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Pediatric Dentistry · patient case question

What is the most appropriate management of the midline supernumerary tooth?

Patient case: Eight-year-old with an unerupted central incisor

Patient: Male, 8 years old, accompanied by his mother

Chief complaint: Mother: “His front tooth still hasn't come in and the other one came in a year ago.”

History: Healthy. No trauma history. No medications.

Findings: Mixed dentition. Tooth #9 is erupted; #8 is unerupted with adequate space. A periapical of the anterior maxilla is of poor quality, but an inverted conical tooth is visible in the midline above the incisor roots. A triangular radiopacity appears in the corner of the film.

  1. Remove it only if the patient becomes symptomatic
  2. Surgically remove it during the mixed dentition, once the permanent incisor roots have begun to form
  3. Extract tooth #9 to create space and allow spontaneous eruption of #8
  4. Leave it and review annually until skeletal maturity
Show answer and explanation

Correct answer: B. Surgically remove it during the mixed dentition, once the permanent incisor roots have begun to form

  • A. Waiting for symptoms is the wrong trigger. Supernumeraries are usually painless while they displace roots, cause diastemas, or seed a dentigerous cyst.
  • B. CORRECT. A mesiodens that is obstructing eruption is removed. The favoured window is the MIXED DENTITION, once roots of the adjacent permanent incisors are partly formed — early enough that spontaneous eruption of #8 still occurs in the majority of cases, and late enough that the developing incisors are not damaged during surgery. Delay beyond this window means eruption will usually require orthodontic exposure and traction.
  • C. Extracting a healthy, erupted permanent incisor is never the answer. The obstruction is the supernumerary, not #9.
  • D. Observation is reasonable only for an asymptomatic supernumerary that is NOT obstructing anything. Here it is demonstrably preventing eruption, so watching costs the child the chance at spontaneous eruption.

Note: Mesiodens is the commonest supernumerary tooth, sits in the maxillary midline, and is often inverted and conical. Beyond failed eruption, watch for midline diastema, incisor displacement, root resorption and dentigerous cyst formation.

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