A mesiodens (midline tooth, conical tooth, palatodens) is the commonest supernumerary tooth located between the maxillary, less frequently mandibular, central incisors. The incidence of mesiodentes is markedly higher in males. They may occur together with various dental defects or maxillofacial abnormalities. The location of conical teeth is highly varied; in the majority of cases they are situated palatally to the alveolar process apex. Mesiodentes may erupt spontaneously or be retained. In cases of retained eruption, clinical symptoms accompanying their presence and radiographic examinations are essential. Although the aetiology of conical teeth is not fully elucidated, there are several theories regarding their development (hypothesis of dental lamina and vascular hyper-reactivity, atavistic, dichotomic or hereditary theories). Mesiodentes are classifi ed according to diff ff erences in shape and size or presence in deciduous or permanent dentition. The mesiodens is likely to result in dental abnormalities; therefore, in the majority of cases its extraction is recommended. However, therapeutic management should be correlated with the period of dental development. The study presents the characteristics of this anomaly, its aetiology and management options based on the literature from 2000 to 2009.