The Surgical Approach in the Treatment of the Mesiodens: A Systematic Review of the Literature with Narrative Synthesis

Background. The mesiodens is a supernumerary tooth located at the midline of the maxilla and represents the most common form of hyperdontia. When symptomatic or threatening the eruption or alignment of adjacent permanent incisors, surgical removal is indicated; however, the literature reports a wide array of surgical techniques without an established standard of care. Objectives. This review aims to evaluate the surgical techniques reported for mesiodens removal, analyzing their outcomes, complications, and predictability, to provide a reference framework for clinical decision-making. Methods. The review followed the PRISMA 2020 guidelines and it was retrospectively registered in PROSPERO (CRD420261462413) on 3 September 2026, after study selection had begun. A systematic search was conducted across PubMed, Scopus, and Web of Science for studies published between 2016 and 2026 the searches being run between January and June 2026 without restriction of language or publication status, with predefined eligibility criteria and methodological quality assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Results. Thirty studies were included, predominantly case reports and case series, with only one randomized controlled trial and one comparative cohort study; consequently, the synthesis remained descriptive. The pooled surgical population comprised 845 patients, mostly pediatric, with a marked male predominance. Cone beam computed tomography (CBCT) was used for three-dimensional localization and surgical planning in 73.3% of studies. Surgical approaches were heterogeneous, including palatal, labial/buccal, nasal floor/transnasal, and endoscopic routes. Extraction was performed freehand in 80.0% of studies and with a surgical guide or dedicated plate in 16.7%. Where reported, outcomes were favorable: adjacent teeth were preserved in all 19 studies documenting this outcome, while intraoperative and postoperative complications were described in two of 20 and in three of 23 studies respectively. Conclusions. Surgical removal appears feasible and has been reported with generally favorable outcomes in the published literature; however, the evidence base consists predominantly of case reports and small case series, with important risks of selection and publication bias. The reported complication frequencies should therefore not be interpreted as the true complication rate of mesiodens surgery, and the available evidence is insufficient to formulate an evidence-based clinical guideline. Prospective comparative studies with standardized inclusion criteria and outcome definitions are warranted.