Intraoral Approach Through the Nasal Floor for Surgical Removal of Inverted Mesiodens: Protocol and Case Series.

The most common form of supernumerary teeth is represented by the mesiodens. Very often, they are impacted, usually palatially, but can be found buccally or between the roots of the permanent central incisors. Their position can be normal, inclined, or inverted. In the possible case where the impacted mesiodens crown is oriented upwards towards the nasal cavity, they are called inverted mesiodens. The inverted mesiodens are mainly asymptomatic, and the main diagnostic methods are radiological, especially CBCT. This paper presents the intraoral approach through the nasal floor as a very reliable method for the surgical removal of inverted mesiodens. We report a protocol, including the diagnosis process, criteria for choosing this surgical approach, and description of the surgical procedure. Preoperative CBCT is mandatory for diagnosis and choice of the surgical approach. This is chosen based on measurements on the cross-sectional view of the CBCT investigation and is in compliance with our criteria related to the appropriate surgical approach. Using this approach, the mesiodens were extracted without intraoperative or postoperative complications or accidents, and operating times were relatively short. 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, mainly regarding the surgical skills of the operating team. The cone-beam computed tomography (CBCT) has a fundamental role in the diagnosis and treatment of included mesiodens.