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.Extraction of a mesiodens at atime 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. 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 . Thus, a significant delay in treatment can create the need for more complex surgical and orthodontic management.