The challenges of treating a fused tooth

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.

Root canal treatment of a fused mandibular incisor using cone-beam computed tomography as a diagnostic aid

“…As shown in the present study, CBCT could be used in these more complex cases, providing dentists with highly accurate three-dimensional anatomical information of the maxilla, mandible, teeth, and supporting structures. [4811]…”

“…[48] Radiographs provide two-dimensional images of three-dimensional structures, resulting in superimposed images. [79] Cone-beam computed tomography (CBCT), in turn, without extra scanning time, offers multiplanar or three-dimensional reconstructions of conventional transaxial computed tomographic images.…”

“…[410] This technology enables the reconstruction of overlapping structures at different slice thicknesses and allows to accurately distinguish small anatomical features. [8911]…”

Management of Fused Tooth with Localized Gingival Growth - A Rare Entity

“…Knowledge of the morphological and anatomical characteristics of the root canal system is the key to ensure a successful treatment. [11,12] The morphology of fusion has to be differentiated from similar developmental anomalies of the tooth for successful endodontic and esthetic management. A suggested scheme of classification is as follows:…”

Clinical management of fused and infected mandible canine and incisor

“…In cases in which the presence of these isthmuses is suspected, it is important to try to clean these narrow cavities, which might contain tissue and biofilm, the best as possible, and use a filling technique that not only plasticizes gutta-percha, but also generates pressure on the filling material causing it to enter into these ramifications. 16,17 The diagnosis of fused teeth allows planning a specific therapeutic approach for these cases. This includes debridement and irrigation with sodium hypochlorite and the use of ultrasound to allow the penetration of NaOCl into isthmuses communicating canals.…”