A periapical radiograph reveals a mesiodens. What is the most appropriate treatment during mixed dentition?

Correct answer: B. Extract the supernumerary (mesiodens) during mixed dentition

• A. INCORRECT. While monitoring is sometimes appropriate for asymptomatic mesiodens in young children, when detected during mixed dentition with potential for eruption interference or tooth displacement, extraction is the preferred active intervention, not passive monitoring alone.
• B. CORRECT. Extraction of the mesiodens during mixed dentition is the preferred treatment to prevent complications including displacement of adjacent permanent teeth, delayed eruption, diastema formation, cyst formation, and root resorption. Early removal facilitates spontaneous correction of tooth position.
• C. INCORRECT. Orthodontic space maintenance alone does not address the supernumerary tooth, which will continue to cause problems. Space management may be needed after extraction but is not the primary treatment.
• D. INCORRECT. Mesiodens rarely erupts spontaneously into a functional position. Waiting without intervention risks impaction, eruption pathway disruption, and associated pathology such as cyst formation.