Orthodontic traction of impacted central incisor after surgical removal of mesiodens using cone-beam computed tomography guidance

Extra tooth like mesiodens is not uncommon; it is conical in shape and smaller in size compared to permanent incisors, with a higher frequency in the maxilla than the mandible and in males than females. The earlier the diagnosis and treatment the lesser the complications in eruption and occlusion. This case describes the treatment of a patient with impacted maxillary incisors and canine in the same quadrant due to retained primary teeth and mesiodens. The treatment was done in three stages. In the first stage, the deciduous incisors were extracted. In the second stage, surgical removal of the mesiodens was done, which allowed enough space for the maxillary right permanent central incisor. The third stage was orthodontic extrusion.