A Rare Case of Bilateral Mesiodens With Dens Invaginatus Obstructing Permanent Incisor Eruption.

The co-occurrence of mesiodens and dens invaginatus (DI) is very uncommon. Such anomalies may impede the eruption of permanent maxillary central incisors and can appear radiographically similar to normally developing teeth. An 11-year-old girl presented with failure of eruption of the permanent maxillary central incisors. Panoramic radiography and cone-beam computed tomography (CBCT) revealed two palatobuccally positioned supernumerary mesiodens, both of which exhibited DI. Surgical extraction of the mesiodens was performed, and guided bone regeneration (GBR) was carried out to preserve the alveolar ridge and optimize conditions for subsequent eruption and orthodontic treatment. At the time of reporting, the permanent incisors remain unerupted. Delay in intervention led to loss of mesiodistal space as adjacent teeth drifted. Advanced orthodontic treatment, including distalization, is currently in progress. This case underscores that prompt diagnosis using CBCT and a coordinated multidisciplinary approach is crucial for managing complex dental anomalies and ensuring favorable outcomes.