J Korean Dent Sci.  2023 Jun;16(1):63-73. 10.5856/JKDS.2023.16.1.63.

The Effect of the Impacted Position of Palatally Inverted Mesiodens on the Selection of Sedation Method

• Choi S
• Song J

• KMID: 2549601
• DOI: http://doi.org/10.5856/JKDS.2023.16.1.63

Abstract

Purpose
Hyperdontia is a developmental disorder of the oral cavity. Mesiodens refers to the hyperdontia located between the maxillary central incisors. During the surgical procedure, the anesthetic method for pain control should be considered along with factors related to the surgery itself. The purpose of this study was to evaluate the effect of the impacted position of the mesiodens on the selection of sedation method and to suggest incisive foramen as a brief reference.
Materials and Methods
This study included 126 patients who were scheduled for extraction of mesiodens. The selection criteria included patients with one palatally impacted inverted mesiodens accessible from the palatal gingival margin, and those with good cooperation potential in order to control for clinical information. Using cone beam computed tomography, vertical, horizontal, and palatal positional factors were measured, and the anesthetic method was determined by two examiners. The patients were grouped into vertical and horizontal groups based on the position of the incisive foramen. Data were statistically analyzed using the Mann–Whitney test, the chi-square test, and logistic regression analysis. Result: All positional factors differed between the outpatient and inpatient anesthetic groups. The vertical minimum distance from the alveolar ridge to the mesiodens (Va) and the minimum distance from the palatal surface to the crown tip of the mesiodens (Tc) were factors affecting the choice of anesthetic method. The distribution of the vertical and horizontal positional groups differed between the outpatient and inpatient anesthetic groups.
Conclusion
The incisive foramen can be used as a brief reference to determine the appropriate anesthetic method. Referral for inpatient anesthesia may be a priority if they are in the V 2 H 2 group with Va ≥5 mm, and Tc ≥6 mm, and outpatient sedation may be considered if they are in the V 1 H 1 group with Va ≤1.5 mm, and Tc ≤2.5 mm.

Keyword

Anesthesia; Extraction; Mesiodens; Supernumerary tooth