Extraction of a supplementary mesiodens in the primary
dentition is usually not recommended because supernumerary
primary teeth often erupt into the oral cavity and
surgical extraction of unerupted teeth may increase the risk
of displacing or damaging the developing permanent
incisors.34–36 However, extraction during the early mixed
dentition stage allows normal eruptive forces to promote
spontaneous eruption of the permanent central incisors
after the extraction.31,35,37 Extraction of a mesiodens at a
time appropriate for promoting self-eruption in the early
mixed dentition may result in better alignment of the teeth
and may minimize the need for orthodontic treatment.
Delayed treatment involves extraction of the mesiodens
when the unerupted central incisor’s apex is almost mature,
usually around 10 years of age.36 The later the extraction of
the mesiodens, the greater the chance that the permanent
tooth either will not spontaneously erupt or will be
malaligned when it does erupt. Unfortunately, by this time
the forces that cause normal eruption of the incisors are
diminished, and surgical exposure and subsequent orthodontic
treatment are more frequently required.31,37 Also,
space loss and a midline shift of the central incisors may
have already occurred by this age, since the lateral incisors
will have erupted and may have drifted mesially into the
central space (Figs. 5a and 5b).12 Thus, a significant delay
in treatment can create the need for more complex surgical
and orthodontic management.