical intervention, and the need for orthodontic treatment after surgery.

Results: The 105 children enrolled had 145 mesiodens. Removal of the mesiodens before the child was 5 years of age or 1/3 root-completed was associated with fewer complications at the time of surgery and a reduced need for orthodontic treatment after surgery. However, no significant difference was noted between the different groups in terms of surgical injury to the adjacent permanent teeth.

Conclusion: The early removal of an unerupted mesiodens before the age of 5 years would seem to reduce complications and the need for orthodontic treatment. With the help of general anesthesia and evaluation by CT imaging, concerns regarding the child's cooperation and the possibility of damage to adjacent permanent teeth during early surgical intervention can be minimized.