the deviation in number from normal complement set of teeth is called as  hyperdontia . the extra tooth or teeth is / are described as supernumerary tooth or teeth , which may occur in different forms ( conical , tuberculate , supplemental and odontomas ) , locations ( mesiodens , paramolar and distomolar ) and shapes , ( supplemental / eumorphic and rudimentary / dysmorphic ) . the prevalence of supernumerary teeth is reported to be 0.1 - 3.6% , with higher incidence rate in males than females ( incidence ratio of 2:1 ) and commonly observed with permanent dentition when compared with deciduous dentition . mesiodens usually occur in singlet 's and their occurrence in multiples is referred to as mesiodentes . this was case report of a 23-year - old male patient who reported to the department of orthodontics with the chief complaint of flower like upper front teeth causing difficulty in speech . the patient had full complement set of teeth , which had yellowish fluorosis stains [ figure 1 ] . two mesiodens were present , one palatal and the other labial to 11 and 21 resulting in proclination and rotation of the maxillary central incisors [ figures 1 and 2 ] . the occlusion and arrangement of anterior teeth was disturbed both in maxillary and mandibular arch due to the presence of mesiodentes [ figures 3 and 4 ] . patient also complained of difficulty in pronunciation of certain words due to proclination of his front teeth . radiographic diagnosis included orthopantomograph ( opg ) , lateral cephalogram and intraoral periapical ( iopa ) radiograph . no other supernumerary teeth or abnormalities were observed in the opg examination [ figure 3 ] . the lateral cephalogram examination was explored to rule out the possibility of crossover of mesiodens from labial to palatal side and also the direction of eruption of mesiodens [ figure 3 ] . the periodontal ligament shadow was clear around both teeth ruling out ankylosis [ figure 4 ] . cephalometric findings indicate that it is a class i skeletal case with overjet of 6 - 7 mm , bimaxillary dentoalveolar protrusion with crowding of upper and lower teeth . intraoral photograph - frontal and lateral view  proclination and rotation of central incisors due to double mesiodentes ( column width ) intraoral photograph of the maxilla and mandibleocclusal view . deranged occlusion and crowding in the mandibular arch ( column width ) orthopantomographic and lateral cephalogram view of the patient with double mesiodens and no signs of cystic formation or any other supernumerary teeth ( column width ) intraoral periapical radiography with two separate clear images of the periodontal ligament with mesiodens represented by dotted lines green and red separately ( column width ) after a detailed examination and case discussion it was decided to extract the two mesiodens as an initial step and align the maxillary permanent central incisors . it was decided to evaluate the case after alignment to make a choice between first and second premolars for extraction to improve the esthetics as well as function [ figure 5 ] . extracted specimen of the two conical shaped mesiodens and post extraction occlusal view of the maxilla with two separate sockets ( column width ) the presence of mesiodens in the midline poses an esthetic as well as functional problem . there are three controversial theories put forward regarding the occurrence of mesiodens in normal dentition . the first theory is atavistic theory which proposes that the mesiodens is a phylogenetic recapitulation of our ancestors who had three central incisors . the dichotomy theory proposes that the mesiodens is the result of unequal splitting of tooth bud to create two teeth . the third theory and most accepted theory suggests hyperactivity of the dental lamina wherein although mesiodens may be familial in nature it does not follow a simple mendelian pattern . they may also occur in association with other developmental abnormalities or syndromic conditions such as cleft lip and palate , down 's syndrome , cleidocranial dysostosis and gardener 's syndrome . majority of mesiodens erupt palatally and in some cases spontaneously erupt into the oral cavity . mesiodentes interfere with the eruption of permanent central incisors and may result in their impaction . mesiodentes may erupt normally but may be unerupted ( unilateral or bilateral ) and inverted . mesiodentes usual present as double mesiodens in most of the cases but a rare case of triple mesiodentes was also reported . the case presented here is unique where as one of the mesiodens is palatal and the other are labial , present in the midline giving a floret like appearance to the premaxillary region . all most all the cases of mesiodentes reported are conical in shape and this case followed the same pattern . however , in our case the mesiodentes erupted normally but resulted in the proclination of upper and lower central incisors and rotation of the maxillary central incisors . in the case presented here , care has to be taken to evaluate whether the mesiodentes have crossed the dental arch from labial to palatal side . in such cases the injudicious extraction of mesiodentes may result in unwarranted luxation avulsion of the permanent central incisors . they may result in delayed or deviation in eruption of succedaneous permanent teeth or cyst formation . the maxillary central incisors were severely rotated as well as proclined resulting in unesthetic appearance . due to his deranged occlusion the normal masticatory function is affected and speech is impaired . in this particular case , taking into consideration the age of the patient as well as the problems associated with the mesiodentes ( speech difficulty , unesthetic appearance and psycho social problems ) , extraction of the mesiodens was performed . we report a rare case of twin mesiodentes in the maxillary arch arranged in floral pattern causing occlusal disturbances as well speech difficulty in the patient . a new flower like pattern of double mesiodens was also observed , which we believe is a rare occurrence .
mesiodens is the most commonly erupting supernumerary in the midline between two maxillary central incisors . 
 mesiodentes is a rare condition when mesiodens erupt in multiples , which may present as either labial or palatal to permanent central incisors . 
 we report a rare case of double mesiodentes ( non - syndromic mesiodentes ) with floret like appearance . 
 the presence of mesiodens has functional and esthetic implications . 
 careful radiographic evaluation should be done to prevent complications during their extraction .