Intraoral Approach Through the Nasal Floor for Surgical Removal of Inverted Mesiodens

The mesiodens is the most common form of a supernumerary tooth. In the majority of cases they are impacted, usually palatally, but can be found buccally or between the roots of the permanent central incisors. Their position can be normal, inclined or inverted. If the crown of the impacted mesiodens is directed to the nasal cavity they are refer to as an inverted mesiodens. The inverted mesiodens is mainly asymptomatic and the main diagnostic methods are radiological, especially CBCT. This paper presents the nasal floor approach as a very reliable option for extracting inverted mesiodens. We report our protocol, including the diagnosis process, criteria for choosing this surgical approach and description of the surgical procedure. The intraoral approach through the nasal floor for surgical removal of inverted mesiodens satisfies all the conditions to be a predictable, safe and time efficient technique. It has its limitations, manly regarding the surgical skills of the operating team. The cone-beam computed tomography (CBCT) has a fundamental role in diagnosis and treatment of included mesiodens.