Endodontic treatment of dental formation anomalies

Abstract

Purpose: Dental fusion is defined as the union of two dental germs at some stage of their development. The aim of this article is to report the endodontic treatment of two clinical cases of dental fusion. Case description: In the first case, the patient was referred by an orthodontist for endodontic treatment of tooth 12, which was fused to 13. Surgical separation and later replacement of the involved elements in the dental arch was indicated. In the second case, the patient sought dental attendance due to spontaneous pain. In the radiographic exam, gemination in tooth 11 and fusion of 21 with a supernumerary tooth was observed. The fused teeth were endodontically treated, and patients were referred to other dental specialties to reestablish esthetics and function. Conclusion: The dentist must be able to diagnose, differentiate and treat these dental anomalies adequately, with the goal of maintaining patients' oral health.

Incisivo lateral permanente doble

“…Por ello, tal como se evidenció en este reporte, el diagnóstico diferencial puede hacerse con base a la fórmula dentaria normal, a partir de la inspección clínica, mediante el conteo de los dientes de la arcada. Mientras que en la geminación el número de dientes no cambia (17); en la fusión de dos dientes normales, el número está reducido, con un diente menos que lo normal (34). Sin embargo, no hay certeza en el diagnóstico clínico cuando la fusión se da entre un germen dental normal y un supernumerario (27).…”

Endodontic Management of Dilacerated Maxillary Central Incisor fused to a Supernumerary Tooth using Cone Beam Computed Tomography: An Unusual Clinical Presentation

“…The physical forces that are formed during development may cause contact between the tooth germs, thereby resulting in necrosis of the epithelium between them, leading to fusion. 11,16 Other possible causes are lack of space between the tooth germs during development, developmental aberrations during morphodifferentiation of the tooth bud, local metabolic disturbances, viral infection during pregnancy, thalidomide intake during pregnancy, and genetic inheritance. 12,17 Despite the fact that fusion and gemination are two different entities, it is often difficult to differentiate clinically, especially in cases of fusion between a permanent tooth and supernumerary tooth.…”

“…3 Clinically, gemination most often presents two crowns, whereas the fused teeth possess large crown with radiographic one or two pulp chambers and root canals when viewed in the radiograph. 11 When the anomalous fused tooth is considered as one unit, the number of teeth in the arch will be less by one count. In contrast, the dimensions of #11 in our case were symmetric with that of #21 except for a labial tubercle and tooth count was normal.…”

“…Therefore, case history, clinical and radiographic examination are indispensable for accurate diagnosis of the condition. 11 The fused teeth do not require any treatment as they are usually asymptomatic, unless they exhibit interference with occlusion, unacceptable esthetic appearance, and pulpal involvement. 9 Depending on the location and the associated pathology, a comprehensive treatment plan including both the endodontic and periodontal procedures has (can be) been recommended.…”

“…9 Dental fusion is relatively common in maxillary anterior region with predilection to primary dentition (permanent -0.1%; primary -0.5%). [10][11][12] Fused teeth are normally prone to caries and periodontal problems due to the presence of scratches and gaps at the place of union. 13 Recently, limited field of view (FOV) cone beam computed tomography (CBCT) has been recommended following intraoral radiograph as a preoperative imaging modality of choice for the initial treatment of teeth with high probability of extra canal complex morphology.…”