Mesiodens Within the Nasopalatine Canal: An Exceptional Entity
Identifieur interne : 001B89 ( Pmc/Corpus ); précédent : 001B88; suivant : 001B90Mesiodens Within the Nasopalatine Canal: An Exceptional Entity
Auteurs : Georges Aoun ; Ibrahim NassehSource :
- Clinics and Practice [ 2039-7275 ] ; 2016.
Abstract
A supernumerary tooth is one that is supplementary to the normal dentition. It can be found anywhere at the dental arch. A mesiodens is a supernumerary tooth located between the two maxillary central incisors usually palatally or within the alveolar process. Less frequently, the mesiodens is in relation with the nasal floor and the nasopalatine canal walls. This paper presents a very rare case of an impacted inverted mesiodens located inside the nasopalatine canal and found incidentally with a cone-beam computed tomography examination.
Url:
DOI: 10.4081/cp.2016.903
PubMed: 28174622
PubMed Central: 5294929
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Mesiodens Within the Nasopalatine Canal: An Exceptional Entity</title><author><name sortKey="Aoun, Georges" sort="Aoun, Georges" uniqKey="Aoun G" first="Georges" last="Aoun">Georges Aoun</name><affiliation><nlm:aff id="aff001">Department of Oral Pathology and Diagnosis,<institution>Lebanese University</institution>,<addr-line>Beirut, Lebanon</addr-line></nlm:aff></affiliation></author><author><name sortKey="Nasseh, Ibrahim" sort="Nasseh, Ibrahim" uniqKey="Nasseh I" first="Ibrahim" last="Nasseh">Ibrahim Nasseh</name><affiliation><nlm:aff id="aff002">Department of Dentomaxillofacial Radiology and Imaging,<institution>Lebanese University</institution>,<addr-line>Beirut, Lebanon</addr-line></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28174622</idno><idno type="pmc">5294929</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294929</idno><idno type="RBID">PMC:5294929</idno><idno type="doi">10.4081/cp.2016.903</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">001B89</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001B89</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Mesiodens Within the Nasopalatine Canal: An Exceptional Entity</title><author><name sortKey="Aoun, Georges" sort="Aoun, Georges" uniqKey="Aoun G" first="Georges" last="Aoun">Georges Aoun</name><affiliation><nlm:aff id="aff001">Department of Oral Pathology and Diagnosis,<institution>Lebanese University</institution>,<addr-line>Beirut, Lebanon</addr-line></nlm:aff></affiliation></author><author><name sortKey="Nasseh, Ibrahim" sort="Nasseh, Ibrahim" uniqKey="Nasseh I" first="Ibrahim" last="Nasseh">Ibrahim Nasseh</name><affiliation><nlm:aff id="aff002">Department of Dentomaxillofacial Radiology and Imaging,<institution>Lebanese University</institution>,<addr-line>Beirut, Lebanon</addr-line></nlm:aff></affiliation></author></analytic><series><title level="j">Clinics and Practice</title><idno type="ISSN">2039-7275</idno><idno type="eISSN">2039-7283</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>A supernumerary tooth is one that is supplementary to the normal dentition. It can be found anywhere at the dental arch. A mesiodens is a supernumerary tooth located between the two maxillary central incisors usually palatally or within the alveolar process. Less frequently, the mesiodens is in relation with the nasal floor and the nasopalatine canal walls. This paper presents a very rare case of an impacted inverted mesiodens located inside the nasopalatine canal and found incidentally with a cone-beam computed tomography examination.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mossaz, J" uniqKey="Mossaz J">J Mossaz</name></author><author><name sortKey="Kloukos, D" uniqKey="Kloukos D">D Kloukos</name></author><author><name sortKey="Pandis, N" uniqKey="Pandis N">N Pandis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Meighani, G" uniqKey="Meighani G">G Meighani</name></author><author><name sortKey="Pakdaman, A" uniqKey="Pakdaman A">A. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Pract</journal-id><journal-id journal-id-type="iso-abbrev">Clin Pract</journal-id><journal-id journal-id-type="publisher-id">CP</journal-id><journal-title-group><journal-title>Clinics and Practice</journal-title></journal-title-group><issn pub-type="ppub">2039-7275</issn><issn pub-type="epub">2039-7283</issn><publisher><publisher-name>PAGEPress Publications, Pavia, Italy</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28174622</article-id><article-id pub-id-type="pmc">5294929</article-id><article-id pub-id-type="doi">10.4081/cp.2016.903</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Mesiodens Within the Nasopalatine Canal: An Exceptional Entity</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Aoun</surname><given-names>Georges</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Nasseh</surname><given-names>Ibrahim</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label>Department of Oral Pathology and Diagnosis,<institution>Lebanese University</institution>,<addr-line>Beirut, Lebanon</addr-line></aff><aff id="aff002"><label>2</label>Department of Dentomaxillofacial Radiology and Imaging,<institution>Lebanese University</institution>,<addr-line>Beirut, Lebanon</addr-line></aff><author-notes><corresp id="cor1">Department of Oral Pathology and Diagnosis, Faculty of Dentistry, Lebanese University, Beirut, Lebanon. <email>aoungeorges@yahoo.com</email></corresp></author-notes><pub-date pub-type="epub"><day>07</day><month>12</month><year>2016</year></pub-date><pub-date pub-type="collection"><day>24</day><month>10</month><year>2016</year></pub-date><volume>6</volume><issue>4</issue><elocation-id>903</elocation-id><history><date date-type="received"><day>23</day><month>9</month><year>2016</year></date><date date-type="accepted"><day>30</day><month>11</month><year>2016</year></date></history><permissions><copyright-statement>©Copyright G. Aoun and I. Nasseh</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Licensee PAGEPress, Italy</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<uri xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</uri>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>A supernumerary tooth is one that is supplementary to the normal dentition. It can be found anywhere at the dental arch. A mesiodens is a supernumerary tooth located between the two maxillary central incisors usually palatally or within the alveolar process. Less frequently, the mesiodens is in relation with the nasal floor and the nasopalatine canal walls. This paper presents a very rare case of an impacted inverted mesiodens located inside the nasopalatine canal and found incidentally with a cone-beam computed tomography examination.</p></abstract><kwd-group><title>Key words</title><kwd>Cone-beam computed tomography</kwd><kwd>mesiodens</kwd><kwd>nasopalatine canal</kwd></kwd-group><counts><fig-count count="3"></fig-count><table-count count="0"></table-count><equation-count count="0"></equation-count><ref-count count="18"></ref-count><page-count count="3"></page-count></counts></article-meta></front><body><sec id="sec1-1"><title>Introduction</title><p>By definition, supernumerary teeth are ones formed in addition to the normal dentition.<sup><xref rid="ref1" ref-type="bibr">1</xref>,<xref rid="ref2" ref-type="bibr">2</xref></sup> They can be single or multiple, unilateral or bilateral, erupted or impacted, and located in the mandible and/or the maxilla.<sup><xref rid="ref3" ref-type="bibr">3</xref></sup></p><p>Mesiodens, which is a supernumerary tooth located between the two central incisors, is the most common type.<sup><xref rid="ref1" ref-type="bibr">1</xref>,<xref rid="ref3" ref-type="bibr">3</xref>,<xref rid="ref4" ref-type="bibr">4</xref></sup> It can occur as isolated entity or as a part of a syndrome (Gardner’s syndrome, cleidocranial dysostosis, etc.).<sup><xref rid="ref5" ref-type="bibr">5</xref>,<xref rid="ref6" ref-type="bibr">6</xref></sup></p><p>Rare in the mandible and in the primary dentition, it is mostly found in the maxilla and in the permanent dentition with a prevalence of 0.15-1.9% in the general population and a higher frequency in males.<sup><xref rid="ref7" ref-type="bibr">7</xref></sup> The shape is usually conical and the position can be normal/inclined or inverted.<sup><xref rid="ref1" ref-type="bibr">1</xref></sup></p><p>Mesiodens can induce many complications, among others, teeth eruption alteration, root resorption and cystic lesions formation.<sup><xref rid="ref1" ref-type="bibr">1</xref>,<xref rid="ref2" ref-type="bibr">2</xref>,<xref rid="ref6" ref-type="bibr">6</xref></sup></p><p>The literature reported that most mesiodens were located palatally; yet very few cases were found in contact with the cortical bone of the nasal floor and the walls of the nasopalatine canal.<sup><xref rid="ref1" ref-type="bibr">1</xref></sup></p><p>Impacted mesiodens may be detected by conventional imaging techniques used in dental practice such as panoramic, occlusal and periapical radiographs. However, some might not be noticed due to radiographic technical parameters that reflect a lack of clarity in the midline region.<sup><xref rid="ref6" ref-type="bibr">6</xref></sup></p><p>In order to overcome the limitations of the conventional imaging techniques, cone-beam computed tomography (CBCT) technology has been used providing alternatives detailed and accurate assessments.<sup><xref rid="ref8" ref-type="bibr">8</xref></sup></p><p>This report describes a case of an exceptional mesiodens located within the nasopalatine canal incidentally found through a CBCT prior to dental treatment.</p></sec><sec id="sec1-2"><title>Case Report</title><p>A 50-year-old healthy male presented to our clinic for implant placement.</p><p>Panoramic radiograph (<xref ref-type="fig" rid="fig001">Figure 1</xref>) showed multiple edentulous upper and lower sites with advanced periodontal disease.</p><p>A CBCT was requested for better assessment before implant placement decision.</p><p>An inverted mesiodens located in the path of the nasopalatine canal was incidentally noticed. No clinical signs were correlated to this pathology. No familial history of supernumerary teeth was reported.</p><p>Its exact location and path are shown in the axial, coronal and sagittal views (<xref ref-type="fig" rid="fig002">Figure 2</xref>), as well in cross sections (<xref ref-type="fig" rid="fig003">Figure 3</xref>).</p></sec><sec id="sec1-3"><title>Discussion</title><p>According to Mossaz <italic>et</italic> al.,<sup><xref rid="ref1" ref-type="bibr">1</xref></sup> mesiodens represents 48.52% (49/101) of supernumerary teeth. This finding is consistent with Montenegro <italic>et al.,<sup><xref rid="ref9" ref-type="bibr">9</xref></sup></italic> and Padró <italic>et</italic> al.,<sup><xref rid="ref10" ref-type="bibr">10</xref></sup> who found in their studies that prevalence among the supernumerary teeth was respectively 46.9% and 53.16%.</p><p>Seventy five percent (75%) are impacted.<sup><xref rid="ref11" ref-type="bibr">11</xref></sup> For Nazif <italic>et al.,<sup><xref rid="ref12" ref-type="bibr">12</xref></sup></italic> 6% are in a labial position, 80% palatally and the remaining 14% located between the roots of the central incisors.</p><p>Mossaz <italic>et</italic> al.,<sup><xref rid="ref1" ref-type="bibr">1</xref></sup> observed that 20.5% of the mesiodens are in contact with the cortical bone of the nasal floor and 49% in relation with the nasopalatine canal; the latter falling under 3 categories: i) 38.8% being in external contact with the canal; ii) 8.2% perforated the canal; and iii) 2% located within the canal.</p><p>Their morphology is variable. The conical shape is the most frequent followed by the tuberculate and the supplemental (toothlike).<sup><xref rid="ref1" ref-type="bibr">1</xref>,<xref rid="ref2" ref-type="bibr">2</xref>,<xref rid="ref6" ref-type="bibr">6</xref></sup></p><p>Generally, conical mesiodens develop with complete root formation and can erupt,<sup><xref rid="ref13" ref-type="bibr">13</xref></sup> unless when they are inverted, with the crown directed superiorly, where they are more likely to remain impacted or erupt occasionally into the nasal cavity.<sup><xref rid="ref2" ref-type="bibr">2</xref>,<xref rid="ref14" ref-type="bibr">14</xref></sup></p><p>The tuberculate type presents numerous tubercles/cusps and incomplete or abnormal root.<sup><xref rid="ref15" ref-type="bibr">15</xref></sup> Unlike conical mesiodens, they can rarely erupt, inducing delayed eruption of the permanent incisors.<sup><xref rid="ref6" ref-type="bibr">6</xref></sup></p><p>The third type, which is much rarer, is the supplemental referring to a duplication of a normal tooth with a totally formed root (permanent maxillary lateral incisor, premolar, and molar).<sup><xref rid="ref13" ref-type="bibr">13</xref>,<xref rid="ref16" ref-type="bibr">16</xref></sup></p><p>Regarding the position, Mossaz <italic>et al.,<sup><xref rid="ref1" ref-type="bibr">1</xref></sup></italic> reported a normal/inclined position in 53% of cases against 36.75% in an inverted position.</p><p>Mesiodens may cause many complications such as adjacent teeth impaction/ectopic eruption, root resorption, cystic lesions formation, teeth crowding, etc.<sup><xref rid="ref17" ref-type="bibr">17</xref>,<xref rid="ref18" ref-type="bibr">18</xref></sup></p><p>In front of such complications, thorough clinical and radiologic assessments are essential. Conventional two-dimensional radiography can be used.</p><p>The problem with the panoramic radiography is that structures outside the focal trough may be totally obscured by other structures and thus do not appear. In our case, the mesiodens was asymptomatic, so nothing would make the clinician suspects its presence.</p><p>However, the identification and/or the localization relative to neighboring structures and adjacent teeth of some mesiodens would require mainly the use of the occlusal technique. But this remains sometimes difficult due to superimposition of multiple anatomical structures, making a three-dimensional imaging <italic>(e.g.</italic>, CBCT) essential to surmount the weakness of the two-dimensional radiographs.<sup><xref rid="ref8" ref-type="bibr">8</xref></sup></p><p>In this case report, an asymptomatic impacted inverted mesiodens located inside the nasopalatine canal of a 50-year-old male patient was presented with CBCT images (<xref ref-type="fig" rid="fig002">Figures 2</xref> and <xref ref-type="fig" rid="fig003">3</xref>).</p><p>Mesiodens within this canal have been very rarely reported. To our knowledge, no such entity was described in the literature, especially when not associated with pathology such as a nasopalatine duct cyst. The vast majority does not produce any complications and due to their high position and to the radiological unclear maxillary midline region, they can go unnoticed by the classic radiographic techniques generally used by the dental practitioner. Nowadays, with the technological enhancement of the imaging techniques used in dentistry like CBCT, more details and better evaluation are provided and consequently, these uncommon impacted structures could be noticed.</p></sec><sec id="sec1-4"><title>Conclusions</title><p>The incidence of a mesiodens located within the nasopalatine canal is very rare. Without clinical symptoms, patients and their dentists may remain unaware of this situation. 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