Introduction
Supernumerary teeth are among the most common dental developmental anomalies. The midline of the maxilla is a common location for supernumerary teeth. Mesiodens is a supernumerary tooth located in the maxillary midline. A review of the recent literature regarding the characteristics of mesiodens revealed a prevalence rate of 0.15% to 1.9% in the general population with a male/female ratio of 2.2 to 2.5:1 [1-4].
Supernumerary teeth could be an isolated finding in patients, and are more common in individuals with a positive family history. Moreover, some syndromes such as the cleidocranial dysostosis, Gardner syndrome, Nance-Horan syndrome, and trichorhinophalangeal syndrome are associated with supernumerary teeth [4]. According to a popular classification, there are two types of mesiodens namely eumorphic and dysmorphic based on their similarity to central incisors in terms of shape and size. Plurality is rare in mesiodens; two mesiodens has the highest frequency of about 20%. Less than 1% of patients have three or four mesiodens [3, 4]. Complications accompanied by the presence of mesiodens such as midline diastema, delayed tooth eruption, root resorption of adjacent teeth, cyst formation, nasal eruption, etc. highlight the significance of early detection and timely surgical intervention to prevent unwanted complications and support correct dental occlusion. Surgical extraction of deeply impacted mesiodens with an inverted position invading the base of the nasal cavity can lead to serious surgical complications and morbidities such as traumatizing or injuring the nasal mucosa or adjacent structures i.e. the roots of the adjacent permanent teeth [3, 5, 6]. In such occasions, an efficient surgical protocol with maximum patient comfort, minimal complications, and no harm to the adjacent structures is imperative. Herein, we describe a novel modified intranasal approach to minimize the complications. Also, it can be performed under local anesthesia with proper preoperative workup.