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González Sánchez JA, Munill Ferrer M, Suresh N, Nagendrababu V, Dummer PMH, Garcia-Font M, Abella Sans F. Successful Root Canal Treatment of an Atypical Mandibular Canine with a Boomerang-shaped Root and Canal System with a Large Periapical lesion-A Case Report with 9-year Follow-up. J Endod 2023; 49:1369-1375. [PMID: 37468060 DOI: 10.1016/j.joen.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
AIM This report describes an atypical mandibular canine with a single boomerang-shaped root and root canal system with a large periapical lesion managed by root canal treatment. METHODS The chief complaint of a 16-year-old male was acute pain and an abnormal sensation in the right mandibular canine (tooth #27). The clinical examination revealed that tooth #27 had an unusual coronal morphology. The buccal aspect of the tooth resembled that of a normal canine but was significantly broader than expected. On the lingual aspect of the crown; however, there was an unusual cusp-like structure with ridges that was slightly less prominent than the buccal incisal tip. The intraoral periapical radiographs revealed a complex root with an obvious cow horn-shaped canal mesially and distally, but with the suggestion of a root structure joining the mesial and distal extensions. A large periapical lesion was present. Computed tomography revealed the presence of a single root and canal system shaped like a boomerang. Root canal treatment was performed and the patient was followed-up for 9 years. RESULTS Following root canal treatment, the patient had no symptoms, no mobility, no periodontal pockets, or root resorption. At 9 years, the cone beam computed tomography images confirmed that satisfactory healing of the periapical tissues had occurred. CONCLUSION The mandibular right canine had a unique boomerang-shaped root and canal system. Effective shaping and cleaning of the complex canal shape plus thermoplastic root filling aided the successful healing of the periapical lesion.
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Affiliation(s)
| | | | - Nandini Suresh
- Faculty of Dentistry, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER), TamilNadu, India
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, University of Sharjah, College of Dental Medicine, Sharjah, United Arab Emirates
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Marc Garcia-Font
- Department of Endodontics, Universitat International de Catalunya, School of Dentistry, Barcelona, Spain
| | - Francesc Abella Sans
- Department of Endodontics, Universitat International de Catalunya, School of Dentistry, Barcelona, Spain.
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Miller HS, Avrahami HM, Zanno LE. Dental pathologies in lamniform and carcharhiniform sharks with comments on the classification and homology of double tooth pathologies in vertebrates. PeerJ 2022; 10:e12775. [PMID: 35578672 PMCID: PMC9107304 DOI: 10.7717/peerj.12775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023] Open
Abstract
Double tooth pathologies are important indicators of trauma, disease, diet, and feeding biomechanics, and are widely documented in mammals. However, diagnosis of double tooth pathologies in extinct non-mammalian vertebrates is complicated by several compounding factors including: a lack of shared terminology reflecting shared etiology, inconsistencies in definitions and key features within and outside of mammals (e.g., gemination, fusion, twinning, concrescence); differences in tooth morphology, heterodonty, regeneration, and implantation between mammals and non-mammalian vertebrates; and the unmet need for diagnostic criteria that can be applied to isolated teeth, which are common in the fossil record. Here we report on double tooth pathologies in the lamniform and carcharhiniform Cenozoic sharks Otodus megalodon (NCSM 33639) and Carcharhinus leucas (NCSM 33640, 33641). All three teeth bear a singular bifid crown with mirrored halves and abnormal internal microstructure-a single, bifurcating pulp cavity in C. leucas and a more than tripling of vessels in O. megalodon (from two to seven main ascending canals). We identify these abnormalities as likely examples of gemination due to their symmetry, which rules out fusion of tooth buds in one tooth file in different developmental stages in polyphyodont taxa; however, we note that incomplete forms of mesiodistal tooth fusion can be morphologically indistinguishable from gemination, and thus fusion cannot be rejected. We further compile and recategorize, when possible, the diversity of tooth pathologies in sharks. The identification of double tooth pathologies in O. megalodon and C. leucas has paleobiological implications. Such pathologies in sharks are largely hypothesized to stem from trauma to developing tooth buds. Carcharhinus leucas is known to feed on prey documented to cause feeding-related oral traumas (e.g., rays, sawfish, spiny fish, and sea urchins). However, O. megalodon, is considered to have largely fed on marine mammals, and perhaps turtles and/or fish, raising the possibility that the dietary diversity of this species is, as of yet, underappreciated. The genetic underpinnings of tooth morphogenesis and regeneration is highly conserved throughout vertebrate evolution, suggesting a homologous framework can be established. However, more research is needed to link developmental, paleobiological, and/or paleoenvironmental factors to gemination/fusion in polyphyodont taxa. We argue that the definitions and diagnostic criteria for dental pathologies in vertebrates require standardization in order to advance macroevolutionary studies of feeding trauma in deep time.
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Affiliation(s)
- Harrison S. Miller
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, United States,North Carolina Museum of Natural Sciences, Raleigh, North Carolina, United States
| | - Haviv M. Avrahami
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, United States,North Carolina Museum of Natural Sciences, Raleigh, North Carolina, United States
| | - Lindsay E. Zanno
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, United States,North Carolina Museum of Natural Sciences, Raleigh, North Carolina, United States
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3
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Chen F, Wang S, Bai N, Li X, Wang L, Xia X, Liu J, Tan F. Management of Fused Anterior Teeth: Review and Clinical Report. J Prosthodont 2022; 31:282-288. [PMID: 35000263 DOI: 10.1111/jopr.13478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/03/2022] [Indexed: 01/02/2023] Open
Abstract
The phenomenon of fusion is a type of tooth dysplasia, but few studies have systematically described the treatment of this kind of abnormality. This paper summarizes the treatment methods for fused teeth and classifies the management schemes according to whether the pulp is fused. Then, the treatment for a patient with bilateral anterior tooth fusion is reported. After orthodontic treatment, porcelain veneers were used to restore the normal shape and aesthetic appearance of the anterior teeth. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Fangbing Chen
- Dental Medical Center, Qingdao West Coast New District People's Hospital, Qingdao, 266000, People's Republic of China.,Department of Prosthodontics, the Affiliated Hospital of Qingdao University, Qingdao, 266003, People's Republic of China
| | - Shaolei Wang
- Department of Prosthodontics, the Affiliated Hospital of Qingdao University, Qingdao, 266003, People's Republic of China.,School of Stomatology of Qingdao University, Qingdao, 266003, People's Republic of China
| | - Na Bai
- Department of Prosthodontics, the Affiliated Hospital of Qingdao University, Qingdao, 266003, People's Republic of China
| | - Xue Li
- Department of Prosthodontics, the Affiliated Hospital of Qingdao University, Qingdao, 266003, People's Republic of China
| | - Lizhe Wang
- Department of Prosthodontics, the Affiliated Hospital of Qingdao University, Qingdao, 266003, People's Republic of China.,School of Stomatology of Qingdao University, Qingdao, 266003, People's Republic of China
| | - Xiaomin Xia
- Department of Prosthodontics, the Affiliated Hospital of Qingdao University, Qingdao, 266003, People's Republic of China.,School of Stomatology of Qingdao University, Qingdao, 266003, People's Republic of China
| | - Jie Liu
- Department of Prosthodontics, the Affiliated Hospital of Qingdao University, Qingdao, 266003, People's Republic of China
| | - Fei Tan
- Department of Prosthodontics, the Affiliated Hospital of Qingdao University, Qingdao, 266003, People's Republic of China
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4
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Nangia D, Dinkar S, Nawal RR, Talwar S. Endodontic management of mandibular second molar fused to odontome with 12-month follow-up using cone beam computed tomography: A case report. AUST ENDOD J 2020; 47:350-357. [PMID: 33030279 DOI: 10.1111/aej.12452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/16/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
Abstract
Fusion is a developmental anomaly characterised by the union of two adjacent teeth or tooth-like substance. Odontomes are malformation of the dental tissue which arise during normal tooth development. They are usually asymptomatic but often associated with tooth eruption disturbance. In this paper, we report a rare case of fusion involving permanent mandibular second molar with an odontome, which led to a partial eruption of the molar as well as its devitalisation. Successful endodontic management was carried out in this case with a supplementary disinfection procedure using XP Endo finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The use of high-end diagnostic imaging modalities such as cone beam computed tomography (CBCT) helped in making a confirmatory diagnosis; determining the treatment plan before undertaking the actual treatment; for better understanding of the fused tooth's complicated root morphology; and for its effective management and to follow up this unusual case for 12 months.
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Affiliation(s)
- Divya Nangia
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sumit Dinkar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sangeeta Talwar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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5
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Badole GP, Shenoi PR, Parlikar A. Endodontic management of central incisor associated with large periapical lesion and fused supernumerary root: a conservative approach. Restor Dent Endod 2018; 43:e44. [PMID: 30483468 PMCID: PMC6237732 DOI: 10.5395/rde.2018.43.e44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/21/2018] [Indexed: 12/01/2022] Open
Abstract
Fusion and gemination are developmental anomalies of teeth that may require endodontic treatment. Fusion may cause various clinical problems related to esthetics, tooth spacing, and other periodontal complications. Additional diagnostic tools are required for the diagnosis and the treatment planning of fused tooth. The present case report describes a case of unilateral fusion of a supernumerary root to an upper permanent central incisor with large periapical lesion in which a conservative approach was used without extraction of supernumerary tooth and obturated with mineral trioxide aggregate to reach a favorable outcome.
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Affiliation(s)
- Gautam P Badole
- Department of Conservative Dentistry & Endodontics, VSPM's Dental College & Research Center, Nagpur, MH, India
| | - Pratima R Shenoi
- Department of Conservative Dentistry & Endodontics, VSPM's Dental College & Research Center, Nagpur, MH, India
| | - Ameya Parlikar
- Department of Conservative Dentistry & Endodontics, Rangoonwala Dental College and Research Center, Pune, MH, India
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6
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Persic Bukmir R, Braut A, Brekalo Prso I. Conservative endodontic management of a fused tooth: A case report. Gerodontology 2017; 34:398-400. [PMID: 28766814 DOI: 10.1111/ger.12266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report a conservative treatment of a rare developmental anomaly. CASE REPORT A 73-year-old patient with previously initiated therapy and acute apical abscess of a maxillary right central incisor fused with the supernumerary tooth sought treatment. The conservative approach included nonsurgical root canal treatment and composite restoration. CONCLUSION This case illustrates the importance of an individual approach when treating anomalous teeth. Priorities in pain and infection management to properly and functionally restore teeth should be unaffected by age.
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Affiliation(s)
- Romana Persic Bukmir
- Department of Endodontics and Restorative Dentistry, Faculty of Medicine, Clinical Hospital Centre Rijeka, University of Rijeka, Rijeka, Croatia
| | - Alen Braut
- Department of Endodontics and Restorative Dentistry, Faculty of Medicine, Clinical Hospital Centre Rijeka, University of Rijeka, Rijeka, Croatia
| | - Ivana Brekalo Prso
- Department of Endodontics and Restorative Dentistry, Faculty of Medicine, Clinical Hospital Centre Rijeka, University of Rijeka, Rijeka, Croatia
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Da Costa GC, Chalakkal P, De Souza N, Gavhane S. Bilateral Complete and Incomplete Fusion of Incisors and its Management. Contemp Clin Dent 2017; 8:171-174. [PMID: 28566874 PMCID: PMC5426155 DOI: 10.4103/ccd.ccd_1090_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case report highlights the management of a case of bilateral complete and incomplete fusion of maxillary incisors in a 10-year-old child. A mock-up was done on the diagnostic cast. Pretreatment esthetic evaluation was done using bis-acryl composite temporaries which were transferred intraorally from the diagnostic cast using a putty index. An incisal overlap veneer preparation was done, following which, an IPS e-max veneer was cemented. A digital mock-up was carried out using the Adobe Photoshop and Corel Draw softwares to aid in laboratorial fabrication of the veneer.
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Affiliation(s)
| | - Paul Chalakkal
- Department of Pedodontics and Preventive Dentistry, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Neil De Souza
- Department of Pedodontics and Preventive Dentistry, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Sanket Gavhane
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, Goa, India
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8
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Smail-Faugeron V, Terradot J, Muller Bolla M, Courson F. Management of non-syndromic double tooth affecting permanent maxillary central incisors: a systematic review. BMJ Case Rep 2016; 2016:bcr-2016-215482. [PMID: 27307427 DOI: 10.1136/bcr-2016-215482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
To assess management of non-syndromic double tooth affecting permanent maxillary central incisors, we performed a systematic review and also present 2 case reports. We searched MEDLINE via PubMed and the reference lists of included reports. Eligible studies were any type of clinical studies describing the management of non-syndromic double tooth affecting the crown of a permanent maxillary central incisor. We included 68 studies corresponding to 72 relevant case reports. Therapeutic options in descending order of priority were restorative dentistry (35%), hemisection (33%), abstention (17%) or extraction (15%). Orthodontic management resulted in 57% of cases. We report an 11-year-old boy with bilateral fusion of the two maxillary central incisors and a 9-year-old boy with a double left central incisor and a supernumerary lateral right incisor. A multidisciplinary approach is key to management of permanent maxillary central incisors affected by coronary anomalies.
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Affiliation(s)
| | - Jeanne Terradot
- Universite Paris Descartes Faculte de Chirurgie Dentaire, Montrouge, Île-de-France, France
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9
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Laverty DP, Thomas BM. The Prosthodontic Pathway for Patients with Anomalies Affecting Tooth Structure. ACTA ACUST UNITED AC 2016; 43:356-8,361-2, 365-6, 369-70, 373-4. [PMID: 29148689 DOI: 10.12968/denu.2016.43.4.356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There are a number of anomalies that affect the structure of the dental hard tissues which impact upon the form, function and aesthetics of the dentition. Understanding the challenges these conditions pose will enable dentists to manage the functional and aesthetic problems with restorative techniques better. This article will present cases that demonstrate the different conditions, the restorative challenges experienced and a variety of restorative treatments in the management of these conditions. Clinical relevance: Awareness of different anomalies affecting tooth structure that may present to the dental practitioner is necessary. Clinicians should appreciate the specific restorative challenges that may arise in treating such patients and the possible treatment options that may be available.
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10
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Zheng J, Shinonaga Y, Kawai S, Abe Y, Harada K, Arita K. Hemisection of fused teeth involving a maxillary permanent incisor and a supernumerary tooth. PEDIATRIC DENTAL JOURNAL 2015. [DOI: 10.1016/j.pdj.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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11
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Nikoloudaki GE, Kontogiannis TG, Kerezoudis NP. Evaluation of the Root and Canal Morphology of Maxillary Permanent Molars and the Incidence of the Second Mesiobuccal Root Canal in Greek Population Using Cone-beam Computed Tomography. Open Dent J 2015; 9:267-72. [PMID: 26464594 PMCID: PMC4598424 DOI: 10.2174/1874210601509010267] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 12/28/2014] [Accepted: 05/05/2015] [Indexed: 12/23/2022] Open
Abstract
Objectives: Cone-Beam Computed Tomography is an alternative imaging technique which has been recently introduced in the field of Oral & Maxillofacial Radiology. It has rapidly gained great popularity among clinicians due to its ability to detect lesions and defects of the orofacial region and provide three-dimensional information about them. In the field of Endodontics, CBCT can be a useful tool to reveal tooth morphology irregularities, additional root canals and vertical root fractures. The objective of this study is to evaluate the root and root canal morphology of the maxillary permanent molars in Greek population using Cone-Beam Computed Tomography. Materials and Methods : 273 cone-beam computed tomography (CBCT) images were examined. The number of roots and root canals of the first and second maxillary molars were evaluated. Root canal configuration was classified according to Weine’s classification by two independent examiners and statistical analysis was performed. Results : A total of 812 molars (410 first and 402 second ones) were evaluated. The vast majority of both first and second molars had three roots (89.26% and 85.07%, respectively). Most first molars had four canals, while most second molars had three. In the mesiobuccal roots, one foramen was recorded in 80.91% of all teeth. Other rare morphologic variations were also found, such as fusion of a maxillary second molar with a supernumerary tooth. Conclusion : Within the limitations of this study, it can be concluded that more attention should be given to the detection of additional canals during root canal treatment in maxillary permanent molars. Towards this effort, CBCT can provide the clinician with supplemental information about the different root canal configurations for successful Root Canal Treatment.
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12
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Sharma D, Kaur R, Monga S, Kaur S, Kundra R. Diagnostic imaging: Morphological and eruptive disturbances in the permanent teeth. World J Stomatol 2015; 4:72-80. [DOI: 10.5321/wjs.v4.i2.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/04/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
This paper reviewed the literature on newer three-dimensional imaging techniques and their applications in diagnosis and treatment planning of various dental anomalies. Developmental anomalies can occur during any of the developmental stages and are manifested clinically after the tooth is fully formed. These dental anomalies may involve a single tooth, a group of teeth, or the entire dentition. Two-dimensional diagnostic imaging, including periapical, occlusal, panoramic, or cephalometric radiographs are essential in localization and management of morphological and eruptive disorders. However, due to their inherent limitations such as insufficient precision because of unusual projection errors and lack of information about spatial relationships, these methods are considered unreliable. Thus, the use of newer image acquisition techniques that allow comprehensive three dimensional imaging and visualization of dental abnormalities is highly recommended for making a confirmatory diagnosis. The significance of accurate endodontic, surgical and orthodontic treatment planning in dental abnormalities cannot be overstated as it pertains to critical anatomic landmarks such as proximity to adjacent teeth or the mandibular canal. The precise information on spatial relationships provided by multiplanar imaging helps the dental surgeon to establish more accurate diagnosis, management strategies and also increases the patient safety. This review highlights the use of high-end diagnostic imaging modalities in diagnosis of the various morphologic and eruptive dental abnormalities.
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13
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Shanthraj SL, Mallikarjun SB, Kiran S, Wilson B. 'Triplication' defect in deciduous teeth: an unusual odontogenic anomaly. BMJ Case Rep 2015; 2015:bcr-2014-205185. [PMID: 25743857 DOI: 10.1136/bcr-2014-205185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Developmental odontogenic anomalies can occur in primary as well as in permanent dentition leading to morphological variations in shape, size and structure and numerical variations such as hypodontia. The most commonly reported odontogenic anomaly in primary dentition is conjoined teeth. Conjoined teeth can be due to fusion or gemination. Relevant clinical and radiographic evaluation is a must to differentiate between the two. Occurrence of double fusion as an anomaly may not be infrequent, but triple fusion is a rare odontogenic anomaly. We report a case of a 7.5-year-old girl who clinically had a large crown due to triple fusion in her dentition, between two normal primary teeth and a supernumerary tooth. This paper gives a brief insight into the incidence, associated quandaries and diagnosis and treatment modalities of a triple fusion.
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Affiliation(s)
- Srinivas L Shanthraj
- Department of Pedodontics and Preventive Dentistry, Coorg Institute of Dental Sciences, Virajpet, Karnataka, India
| | - Shanthala B Mallikarjun
- Department of Pedodontics and Preventive Dentistry, Coorg Institute of Dental Sciences, Virajpet, Karnataka, India
| | - Shital Kiran
- Department of Pedodontics and Preventive Dentistry, Karnavati School of Dentistry, Gandhinagar, Gujarat, India
| | - Bobby Wilson
- Department of Pedodontics and Preventive Dentistry, Coorg Institute of Dental Sciences, Virajpet, Karnataka, India
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Cho KM, Jang JH, Park SH. Clinical management of a fused upper premolar with supernumerary tooth: a case report. Restor Dent Endod 2014; 39:319-23. [PMID: 25383352 PMCID: PMC4223103 DOI: 10.5395/rde.2014.39.4.319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022] Open
Abstract
In dentistry, the term 'fusion' is used to describe a developmental disorder of dental hard tissues. In the permanent dentition, fusion of a normal tooth and a supernumerary tooth usually involves the incisors or canines. However, a few cases of fusion involving premolars have also been reported to date. We present a rare case in which fusion of the maxillary left second premolar and a supernumerary tooth in a 13-year-old girl was diagnosed using cone beam computed tomography (CBCT, Alphard-3030, Asahi Roentgen Ind. Co., Ltd.). The tooth was bicuspidized after routine nonsurgical root canal treatment, and the separated teeth underwent appropriate restoration procedures. The second premolar and supernumerary tooth remained asymptomatic without any signs of inflammation after a follow-up period of 9 years. Identification of anatomical anomalies is important for treatment in cases involving fusion with supernumerary tooth, and therefore the microscopic examinations and CBCT are essential for the diagnosis. Fused teeth can be effectively managed by the comprehensive treatment which includes both endodontic and periodontal procedures.
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Affiliation(s)
- Kyu-Min Cho
- Program in Conservative Dentistry, Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Ji-Hyun Jang
- Department of Conservative Dentistry, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
| | - Sang-Hyuk Park
- Department of Conservative Dentistry, Kyung Hee University School of Dentistry and Oral Biology Research Institute, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
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15
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Ghogre P, Gurav S. Non-invasive endodontic management of fused mandibular second molar and a paramolar, using cone beam computed tomography as an adjunctive diagnostic aid: A case report. J Conserv Dent 2014; 17:483-6. [PMID: 25298654 PMCID: PMC4174713 DOI: 10.4103/0972-0707.139849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/22/2014] [Accepted: 06/25/2014] [Indexed: 11/17/2022] Open
Abstract
Tooth fusion is a developmental anomaly characterized by the union between the dentin and/or enamel of at least two separately developing teeth. Fusion is a rare occurrence, with overall prevalence to be approximately 0.5% in deciduous teeth and 0.1% in permanent dentition. The significance of this particular case was that the unilateral fusion occurred in a permanent mandibular second molar with a paramolar and successful endodontic management was done. The rarity with which this entity appears, along with its complex characteristics, often makes it difficult to treat. In this case, a new advanced three-dimensional imaging Cone Beam Computed Tomography (CBCT) was used as an adjunctive diagnostic aid to differentiate between fusion occurred before or after root formation and help to reach the correct diagnosis.
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Affiliation(s)
- Priyanka Ghogre
- Department of Conservative Dentistry and Endodontics, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Sandeep Gurav
- Department of Prosthodontics, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
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16
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The multidisciplinary management of fused maxillary lateral incisor with a supernumerary tooth in cleft lip adolescence. Case Rep Dent 2014; 2014:459416. [PMID: 24516763 PMCID: PMC3910257 DOI: 10.1155/2014/459416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/02/2013] [Indexed: 12/22/2022] Open
Abstract
Fusion, an uncommon anomaly of the hard dental tissues, is potentially the cause of clinical problems related to esthetics, tooth spacing, and other periodontal complications. This paper describes a multidisciplinary approach involving surgical, endodontic, restorative, and orthodontic attention for the successful, functional, and esthetic rehabilitation of a maxillary left lateral incisor fused with a supernumerary tooth in unilateral cleft lip adolescence in contralateral side. After clinical and radiographic examinations, a fusion between the left maxillary lateral incisor and a supernumerary tooth was diagnosed in the patient, and a small connection was detected between the pulp systems of the two root canals. The case reported in this paper presents the successful resolution of a fused maxillary lateral incisor with a supernumerary tooth, using endodontic, surgical, restorative, and orthodontic management. The decision made in extracting or retaining the fused tooth depends on the arch discrepancy and esthetic needs. Future studies, with long-term followup, will be helpful in evaluating the long-term efficacy of the different treatment options.
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Multidisciplinary management of a fused tooth: a case report. Case Rep Dent 2014; 2013:634052. [PMID: 24396611 PMCID: PMC3874312 DOI: 10.1155/2013/634052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 11/10/2013] [Indexed: 11/26/2022] Open
Abstract
Objective. Fusion is a dental anomaly that arises through the union of two adjacent teeth. The case report presents multidisciplinary management of a fused maxillary anterior tooth. Case Report. A 10-year-old boy was referred to the pediatric dental clinic with the chief complaint of a large upper anterior tooth. Intraoral and radiographic examinations indicated fusion between the permanent maxillary right central incisor and a supernumerary tooth. According to the treatment plan, the fused tooth was sectioned, and the mesial portion was removed. The remaining tooth section was restored with composite resin, and the diastema between the central incisors was closed with orthodontic treatment. After an 18-month followup period, the tooth showed no sign of pathosis. Conclusion. The technique described here offers a simple and effective method for restoring a fused tooth that reestablishes function, shape, and esthetics.
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Gupta SK, Gupta J, Acharya SR, Ather A. Mandibular lateral incisor with four root canals: A unique case of double tooth diagnosed using multidetector computed tomography. Imaging Sci Dent 2013; 43:123-8. [PMID: 23807937 PMCID: PMC3691373 DOI: 10.5624/isd.2013.43.2.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/13/2012] [Accepted: 08/12/2012] [Indexed: 12/03/2022] Open
Abstract
Double tooth is a dental anomaly consequent to fusion of two or more teeth or gemination of a single tooth. This report describes a unique case of double tooth in relation to a mandibular lateral incisor exhibiting the presence of four root canals. The role of conventional radiography and advanced three-dimensional imaging techniques in the better assessment of complex root canal systems and their aid in endodontic management has also been highlighted.
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Affiliation(s)
- Sunil Kumar Gupta
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Manipal, India
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19
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Karjodkar FR, Mali S, Sontakke S, Sansare K, Patil DJ. Five developmental anomalies in a single patient: a rare case report. J Clin Diagn Res 2013; 6:1603-5. [PMID: 23285473 DOI: 10.7860/jcdr/2012/4174.2576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 09/11/2012] [Indexed: 11/24/2022]
Abstract
Developmental dental anomalies are marked deviations from the normal colour, contour, size, number, and the degree of the development of teeth. Local as well as systemic factors may be responsible for these developmental disturbances. Such influences may begin before or after birth and hence the deciduous or the permanent teeth may be affected. These anomalies not only affect the aesthetic appearance of the teeth but also pose difficulties during the dental treatment and sometimes are the cause of dental problems.A rare case of dental developmental fusion of the permanent right lateral incisor with two supernumerary teeth, with dens invagination, dilacerations, talon's cusp and a periradicular lesion reported to the Department of Oral Medicine and Radiology, NHDC.The clinical and the radiographical findings led to the diagnosis of fusion of the permanent lateral incisor with two supplementary teeth. All the 3 involved teeth showed dens invaginatus, dilacerations of the roots and a talons cusp with a chronic periapical lesion.The rarity with which this entity appears, along with its complex characteristics, often makes it difficult to treat. A multidisciplinary approach, with different specialists working together, can contribute to the success of a treatment plan.
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Affiliation(s)
- Freny R Karjodkar
- Professor and HOD, Department of Oral Medicine and Radiology, Nair Hospital Dental College , Mumbai-400008, Maharashtra, India
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20
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Abstract
This case report describes the diagnosis and endodontic therapy of maxillary fused second and third molars, using cone-beam computed tomography (CBCT). A 31-year-old Chinese male, with no contributory medical or family/social history, presented with throbbing pain in the maxillary right molar area following an unsuccessful attempted tooth extraction. Clinical examination revealed what appeared initially to be a damaged large extra cusp on the buccal aspect of the distobuccal cusp of the second molar. However, CBCT revealed that a third molar was fused to the second molar. Unexpectedly, the maxillary left third molar also was fused to the second molar, and the crown of an unerupted supernumerary fourth molar was possibly also fused to the apical root region of the second molar. Operative procedures should not be attempted without adequate radiographic investigation. CBCT allowed the precise location of the root canals of the right maxillary fused molar teeth to permit successful endodontic therapy, confirmed after 6 months.
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21
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Abstract
BACKGROUND Abnormally, large teeth are often referred to as 'double teeth'. These can pose numerous challenges for the clinician. There is no published protocol on the management of double teeth. AIM To review the published literature and also patients managed at the Eastman Dental Hospital (EDH) and to develop a clinical protocol for the management of double teeth in children and adolescents. DESIGN Literature was searched (Medline and Embase) and data collated. Patient notes of cases managed at the EDH were reviewed. RESULTS Eighty-one teeth from 53 papers and 22 patients were included in the review. Success criteria were only reported in 32 papers and were variable. Twenty-three papers had no follow-up period. The main factor in determining the management of a double tooth was root and root canal system morphology. The treatment of choice in teeth with separate roots was hemisection and in those with a single root was crown modification or extraction. CONCLUSION It was not possible to determine the best management strategies because of the variable reporting in the literature. The authors have proposed a protocol for management and a data collection sheet for essential information needed when reporting on double teeth cases.
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22
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Endodontic management of mandibular second molar fused to a supernumerary tooth, using spiral computed tomography as a diagnostic aid: a case report. Case Rep Dent 2012; 2012:614129. [PMID: 22900210 PMCID: PMC3415096 DOI: 10.1155/2012/614129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 06/26/2012] [Indexed: 11/22/2022] Open
Abstract
Fusion is a developmental anomaly characterized by the union of two adjacent teeth. In this paper we report a rare case of fusion involving permanent mandibular second molar with supernumerary tooth. The rarity with which this entity appears, along with its complex characteristics, often makes it difficult to treat. The use of high-end diagnostic imaging modalities such as spiral computed tomography can help the clinician in making a confirmatory diagnosis and determining the treatment plan before undertaking the actual treatment. In the present case, we have used spiral computed tomography (SCT) for better understanding the complicated root canal morphology of the fused tooth and successful management of this rare case.
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23
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Kulkarni VK, Ragavendra TR, Deshmukh J, Vanka A, Duddu MK, Patil AKG. Endodontic treatment and esthetic management of a primary double tooth with direct composite using silicone buildup guide. Contemp Clin Dent 2012; 3:S92-5. [PMID: 22629077 PMCID: PMC3354813 DOI: 10.4103/0976-237x.95114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation.
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Affiliation(s)
- Vinaya Kumar Kulkarni
- Department of Pedodontics and Preventive Dentistry, Modern Dental College and Research Centre, Indore, India
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24
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Sachdeva GS, Malhotra D, Sachdeva LT, Sharma N, Negi A. Endodontic management of mandibular central incisor fused to a supernumerary tooth associated with a talon cusp: a case report. Int Endod J 2012; 45:590-6. [PMID: 22394311 DOI: 10.1111/j.1365-2591.2012.02029.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To report the successful non-surgical endodontic management of a mandibular central incisor fused to a supernumerary tooth associated with a talon cusp. SUMMARY Fusion and gemination are developmental anomalies of teeth that may require endodontic treatment. In this article, a case of successful endodontic management of a permanent mandibular right central incisor fused to its supernumerary counterpart associated with a talon cusp is reported. The incidence of fusion in mandibular anteriors is rare. A search of the literature failed to reveal any reports on the fusion of a permanent mandibular central incisor with its supernumerary counterpart associated with a talon cusp. Successful non-surgical endodontic management of a case is reported. KEY LEARNING POINTS • Fused and geminated teeth requiring endodontic treatment present diagnostic and technical challenges. • An exact differentiation between fusion and gemination may not be critically important for treatment. • The use of an operating microscope for detection of additional root canal orifices in complicated cases is recommended.
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Affiliation(s)
- G S Sachdeva
- Department of Conservative Dentistry and Endodontics, Himachal Dental College and Hospital, District Mandi, Himachal Pradesh, India.
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25
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Abstract
The union of two different dental sprouts which can happen in any phase of dental development is commonly called fusion. This developmental anomaly may cause clinical problems including esthetic impairment, which are mainly treated by endodontic and surgical treatments. There are a few reports of conservative not invasive treatment of fused incisors teeth through restorative or prosthetic techniques. They are rarely reported in mandibular posterior teeth. This paper presents an unusual case of fusion of 7 and 8, and also 9 and 10 teeth which was treated with a nonendodontic and nonsurgical conservative approach. Patient was a healthy18-year-old female with chief complaint of bad-looking teeth that in intraoral examination revealed the fusion of 7 and 8, and also 9 and 10 teeth. The space between the mesial of the 6 and 11 teeth was reconstructed. Diastema between the fused teeth was closed. A new lateral tooth was replaced between the fused teeth (7 and 8) and 6 tooth with direct fiber-reinforced composite. The space between the fused teeth (9 and 10) and also tooth 11 was partially closed. Gingival papillas were reconstructed using pink composite. The mandibular anterior missing teeth were replaced with rochett bridge. At the end of treatment the esthetic of the patient was improved. As the treatment was not invasive, major complications are not expected; however, there is potential for eventual long-term periodontal problems due to poor oral hygiene. Debonding of the rochett bridge may happen as well.
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Affiliation(s)
- Pouran Samimi
- Department of Operative Dentistry and Torabinejad Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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26
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Baratto-Filho F, Leonardi DP, Crozeta BM, Baratto SP, Campos EA, Tomazinho FSF, Deliberador TM. The challenges of treating a fused tooth. Braz Dent J 2012; 23:256-62. [DOI: 10.1590/s0103-64402012000300013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 04/13/2012] [Indexed: 11/22/2022] Open
Abstract
This paper describes and discusses the multidisciplinary treatment involving a permanent maxillary lateral incisor fused to a supernumerary tooth, both presenting pulp necrosis and periapical lesion. A 15-year-old male patient sought treatment complaining of pain, swelling and mobility on the maxillary right lateral incisor. After clinical and radiographic examination, root canal preparation was performed according to the crown-down technique and a calcium hydroxide dressing was placed for 15 days. The patient returned and the definitive endodontic filling was done with thermomechanical compaction of gutta-percha and sealer. After 18 months, clinical and radiographic examinations were carried out and no pain or swelling was reported. Two years after endodontic treatment, the patient returned for periodontal and cosmetic treatments. Nine months later, a cone-beam computed tomography (CBCT) revealed that the previously detected periodontal defect and periapical lesion were persistent. Apical endodontic surgery was indicated. The supernumerary tooth was removed, the communicating distal surface was filled and the surgical site received bioactive glass and demineralized bovine organic bone. The pathological tissue was submitted to histopathological examination and the diagnosis was periapical cyst. One year after the apical endodontic surgery, CBCT showed bone formation at maxillary lateral incisor apical area. Two years after the surgery, the restoration was replaced due to aesthetic reasons and periapical radiograph showed success after 5 years of treatment. A correct diagnosis and establishment of an adequate treatment plan resulted in a successful management of the case.
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27
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Kim SY, Choi SC, Chung YJ. Management of the fused permanent upper lateral incisor: a case report. ACTA ACUST UNITED AC 2011; 111:649-52. [PMID: 21333564 DOI: 10.1016/j.tripleo.2010.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 11/14/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Fusion is the embryologic union of normally discrete structures. The treatment of this anomaly usually requires a multidisciplinary approach. Cone-beam computerized tomography (CBCT) is more common in dentistry and provides valuable information on fused teeth, allowing us to confirm its 3-dimensional structure and precise 3-dimensional cutting-plane line, which is very important to prevent pulp exposure in the conserved tooth. STUDY DESIGN An 8-year-old boy presented with a permanent maxillary left lateral incisor fused with a supernumerary tooth. Hemisection was delayed until the pulp chamber separated. We used CBCT to decide the separation time and a precise 3-dimensional cutting plane line to avoid pulp exposure. The abnormally positioned lateral incisor and canine biologically moved to normal positions without orthodontic treatment. RESULTS At 1-year follow-up, there was no esthetic problem, hypersensitivity, periapical pathosis, or external resorption. CONCLUSIONS Hemisection could be selected as an appropriate treatment alternative and more recommended procedure in cases where a permanent tooth is fused with a supernumerary tooth.
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Affiliation(s)
- Sun-Young Kim
- Department of Conservative Dentistry, School of Dentistry, Kyung Hee University, Seoul, South Korea
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28
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Zeylabi A, Shirani F, Heidari F, Farhad AR. Endodontic management of a fused mandibular third molar and distomolar: a case report. AUST ENDOD J 2010; 36:29-31. [PMID: 20377561 DOI: 10.1111/j.1747-4477.2009.00190.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Careful management of fused teeth is essential as abnormal morphology can predispose a tooth to caries and periodontal disease. In this paper, a rare case of successful endodontic management of unilateral mandibular third molar fused to a distomolar is reported. Caries was removed from the tooth complex under local anaesthesia. The pulp chambers of the third molar and supernumerary tooth were accessed and the root canals were prepared using rotary instrumentation and copious irrigation with 2.5% sodium hypochlorite. Obturation using the lateral condensation technique with gutta-percha and AH26 sealer was subsequently performed. A 1-year recall showed a good treatment result.
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Affiliation(s)
- Ali Zeylabi
- Department of Endodontics, Faculty of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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29
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Lucey S, Heath N, Welbury RR, Wright G. Case report: Cone-beam ct imaging in the management of a double tooth. Eur Arch Paediatr Dent 2010; 10 Suppl 1:49-53. [PMID: 19863901 DOI: 10.1007/bf03262702] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnosis and management strategies of double teeth have largely relied on clinical examination and conventional radiographic findings. Cone-Beam Computed Tomography (Cone-beam CT) was developed in the late 1990's and, therefore, is a relatively recent addition to the imaging armamentarium for use in Maxillofacial Radiology. There have been no publications in the dental literature demonstrating the use of Cone-beam CT or 3D stereolithography in the diagnosis and surgical planning of the management of double teeth. CASE REPORT An 11 year old girl presented with a double left lateral maxillary incisor. Conventional plain film radiography failed to provide the requisite information for pre-operative planning. Cone-beam Computed Tomography (Cone-beam CT) allowed determination of location of fusion, three-dimensional (3D) visualisation of pulpal anatomy and the construction of a 3D stereolithographic model for surgical planning. The double tooth was surgically divided in situ under local analgesia. The redundant distal unit was extracted and the residual mesial unit built up in composite resin following physiological mesial drift of displaced maxillary left canine. No endodontic therapy was required. FOLLOW-UP At a 10-month follow-up visit, clinical and radiographic vitality and success was noted. CONCLUSION The great amount of radiological information which Cone-beam CT can offer not only improves pre-operative and surgical planning, but the 3D models provided can be used to further educate and inform patients and guardians in the management of double teeth.
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Affiliation(s)
- S Lucey
- Dept. Paediatric Dentistry, University of Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow, Scotland
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30
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Ozalp SO, Tuncer BB, Tulunoglu O, Akkaya S. Endodontic and orthodontic treatment of fused maxillary central incisors: a case report. Dent Traumatol 2008; 24:e34-7. [PMID: 18557749 DOI: 10.1111/j.1600-9657.2008.00635.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this case report was to describe combined endodontic and orthodontic treatment of a patient who had permanent maxillary central incisors fused with supernumerary teeth. A severe esthetic problem and crowding in the maxillary arch were present clinically. Radiographic examination demonstrated two separate crowns, roots and pulpal canals on each side. The therapy was initiated with endodontic treatment. Six months after the completion of endodontic therapy, mesio-distal trimming was performed and the defects were restored with anterior resin composites in order to re-establish the esthetics. Orthodontic treatment was performed for the alignment of the upper arch. Follow-up at 4 years demonstrated that the teeth were asymptomatic and neither root nor alveolar bone resorption was found. In conclusion, instead of extracting the supernumerary teeth, the anomaly was treated successfully in a conservative way.
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Affiliation(s)
- Serife Ozdemir Ozalp
- Department of Paediatric Dentistry, Faculty of Dentistry, University of Gazi, Ankara, Turkey
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31
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Sivolella S, Bressan E, Mirabal V, Stellini E, Berengo M. Extraoral endodontic treatment, odontotomy and intentional replantation of a double maxillary lateral permanent incisor: case report and 6-year follow-up. Int Endod J 2008; 41:538-46. [PMID: 18363700 DOI: 10.1111/j.1365-2591.2008.01391.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY Double tooth is a dental irregularity consequent to fusion of two or more teeth or dental gemination. The teeth most commonly involved are deciduous, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, functional and periodontal problems can result. This paper reports a clinical case of a double tooth in the position of the maxillary right lateral permanent incisor. Combined orthodontic, endodontic and surgical treatment (intentional replantation) allowed the tooth to be retained without periodontal compromise and with a positive orthodontic result both immediately and 6 years following intervention. *A conservative approach that addresses periodontal, pulpal and tooth tissues, can result in the retention of a double tooth. *Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective.
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Affiliation(s)
- S Sivolella
- Department of Oral Surgery, University of Padova, Institute of Clinical Dentistry, Padova, Italy.
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32
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Cetinbas T, Halil S, Akcam MO, Sari S, Cetiner S. Hemisection of a fused tooth. ACTA ACUST UNITED AC 2007; 104:e120-4. [PMID: 17656128 DOI: 10.1016/j.tripleo.2007.03.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 03/26/2007] [Accepted: 03/27/2007] [Indexed: 11/28/2022]
Abstract
Fusion is a developmental anomaly which occurs due to a union of 1 or more adjacent teeth during morphodifferentiation of the dental germs. The present case report presents the hemisection of a maxillary central incisor fused with a supernumerary tooth. A 10-year-old boy was referred to clinic with the chief complaint of the presence of a large anterior tooth. Intraoral and radiographic investigations indicated fusion between the left central incisor and a supernumerary tooth. The fused tooth was separated with a diamond bur, and the supernumerary tooth was extracted. The left central incisor was restored with composite resin and the diastema between the maxillary central incisors was closed with orthodontic treatment. The left central incisor was still healthy after a follow-up examination period of 24 months. An ideal overjet and overbite relation was achieved at the end of the orthodontic treatment. Hemisection can be considered as an appropriate treatment alternative for a permanent tooth fused with a supernumerary tooth.
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Affiliation(s)
- Tugba Cetinbas
- Department of Pedodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey.
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33
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Ballal S, Sachdeva GS, Kandaswamy D. Endodontic management of a fused mandibular second molar and paramolar with the aid of spiral computed tomography: a case report. J Endod 2007; 33:1247-51. [PMID: 17889700 DOI: 10.1016/j.joen.2007.06.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 06/10/2007] [Accepted: 06/22/2007] [Indexed: 01/12/2023]
Abstract
Fusion and gemination are developmental anomalies of the dental hard tissues that might require endodontic and surgical treatment for functional, orthodontic, or esthetic reasons. In this article, we report a rare case of successful endodontic management of unilateral fused mandibular second molar with a paramolar. The rarity with which this entity appears, along with its complex characteristics, often makes it difficult to diagnose and treat. The use of high-end diagnostic imaging modalities such as spiral computed tomography can help the clinician in making a confirmatory diagnosis and determining the treatment plan before undertaking the actual treatment. This case report highlights the usefulness of spiral computed tomography in accurate diagnosis and endodontic management of these unusual cases.
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Affiliation(s)
- Suma Ballal
- Department of Conservative Dentistry & Endodontics, Meenakshi Ammal Dental College & Hospital, Chennai, Tamil Nadu, India
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34
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Hong HH, Tsai AI, Liang CH, Kuo SB, Chen CC, Tsai TP, Lu CF. Preserving pulpal health of a geminated maxillary lateral incisor through multidisciplinary care. Int Endod J 2006; 39:730-7. [PMID: 16916363 DOI: 10.1111/j.1365-2591.2006.01150.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To report the multidisciplinary care of an unaesthetic geminated maxillary lateral incisor tooth, which allowed its preservation in the mouth. SUMMARY Preoperative examination of an unsightly geminated maxillary lateral incisor (tooth 22) demonstrated two pulp chambers and open apices, with normal pulp sensitivity responses. At surgery, a periodontal mucoperiosteal flap was reflected and the distal part of the geminated tooth was removed. The exposed root canal of the preserved tooth was sealed with mineral trioxide aggregate (MTA). The extraction socket and osseous defect was grafted with decalcified freeze-dried bone allograft (DFDBA) before flap closure. During follow-up, distal caries in tooth 22 and a diastema between tooth 22 and 23 were managed with composite resin restorations. Forty-two months postoperatively, normal thermal and electrical pulp sensitivity tests confirmed pulp health. Convincing apexogenesis and dentinogenesis of the developing root was confirmed by radiographic examination. Acceptable periodontal health including 3-4 mm clinical probing depths was achieved. Optimizing aesthetics and occlusion was accomplished without orthodontic treatment.
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Affiliation(s)
- H-H Hong
- Division of Periodontics, Chang Gung Memorial Hospital Lin-Kou Medical Center, Gueishan, Taiwan
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35
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Reiter AM, Lewis JR, Rawlinson JE, Gracis M. Hemisection and partial retention of carnassial teeth in client-owned dogs. J Vet Dent 2006; 22:216-26. [PMID: 16494269 DOI: 10.1177/089875640502200401] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nine client-owned dogs presented with periodontally and/or endodontically involved mandibular or maxillary carnassial teeth that were either individually affected or adjacent to a jaw fracture. A total of 10 teeth were hemisected (8 mandibular first molar teeth and 2 maxillary fourth premolar teeth), and one crown-root segment was extracted for each tooth. Gingival tissues were approximated and sutured over the extraction sites, and the retained tooth portions were treated by means of standard root canal therapy or vital pulp therapy followed by standard root canal therapy. Retained crown-root segments of 2 of the 10 hemisected teeth were extracted following short- and long-term postoperative examinations due to continued periodontal complications. It was concluded that resection of a portion of a tooth can be a useful treatment for periodontally and/or endodontically involved carnassial teeth that are affected individually or located adjacent to a jaw fracture in dogs.
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Affiliation(s)
- Alexander M Reiter
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, School of Veterinary Medicine, Philadelphia 19104-6010, USA.
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36
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Ghoddusi J, Zarei M, Jafarzadeh H. Endodontic treatment of a supernumerary tooth fused to a mandibular second molar: a case report. J Oral Sci 2006; 48:39-41. [PMID: 16617200 DOI: 10.2334/josnusd.48.39] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Since abnormal tooth morphology can predispose to caries and periodontal disease, careful management of fused teeth is essential. In this paper we report a rare case of a fused molar and supernumerary tooth and describe its management. Caries was removed from the tooth complex under local anesthesia. The pulp chamber of the supernumerary tooth was exposed without involvement of second molar pulp chamber. The root canal of the supernumerary tooth was prepared using the step back technique and copious irrigation with 2.6% sodium hypochlorite. Obturation using the lateral condensation technique with gutta-percha and AH26 sealer was subsequently performed and final restoration was accomplished with composite resin. Nine months after the treatment, no clinical or radiographic concern is apparent, and the second molar tooth has remained vital.
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Affiliation(s)
- Jamileh Ghoddusi
- Department of Endodontics, Faculty of Dentistry, Mashad University of Medical Sciences, Iran. jamileh_ghoddusi@yahoo
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37
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Onçag O, Candan U, Arikan F. Comprehensive therapy of a fusion between a mandibular lateral incisor and supernumerary tooth: case report. Int Dent J 2005; 55:213-6. [PMID: 16167609 DOI: 10.1111/j.1875-595x.2005.tb00318.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The term fusion is used to define a developmental anomaly characterised by the union of two adjacent teeth. In the case reported here, clinical and radiographic examinations suggested a unilateral fusion between the mandibular left permanent incisor and a super-numerary tooth. Radiographs showed that the fused teeth had two distinct pulp chambers and canals. A diagnosis of chronic periapical abscess of the supernumerary tooth was made. Before root canal therapy, a periodontal surgical procedure was performed to section the central incisor and its fused supernumerary. Also, odontoplasty was performed on the roots, to establish an anatomy consistent with a normal central incisor. Later, the chronic apical abscess on the supernumerary tooth was instrumented chemo-mechanically, root canal filling was performed and an anterior composite resin restoration was placed. The patient was evaluated for one year after root canal therapy. The tooth was asymptomatic, not exhibiting any pathological root resorption or alveolar resorption, and the anterior composite restoration was intact. Instead of extracting the supernumerary tooth, the application of endodontic, periodontal, and restorative procedures proved to be an alternative treatment.
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Affiliation(s)
- Ozant Onçag
- Ege University, Faculty of Dentistry, Department of Pedodontics, Bornova-lzmir, Turkey.
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Abstract
AIM A geminated maxillary incisor required complex multidisciplinary treatment to preserve health and restore aesthetics. This report describes the coordination of coronal division, root extraction, bone grafting, endodontic treatment and orthodontics in achieving treatment goals. It is the intention of this report to show how a difficult case could be managed by properly coordinated multidisciplinary care. SUMMARY Pulp testing of the geminated central right maxillary incisor gave a normal response. Radiographic investigation indicated a connection of the pulp chambers. Both the mesial and distal root were filled with gutta-percha. The connection between the two root canals was sealed with a flowable dentine-bonded resin. After dividing the crown with a diamond bur, the mesial part of the tooth was removed and the extraction socket was filled with beta-tricalcium phosphate ceramic (Cerasorb). Radiographs taken immediately after surgery and after 6 months showed no periodontal or periapical lesions. No signs of external resorption were identified. The diastema between the central incisors was closed by orthodontic treatment. KEY LEARNING POINTS Geminated teeth may present aesthetic and functional problems which require multidisciplinary care. Careful clinical and radiographic examination is essential to decide on the fate of the coronal and root halves involved. A proper coordination between endodontic and surgical treatment may result in maintaining one tooth half, even if a midroot connection between the pulp chambers becomes evident. Orthograde endodontic treatment, hemisection and orthodontics may solve the aesthetic problem of a geminated tooth.
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Affiliation(s)
- A Braun
- Department of Operative Dentistry and Periodontology, University of Bonn, Welschnonnenstr. 17, D-53111 Bonn, Germany.
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Nunes E, de Moraes IG, de Novaes PMO, de Sousa SMG. Bilateral fusion of mandibular second molars with supernumerary teeth: case report. Braz Dent J 2003; 13:137-41. [PMID: 12238806 DOI: 10.1590/s0103-64402002000200012] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fusion is a developmental anomaly characterized by the union of two adjacent teeth. In this article we report a rare case of bilateral fusion of permanent mandibular second molars with supernumerary teeth. The rarity with which this entity appears, along with its complex characteristics, often make it difficult to treat. The endodontic management of one tooth is described, as well as the successful treatment of a periradicular lesion.
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Affiliation(s)
- Eduardo Nunes
- Department of Endodontics, Pontificial Catholic University, Belo Horizonte, MG, Brazil
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Aryanpour S, Bercy P, Van Nieuwenhuysen JP. Endodontic and periodontal treatments of a geminated mandibular first premolar. Int Endod J 2002; 35:209-14. [PMID: 12019492 DOI: 10.1046/j.1365-2591.2002.00464.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To describe a rare case of gemination involving a mandibular first premolar. SUMMARY The complex morphology of geminated teeth renders their endodontic and periodontal management difficult. Root canal and periodontal treatments were performed on a geminated mandibular first premolar with three canals. Clinical examination showed two separated crowns with united roots. Radiographically, two distinct pulp chambers with two joined and a third independent canal were seen. Conventional root canal treatment resulted in complete healing of the apical lesion. However, the occurrence of a vertical fracture led to the extraction of the mesial segment. At the follow-up visit, the distal segment was clinically healthy and continued to satisfy functional demands.
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Affiliation(s)
- S Aryanpour
- Department of Dental Medicine and Stomatology, Université Catholique de Louvain, Brussels, Belgium
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