Erupted Mesiodens Management — ORE Part 1 MCQ

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ModeratePaediatric DentistryErupted Mesiodens ManagementORE Part 1

A child presents with a conical erupted mesiodens located between the permanent maxillary central incisors. A maxillary midline diastema is present and there is no other pathology. What is the most appropriate initial management?

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Correct answer: A — Extract the mesiodens and review the diastema before orthodontic treatment

Explanation lettering: E = shown as B · B = shown as C · C = shown as E

A is correct because the erupted mesiodens is the local cause of the diastema and should be removed first. Following removal, review is appropriate because some improvement in incisor position or spacing may occur; persistent diastema or malalignment can then be managed orthodontically. B is wrong because orthodontic closure without removing the interdental obstruction is not appropriate. C is wrong because reshaping does not address the abnormal tooth’s presence in the midline or its effect on alignment. D is unjustifiably destructive: normal permanent central incisors should not be removed. E is inappropriate because retaining a mesiodens associated with displacement or spacing risks persistence of the occlusal and aesthetic problem. UK guidance recognises supernumerary teeth as a cause of maxillary incisor disturbance and supports removal with further orthodontic management when needed.

Reference: Faculty of Dental Surgery, Royal College of Surgeons of England. Management of Unerupted Maxillary Incisors, 2022 update. https://www.rcseng.ac.uk/-/media/management-of-unerupted-maxillary-incisors-2022-update.pdf