Introduction: Mesiodens is the most common type of supernumerary tooth with proportion of males: females of 2: 1. The etiology of this anomaly is various and includes both genetic and environmental factors, syndromic conditions and disturbances in dental development.
Case Presentation: A palatally positioned maxillary midline mesiodens was incidentally found during x-ray check-up in a 14-year-old female. It was associated with major crowding and a huge upper midline shift. The oral surgeon did not deem prudent a surgical access due to crowding. Patient was treated with screw-borne active anchorage, all four first bicuspids extracted, braces bonded on both arches and consequent mesiodens surgery removal. After alignment a safe palatal surgical access was available. Satisfactory functional and esthetic results were achieved and stable at a 2-year follow-up.