Comprehensive Orthodontic Management of Erupted Mesiodens in an Adult Patient: A Case Report

Supernumerary teeth are relatively rare anomalies, with mesiodens being the most common type. They are often detected in childhood, but when left undiagnosed, can persist into adulthood and interfere with occlusion and aesthetics. Timely identification and management are therefore essential to prevent long-term complications. The presence of a mesiodens in adult patients, although rare, often leads to complications including midline deviation, localised spacing, and aesthetic concerns. This case report presents the comprehensive orthodontic management of a 25-year-old male with an erupted mesiodens positioned between the maxillary central incisors. The patient exhibited localised spacing in both arches with a skeletal and dentoalveolar Class I malocclusion. Following the extraction of the mesiodens under local anaesthesia, fixed appliance therapy with pre-adjusted MBT 0.022″ brackets was initiated. Alignment and levelling were achieved with 0.016″ NiTi wires progressing to 0.019×0.025″ stainless steel wires. Space closure was accomplished using continuous light forces through elastomeric chains, with careful anchorage management to achieve midline correction and preserve molar and canine relationships. The total treatment duration was 12 months. Post-treatment assessment revealed successful space closure, corrected midline, and improved smile aesthetics. Bonded lingual retainers were placed to ensure long-term stability. This case highlights the importance of early identification and management of mesiodens to achieve optimal orthodontic and aesthetic outcomes. Detection of mesiodens in adulthood can still be regarded as early because it precedes the onset of secondary complications such as cyst formation, root resorption, or complex malocclusion. Additionally, orthodontic correction is more efficient and stable at this stage when compared to later decades of life. Controlled biomechanics and diligent retention protocols are crucial in achieving predictable and stable results in adult patients. The novelty of this case lies in managing space closure and midline correction following the extraction of an erupted mesiodens in an adult patient, which is rare compared to routine cases.