Concrescence: can the teeth involved be moved or separated?

Abstract

The atrophy of the periodontal ligament places the tooth very close to the bone or another tooth, as occurs in unerupted teeth. The absent interdental bone and the lack of functional periodontal stimulus may lead to the fusion of the appositional layers of cement between the roots of the teeth. Concrescence almost always occurs in the region of the maxillary molars. Asymptomatic, it should always be remembered when the proper response to orthodontic movement is not obtained, and there is no apparent explanation. When surgically extracting a tooth and there is resistance, insisting will not be the best strategy. Moving the teeth with concrescence is not convenient, as it requires very intense forces. Once separated, these teeth can be considered normal for movement. It is possible to separate two teeth presenting concrescence, but it depends on the extension of the area, the surgical access and, especially, the clinical convenience. The tooth to be extracted will be repaired with new cement deposited in the sectioned area. The simple separation with the maintenance of the proximity and the lack of function of one of the teeth will cause a new concrescence. After a period of 1 to 3 months, the separated teeth are biologically prepared to be moved. The most important detail in this separation of teeth presenting concrescence is that the diagnosis should be made in advance, and not at the time of the intervention.

Concrescence of the right maxillary second and third molars: A case report

“…However, Consolaro et al suggested that inflammation caused by trauma or microbial contamination often leads to adhesion of the alveolar bone or root resorption rather than concrescence. 9 …”

“…Moreover, the continuously deposited cementum can result in the fusion with the adjacent teeth and even cause bone lesions. However, Consolaro et al suggested that inflammation caused by trauma or microbial contamination often leads to adhesion of the alveolar bone or root resorption rather than concrescence 9 …”

“…For example, in the case of a disorder in the differentiation and function of osteoclasts, there may be a tooth eruption failure due to the tooth's adhesion to the surrounding bone. According to Consolaro et al, 9 the Malassez epithelial rest in the periodontal ligament continuously releases epidermal growth factors (EGFs), thus affecting the periodontal space. Furthermore, owing to the existence of EGF receptors in osteoblasts and its absence in cementum cells, EGF in periodontal ligament stimulates bone resorption on the surface of the alveolar bone, but not the cementum.…”

“…The absence of interdental bone and lack of stimulation of periodontal function can lead to the union at the same level of cementum between the roots of two teeth, even between the roots of one tooth in some cases. 9 In case of encountering two pre‐cementum (cementoid) layers that have not yet been mineralized, similar to two "cemented" layers, there may be union and mineralization in both layers, eventually forming concrescence. According to the observation of the histological sections, it is possible to observe an increase in the cellular cementum and increased Salter lines in the cemental–cemental junction.…”

“…Similarly, when one of the two adjacent teeth has no significant periodontal activity due to the failure of eruption or infraocclusion, there may be a gradual shrinkage of the bone between teeth and gradual deposition of the cementum, which gets closer to the root of the other tooth. The absence of interdental bone and lack of stimulation of periodontal function can lead to the union at the same level of cementum between the roots of two teeth, even between the roots of one tooth in some cases 9 . In case of encountering two pre‐cementum (cementoid) layers that have not yet been mineralized, similar to two "cemented" layers, there may be union and mineralization in both layers, eventually forming concrescence.…”