Clinical and Timing Considerations for Surgical Removal of Mesiodens: Early vs Late Treatment

Background: The management of impacted mesiodens represents a significant challenge in pediatric oral and maxillofacial surgery. The optimal timing for surgical intervention remains a subject of clinical debate, balancing the benefits of preventing eruption disturbances against potential surgical risks to developing adjacent structures. This study evaluates the outcomes of early versus late surgical removal of mesiodens over a 30-year period. Methods: A retrospective analysis was conducted on 50 healthy pediatric patients who underwent surgical extraction of mesiodens between 1989 and 2018. All surgical procedures were performed exclusively under local anesthesia (4% articaine) combined with non-pharmacological behavioral management strategies. Patients were stratified into two groups based on age at the time of intervention: an early intervention group (6–8 years old) and a late intervention group (>8 years old). Diagnostic and surgical planning utilized intraoral radiographs, panoramic films, and Cone-Beam Computed Tomography (CBCT) for complex cases. Surgical approaches included 20 palatal flaps, 1 buccal flap, and 29 cases managed with specialized pediatric extraction techniques. Adjacent teeth eruption and the need for subsequent orthodontic traction were monitored. Results: Early surgical intervention (6–8 years of age) yielded a 100% rate of spontaneous eruption of the adjacent permanent maxillary incisors, completely eliminating the need for postoperative orthodontic traction. In contrast, delayed intervention (>8 years of age) was significantly associated with permanent incisor impaction, root dilaceration, and a high requirement for complex orthodontic traction. All procedures were successfully completed under local anesthesia; no severe intraoperative or postoperative complications were recorded, and no patient required general anesthesia. Conclusions: Early surgical removal of mesiodens between 6 and 8 years of age significantly optimizes clinical outcomes by ensuring the spontaneous eruption of adjacent permanent teeth and preventing the need for orthodontic traction. Furthermore, pediatric oral surgery for supernumerary teeth can be safely and effectively executed under local anesthesia alone, provided it is supported by tailored behavioral guidance techniques, thereby reducing systemic risks and healthcare costs associated with general anesthesia.