Comparative proteomic analysis of dental pulp from supernumerary and normal permanent teeth.

OBJECTIVES: To obtain and compare the protein profiles of supernumerary and normal permanent dental pulp tissues. MATERIALS AND METHODS: Dental pulp tissues were obtained from supernumerary and normal permanent teeth. Proteins were extracted and analyzed by liquid chromatography-tandem mass spectrometry (LC/MS-MS). Protein identification and quantification from MS data was performed with MaxQuant. Statistical analysis was conducted using Metaboanalyst to identify differentially expressed proteins (DEPs) (P-value < 0.05, fold-change > 2). Gene Ontology enrichment analyses were performed with gProfiler. RESULTS: A total of 3,534 proteins were found in normal dental pulp tissue and 1,093 in supernumerary dental pulp tissue, with 174 DEPs between the two groups. This analysis revealed similar functional characteristics in terms of cellular component organization, cell differentiation, developmental process, and response to stimulus, alongside exclusive functions unique to normal permanent dental pulp tissues such as healing, vascular development and cell death. Upon examination of DEPs, these proteins were associated with the processes of wound healing and apoptosis. CONCLUSIONS: This study provides a comprehensive understanding of the protein profile of dental pulp tissue, including the first such profiling of supernumerary permanent dental pulp. There are functional differences between the proteomic profiles of supernumerary and normal permanent dental pulp tissue, despite certain biological similarities between the two groups. Differences in protein expression were identified, and the identified DEPs were linked to the healing and apoptosis processes. CLINICAL RELEVANCE: This discovery enhances our knowledge of supernumerary and normal permanent pulp tissue, and serves as a valuable reference for future studies on supernumerary teeth.

Image segmentation of impacted mesiodens using deep learning.

This study aimed to evaluate the performance of deep learning algorithms for the classification and segmentation of impacted mesiodens in pediatric panoramic radiographs. A total of 850 panoramic radiographs of pediatric patients (aged 3-9 years) was included in this study. The U-Net semantic segmentation algorithm was applied for the detection and segmentation of mesiodens in the upper anterior region. For enhancement of the algorithm, pre-trained ResNet models were applied to the encoding path. The segmentation performance of the algorithm was tested using the Jaccard index and Dice coefficient. The diagnostic accuracy, precision, recall, F1-score and time to diagnosis of the algorithms were compared with those of human expert groups using the test dataset. Cohen's kappa statistics were compared between the model and human groups. The segmentation model exhibited a high Jaccard index and Dice coefficient (>90%). In mesiodens diagnosis, the trained model achieved 91-92% accuracy and a 94-95% F1-score, which were comparable with human expert group results (96%). The diagnostic duration of the deep learning model was 7.5 seconds, which was significantly faster in mesiodens detection compared to human groups. The agreement between the deep learning model and human experts is moderate (Cohen's kappa = 0.767). The proposed deep learning algorithm showed good segmentation performance and approached the performance of human experts in the diagnosis of mesiodens, with a significantly faster diagnosis time.

Endodontic Treatment for a Mesiodens: A Case Report.

Mesiodens are common supernumerary teeth that prominently erupt in the midline between the maxillary central incisors. If two or more mesiodens are present, they are termed mesiodentes, indicating the presence of multiple supernumerary teeth in the midline. These often cause aesthetic disharmony in the anterior teeth due to their abnormal position, leading to extraction in most cases and resulting in midline diastema when impacted or partially erupted. This case is uncommon, as the patient expressed a desire to preserve their mesiodens as a distinctive feature, considering them a familial trait worth retaining. The family history of the patient revealed the occurrence of mesiodens in three generations, highlighting a hereditary pattern of supernumerary teeth within the family. The endodontic therapy involving root canal treatment successfully treated the mesiodens, alleviating pain, and preserving them as desired.

Minimally invasive intraoral removal of mesiodens via a transnasal, non-endoscopic approach: a systematic review on the purpose of 10 cases.

Mesiodens, which emerge towards the nasal cavity, often require consultation in maxillofacial practice. Typically accessed through wide palatal flaps with ostectomy, this method involves limited visibility and poses the risk of damaging the roots and apex of adjacent dental structures. This study advocates a minimally invasive technique that involves vestibulotomy between the central incisors, facilitating direct and rapid access through nasal floor dissection, minimizing comorbidities. A systematic review was performed, following the PRISMA guidelines, apropos on ten clinical cases reported in this study. The MEDLINE/Pubmed and Web of Science databases were searched. Several variables were considered and are presented comprehensively in tables and figures. Additionally, 10 case reports with mesiodens in the maxilla were submitted to surgical treatment using a minimally invasive intraoral transnasal disinclusion. The initial literature search resulted in 37 articles, of which 9 met the inclusion criteria for the analysis. Regarding postoperative complications, no bone exposure, incisor root damage, extensive surgical approach, palatal or vestibular hematoma, or palatal necrosis was observed. However, 10% experienced superficial damage to the nasopalatine neurovascular, while 80% and 20% presented mild and moderate postoperative facial edema, respectively. Hypoesthesia in 20% of patients recovered in the first week, 40% in the first month and 40% at 3 months. The minimally invasive intraoral, transnasal, non-endoscopic approach emerges as a safe and predictable alternative to conventional surgical techniques. Presumes minimal postoperative complications, mitigating the risk of excessive bone removal and damage to adjacent structures.

Double Mesiodens in the Mixed Dentition of Non-syndromic North-Indian Patients: A Case Series.

The presence of double mesiodens or mesiodentes, i.e., two supernumerary teeth in the maxillary midline, presents unique challenges in mixed dentition. Common clinical manifestations include delayed eruption, midline diastema, and occlusal disturbances, leading to complications such as root resorption, pathological migration of tooth, crowding, cyst formation, and malocclusion. Mesiodens can be associated with several syndromes, like cleidocranial dysplasia, familial adenomatous polyposis, trichorhinophalangeal syndrome, type I, Rubinstein-Taybi syndrome, and Nance-Horan syndrome, among others. It can also be secondary to trauma, hyperactivity of the dental lamina, and a combination of genetic and environmental factors, but its etiology continues to be idiopathic. Double mesiodens are relatively rare, so this clinical observation aimed to highlight five such cases of double mesiodens in mixed dentition in non-syndromic children and adolescents. Additionally, a literature search reporting cases of double mesiodens in the mixed dentition was done, and the results were tabulated. Clinicians should be able to identify indications of supernumerary teeth, specifically deviations in the eruption pattern. Appropriate investigations and timely intervention are essential to reducing complications that may arise in the developing dentition.

Clinical and radiological features of malformed mesiodens in the nasopalatine canal: an observational study.

OBJECTIVES: The purpose of this study is to investigate the morphological changes that occur when mesiodens is located within the nasopalatine canal, as well as clinical characteristics. METHODS: Clinical records and CT images of patients who had mesiodens in the nasopalatine canal were retrospectively analysed. In addition to demographic information, clinical symptoms and complications associated with extraction of mesiodens were recorded. Using CT images, number, location, size, and tooth morphology were evaluated. RESULTS: This study included 32 patients and 38 mesiodens within the nasopalatine canal. Supernumerary teeth exhibited a characteristic feature of thin and elongated shape in the canal (narrow width and elongation were observed in 96.6% and 53.3% of the patients, respectively). Fusion was found in 4 patients and dilaceration in 12. A complication occurred in 2 patients, which was tooth remnant, not a neurologic complication. Only 5 mesiodens could be detected in the nasopalatine canal on panoramic images. CONCLUSIONS: Morphological abnormalities in mesiodens within the nasopalatine canal were frequently detected, and these could be effectively diagnosed through 3D imaging analysis.

Extraction of high inverted mesiodentes via the labial, palatal and subperiostal intranasal approach：A clinical prospective study.

The aim of this study is to provide criteria for the choice of the surgical approach for extraction of high inverted mesiodens. The operation statistics, life quality of postoperative patients, and the operative injury/recovery were compared and analysed. The laser Doppler blood flowmetry, laser speckle contrast imaging, and electric pulp testing were explored to detect the postoperative pulp and gingiva blood supply of adjacent teeth. For the clinician's primary concerns, the surgical time, the volume of osteotomy, and the amount of bleeding in the labial approach group (The p values are 0.0001, <0.0001, and 0.0131, respectively.) and intranasal approach group (All p values were <0.0001.) were significantly less than that in the palatal approach group. However, from the patient's perspective, the postoperative swelling in the labial approach was far more than that in the intranasal approach group (p =0.0044), with unsurprisingly lower satisfaction (p <0.0001). There were no significant differences in pulp and gingival blood supply of adjacent teeth and jaw development. Trauma was manageable in all patients. Within the limitations of the study it seems that extraction of mesiodens by the intranasal approach achieves a delicate balance between reducing surgical trauma and optimizing postoperative recovery.

Mesiodens: a propósito de dos casos / Mesiodens: two cases

El mesiodens es el diente supernumerario más común, localizado en la línea media maxilar entre los incisivos centrales. Su etiología es incierta y se han planteado múltiples teorías. El diagnóstico y tratamiento precoz permite la erupción espontánea de los incisivos permanentes, evitar las complicaciones asociadas, así como tratamientos posteriores más complejos. En este artículo se presentan dos casos de mesiodens de pacientes que acuden a la consulta de Pediatría de Atención Primaria (AU)

The mesiodens is the most common supernumerary tooth, located in the maxillary midline between the central incisors. Its etiology is uncertain and multiple theories have been put forward. Early diagnosis and treatment allows the spontaneous eruption of the permanent incisors, and avoids associated complications as well as more complex subsequent treatments. In this article, two cases of mesiodens in patients attending the primary care pediatric outpatient clinic are presented. (AU)

Heterozygous Variants in FREM2 Are Associated with Mesiodens, Supernumerary Teeth, Oral Exostoses, and Odontomas.

BACKGROUND: Supernumerary teeth refer to extra teeth that exceed the usual number of dentitions. A mesiodens is a particular form of supernumerary tooth, which is located in the premaxilla region. The objective of the study was to investigate the genetic etiology of extra tooth phenotypes, including mesiodens and isolated supernumerary teeth. METHODS: Oral and radiographic examinations and whole-exome sequencing were performed on every patient in our cohort of 122 patients, including 27 patients with isolated supernumerary teeth and 94 patients with mesiodens. A patient who had multiple supernumerary teeth also had odontomas. RESULTS: We identified a novel (c.8498A>G; p.Asn2833Ser) and six recurrent (c.1603C>T; p.Arg535Cys, c.5852G>A; p.Arg1951His, c.6949A>T; p.Thr2317Ser; c.1549G>A; p.Val517Met, c.1921A>G; p.Thr641Ala, and c.850G>C; p.Val284Leu) heterozygous missense variants in FREM2 in eight patients with extra tooth phenotypes. CONCLUSIONS: Biallelic variants in FREM2 are implicated in autosomal recessive Fraser syndrome with or without dental anomalies. Here, we report for the first time that heterozygous carriers of FREM2 variants have phenotypes including oral exostoses, mesiodens, and isolated supernumerary teeth.

Evaluation of radiographic characteristics and surgical removal of 147 mesiodens.

The aim of this study was to evaluate the radiographic characteristics and surgical removal of mesiodens among patients who had attended the Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery of the Faculty of Medicine, Yamagata University. This study included 121 patients in the final analysis. We retrospectively reviewed medical records including patient age, sex, mesiodens number, direction, position, opportunity for detection, surgical approach and operating time. The 121 patients comprised 82 males and 39 females. Mean age was 7.6 ± 3.1 years (range, 4-35 years). The total number of mesiodens among these 121 patients was 147. Ninety-six patients had one mesiodens, 24 patients had two mesiodens and 1 patient had 3 mesiodens. Seventy-nine mesiodens were detected while taking X-rays for routine dental examination and/or orthodontic treatment at their family dental/orthodontic clinic. Mean operating time for removal of the 147 mesiodens was 32.2 ± 18.1 min. Among the 96 patients with one mesiodens, mean operating time for removal of the mesiodens was 30.7 ± 16.5 min. Operating time for removal of a mesiodens tended to be prolonged with increased distance from the alveolar crest. Early detection of mesiodens on routine radiographic check-ups and surgical planning considering patient age, crown direction, position of the mesiodens will contribute to improved treatment of mesiodens.

DKK1 is a strong candidate for mesiodens and taurodontism.

A mutation in DKK1 gene leads to inhibitory DKK1 function, over-activation of WNT/ß-catenin signaling, disruptive development of dental epithelium, and subsequent mesiodens formation.

Effect of extraction timing of mesiodens on orthodontic treatment duration for abnormal eruption of permanent teeth in children / 口腔疾病防治

Objective@# To discuss the correlation between the extraction timing of mesiodens and the orthodontic treatment duration of its eruption-related complications in children to provide a reference for the clinic.@*Methods @#The mesiodentes of 187 children were classified as eruption type (typeⅠ), dental crown impacted type (type Ⅱ), interdental impacted type (type Ⅲ), and dental root impacted type (type Ⅳ). According to the timing of extraction, mesiodentes in typeⅠ, type Ⅲ, and type Ⅳ were divided into Groups A: before the eruption of the adjacent central incisor and B: after the eruption of the adjacent central incisor. Mesiodentes in type Ⅱ were divided into Group A: before the eruption of the contralateral central incisor and B: after the eruption of the contralateral central incisor. Eruption-related complications and orthodontic treatment durations caused by mesiodens were statistically analyzed. @*Results @# There were 106 cases of displacement, 28 cases of failed eruption, 27 cases of tooth rotation, and 26 cases of individual cross-bite among the eruption-related complications caused by mesiodens. The mean orthodontic treatment cycle in Group A of type Ⅰ (7.07 ± 2.45 month), Group A of type Ⅱ (6.57 ± 1.12 month), and Group A of type Ⅲ (6.95 ± 2.52 month) were lower than that in Group B of type Ⅰ (9.67 ± 3.04 month), Group B of type Ⅱ (10.25 ± 1.29 month), and Group B of type Ⅲ (9.33 ± 3.26 month), and the differences were statistically significant (P<0.01). Meanwhile, there was no significant difference in the mean orthodontic treatment duration between Groups A (6.00 ± 0.94 month) and B (6.33 ± 0.80 month) of type Ⅳ (P>0.05).@*Conclusion@# In most cases, the mesiodens are removed before the eruption of the adjacent central incisor, which can reduce the duration of orthodontic treatment for eruption-related complications in children.

Nonsyndromic supernumerary teeth in patients in National Taiwan University Children's hospital.

Background/purpose: A literature review reveals limited data for supernumerary teeth in Taiwan. This study aimed to analyze the characteristics of nonsyndromic supernumerary teeth in patients in the National Taiwan University Children's Hospital. Materials and methods: This retrospective study analyzed the nonsyndromic supernumerary teeth in 1280 patients (710 boys and 570 girls) based on examination of mainly panoramic radiographs and related radiographs. Chi-square test was used for trend analysis. Results: The incidence of nonsyndromic supernumerary teeth was 11.25% (179 supernumerary teeth in 144 of the 1280 patients). There was a male predominance (4.33: 1, P < 0.0001) for our 144 patients. Most supernumerary teeth were single (63.69%), conical-shaped (78.77%), and unerupted (77.09%). Supernumerary teeth also tended to be located in the premaxilla (93.85%), fully developed (51.40%), invertedly oriented (45.25%), sagittally located in a palatal/lingual position (67.60%), and adjacent to the root and root apex of permanent teeth (70.39%). The supernumerary teeth with a normal orientation (64.52%) had a high potential to erupt into the oral cavity, but the majority of the supernumerary teeth with a transverse orientation (97.22%) or an inverted orientation (100%) were unerupted. Conclusion: The nonsyndromic supernumerary teeth occur most commonly in male patients with a male to female ratio of 4.33: 1. The incidence of nonsyndromic supernumerary teeth in our 1280 patients is 11.25%, and the most frequent location of supernumerary teeth is the anterior maxillary region. More than three quarters of supernumerary teeth are conical-shaped or unerupted. Inverted supernumerary teeth are all embedded in the jawbones.

Bilateral Inverted Mesiodens: A Rare Case Evaluated by Cone-Beam Computed Tomography.

Mesiodens is the most commonly occurring supernumerary tooth between the two maxillary central incisors. Mesiodens can be inverted, impacted, or placed buccally or palatally between the two maxillary central incisors. It mostly occurs unilaterally and rarely occurs bilaterally. We describe a rare occurrence of such a bilateral inverted mesiodens extended near the anterior nasal spine, evaluated by cone-beam computed tomography.

Mutations in LRP6 highlight the role of WNT signaling in oral exostoses and dental anomalies.

OBJECTIVE: The objective of this study was to investigate molecular etiologies of oral exostoses and dental anomalies in 14 patients from eight families. METHODS: Oral and radiographic examinations were performed on every patient. Whole exome and Sanger sequencing were performed on DNA of the patients, the unaffected parents and unaffected siblings. LRP6 mutant proteins were modeled and analyzed. RESULTS: Five mutations in LRP6, including four missense (p.Glu72Lys, p.Lys82Asn, Tyr418His, and p.Ile773Val) and one nonsense mutation (p.Arg32Ter), were identified. These mutations have not been reported to be associated with dental anomalies or oral exostoses. Oral features included a variety of oral exostoses (7 of the 14 patients), root defects (6 of the 14 patients), and tooth agenesis (5 of the 14 patients). Less common dental anomalies included microdontia, tooth fusion, odontomas, and mesiodens. Analysis of the protein models of the five LRP6 mutations shed light on their likely impact on LRP6 protein structure and function. CONCLUSION: Fourteen patients with five LRP6 mutations, including two recurrent mutations and three novel ones, are reported. Our study shows for the first time that mutations in LRP6 are associated with mesiodens, fusion of teeth, odontomas, microdontia, long roots, molars with unseparated roots, and taurodontism.

Photobiomodulation Therapy After Mesiodens Surgery: Evaluation of Immunological Markers and Three-Dimensional X-Ray Analysis-Placebo-Controlled Study.

Objective: Photobiomodulation therapy (PBMT) applies therapeutic lasers or light-emitting diodes radiation to the surface of the body. From the medical point of view, PBMT systems have been employed for reducing pain, inflammation, and edema, promoting healing of wounds, deeper tissues and nerves, preventing tissue damage, etc. Background data: PBMT or biostimulation has a wide range of applications in maxillofacial surgery. It is known that the therapy effect using three-dimensional (3D) image was not really clear during the healing process. Materials and methods: The treatment group comprised 38 patients, 18 of them were treated with laser radiation (diode laser 808 nm) and 20 patients presented the control group. The surgery plan was monitored using cone beam computed tomography, in particular the number, shape, and size of mesiodens were registered. The effectivity of laser therapy was assessed based on immunological tests-secretory immunoglobulin A (sIgA) and lysozyme levels measured in nonstimulated saliva before and after treatment. Results: For sIgA (both in millimeters and milligrams per liter), the measurements displayed differences between pre- and postsurgery values, the postsurgery values being significantly lower than the presurgery values. In addition, interaction with the laser treatment plan was found, meaning that the laser treatment affected the sIgA levels. The decrease in sIgA levels in the control group was statistically significant. However, there was no significant change in sIgA levels in the laser group. The lysozyme trends appeared to be identical to the sIgA levels, that is, rising in the laser group and decreasing in the control group. The initial values for each group, however, go in the opposite direction. Conclusions: The study has shown that the 3D techniques and technologies in combination with therapeutic laser systems could support not only a treatment plan, but they also directly influence the process of healing and reduce inflammation. The study was carried out under clinical project No. 00064203 (FN MOTOL).

Deep learning-based identification of mesiodens using automatic maxillary anterior region estimation in panoramic radiography of children.

OBJECTIVES: The purpose of this study is to develop and evaluate the performance of a model that automatically sets a region of interest (ROI) and diagnoses mesiodens in panoramic radiographs of growing children using deep learning technology. METHODS: Out of 988 panoramic radiographs, 489 patients with mesiodens were classified as an experimental group, and 499 patients without mesiodens were classified as a control group. This study consists of two networks. The first network (DeeplabV3plus) is a segmentation model that uses the posterior molar space to set the ROI in the maxillary anterior region with the mesiodens in the panoramic radiograph. The second network (Inception-resnet-v2) is a classification model that uses cropped maxillary anterior teeth to determine the presence of mesiodens. The data were divided into five groups and cross-validated. Deep learning model were created and trained using Inception-ResNet-v2. The performance of the segmentation network was evaluated using accuracy, Intersection over Union (IoU), and MeanBFscore. The overall network performance was evaluated using accuracy, precision, recall, and F1-score. RESULTS: Segmentation performance using posterior molar space in panoramic radiographs was 0.839, IoU 0.762, and MeanBFscore 0.907. The mean values of accuracy, precision, recall, F1-score, and area under the curve for the diagnosis of mesiodens using automatic segmentation were 0.971, 0.971, 0.971, 0.971, and 0.971, respectively. CONCLUSIONS: The diagnostic performance of the deep learning system using posterior molar space on the panoramic radiograph was sufficiently useful. The results of the deep learning system confirmed the possibility of complete automation of the classification of mesiodens.

Mystery Behind a Broken, Discolored Right Maxillary Central Incisor: A Case Report.

Odontoma is a hamartomatous benign odontogenic tumor that may resemble tooth-like structures. Odontomas can impede the eruption of the permanent underlying tooth or can cause devitalization of the tooth resulting in pain and swelling near the tooth, causing diagnostic dilemmas to the dentist. We describe a case of an unusual occurrence of such an odontoma in a 31-year-old male patient in the periapical region of a broken, discolored maxillary central incisor tooth causing a diagnostic dilemma and its treatment.

Presence of impacted supernumerary teeth in the Indian population.

A tooth that does not erupt into the dental arch during the anticipated developmental window is said to be impacted. A supernumerary tooth (ST) would be any dentition or odontogenic entity that grows from a tooth germ more often than is typical for a particular area of the dental arch (ST). The study's goal is to determine how commonly impacted supernumerary teeth are present within the Indian community. This research project at the institution which was retrospective was done on dental patients who went to the private dental hospital between March 2020 and March 2021. We looked over the medical records of 86,000 patients at the private dental institution and analyzed the data. In the study's 74,421 impaction cases, 139 instances of impacted extra teeth were found. For statistical analysis, collected data were analyzed, entered into an Excel document, and imported into SPSS version 21. In the study population, males between the ages of 21 and 35 years were more frequently observed to have supernumerary impacted teeth. Impacted teeth were more frequently observed in the posterior region rather than the anterior region. Within the constraints of the study, it was shown that males between the ages of 21 and 35 years and the posterior part of the mouth experienced impacted supernumerary teeth the most frequently.

Prevalence of Supernumerary Teeth and Its Associated Complications among School-going Children between the Ages of 6 and 15 Years of Jamshedpur, Jharkhand, India.

Background: Supernumerary teeth (ST) are those that exceed the normal dental formula. This phenomenon is also known as hyperdontia, and can occur in solitary or multiple forms, might be unilateral or bilateral, and affect one or both jaws. Aim: To study the prevalence, gender variations in terms of frequency, characteristic, distribution, and associated complications with the presence of ST in 3,000 school-going children of age 6-15 years in Jamshedpur, Jharkhand, India. Materials and methods: The study consisted of an examination of randomly selected 3,000 children, female (group I) and male (group II), between the age-group of 6 and 15 years, from both private and government-aided schools. Clinical examinations were carried out by a single investigator under natural daylight in a systematic manner using a mouth mirror and straight probe only. The demographic profiles and number of teeth, including the presence of any ST (site, region, eruption status, morphology, and whether it was present unilaterally or bilaterally), were ascertained. Malocclusion or any complications associated with ST were also noted. Results: ST prevalence was found to be 1.87%, with male to female ratio of 2.29:1. Out of 56 children with ST, eight children had double ST while 48 had single, 53 ST were present in maxilla, and only three in mandible. Based on the region, 51 ST were present in the midline, four in the central incisor region, and one in the molar region. According to morphology, 38 ST were conical, 11 ST were tuberculate, and seven ST were supplementary. Twenty-two ST had associated complications, while 34 ST were asymptomatic. Conclusion: ST prevalence is relatively less, but if left neglected, it can pose serious associated dental problems in the child. How to cite this article: Singh AK, Soni S, Jaiswal D, et al. Prevalence of Supernumerary Teeth and Its Associated Complications among School-going Children between the Ages of 6 and 15 Years of Jamshedpur, Jharkhand, India. Int J Clin Pediatr Dent 2022;15(5):504-508.