Extraoral endodontic treatment, odontotomy and intentional replantation of a double maxillary lateral permanent incisor: case report and 6‐year follow‐up

Abstract

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.

The challenges of treating a fused tooth

“…The incidence of fusion in permanent supernumerary teeth is 0.1% and it generally involves maxillary anterior teeth, just as the case presented here (8). Unilateral incidence is about 0.5% in primary dentition and 0.1% in permanent dentition (7,9).…”

“…Tooth fusion in the permanent dentition is less frequent than in the primary dentition, occurring particularly in incisors and canines (7). The incidence of fusion in permanent supernumerary teeth is 0.1% and it generally involves maxillary anterior teeth, just as the case presented here (8).…”

“…In the present case, CBCT was performed to have a more detailed view of the complex root canal system morphology since CBCT enables threedimensional image reconstruction (11). Case reports have described the multidisciplinary treatment of fused permanent teeth, comprising extraction, endodontic treatment, tooth mesiodistal dimension reduction followed by orthodontic treatment, tooth hemisection, and intentional replantation (7,12). In this case, endodontic treatment was performed and an apical surgery was necessary.…”

Endodontic and Esthetic Management of Maxillary Lateral Incisor Fused to a Supernumerary Tooth Associated with a Talon Cusp by Using Spiral Computed Tomography as a Diagnostic Aid: A Case Report

“…On literature review, there are several reports concerning dens evaginatus (7-10) and dental fusion (11)(12)(13)(14)(15)(16)(17)(18); concurrence of dens evaginatus and dental fusion in the same tooth is a rarity (19,20).…”

Intentional Replantation: A Procedure as a Last Resort

“…For RCT of teeth with certain anatomical malformations such as radicular groove or double teeth. [44][45][46] 15. Maintenance of the alveolar bone.…”