Macrodont management.

UNLABELLED: Macrodontia is an uncommon dental anomaly that can present in both primary and permanent dentition. It has often been reported to occur concomitantly with other dental anomalies and has also been an established clinical characteristic of numerous systemic conditions and syndromes. The following case reports illustrate the challenges of managing macrodont teeth in view of the various treatment options available, as well as the multiple factors that tend to influence each case individually. CLINICAL RELEVANCE: This article highlights the importance of early referral and a multidisciplinary approach to treating patients with dental anomalies.

Surgical resection technique of a fused supernumerary lateral incisor: a clinical report and review of the literature.

This case report presents the surgical and restorative management of a fused supernumerary left lateral incisor. The diagnosis was confirmed using conventional radiographs and CT. The case report discusses the value of CT for evaluation of the root relationships and describes the varied morphology associated with supernumerary incisors, the surgical resection technique, partial pulpotomy, and restoration with composite resin after mechanical exposure of the remaining tooth's pulp.

Fusion of the 2nd maxillary molar with the impacted 3rd molar.

UNLABELLED: Subject matter: The dentist has to deal with complicated cases of fused molars, which are rather rare and morphologically very varied. A wrong or incomplete diagnosis can considerably complicate a planned therapy. CASE REPORT: The authors describe a case of apical periodontal complication of fused teeth that had to be removed surgically. The upper 2nd molar fused with the impacted 3rd molar and was diagnosed for extraction. CONCLUSION: Even a careful diagnostic procedure and X-ray image sometimes may not indicate the exact location and mutual position of the fused teeth. The authors make us aware of the possible occurrence of fused roots, and the necessity to inform the patient ahead of time about the course of endodontic or surgical interventions, possible complications and their removal. They describe the positive influence of PRP (platelet rich plasma) in wound healing. In order to establish the exact indication and therapy, they emphasize the importance of using CT imaging diagnostics or a 3D-CT examination (Fig. 7, Ref. 15).

Orthodontic treatment of bilateral geminated maxillary permanent incisors.

Geminated teeth occur more frequently in the deciduous dentition than in the permanent dentition, with prevalence figures of 0.6% and 0.1%, respectively. Bilateral presentation is rare. A survey of the literature showed that the prevalence estimates for bilateral double teeth range from 0.01% to 0.04% in the deciduous dentition, and 0.05% in the permanent dentition. In this article, we report a rare case of bilateral fusion of the maxillary permanent incisors, discuss possible histogenetic mechanisms related to this anomaly, and explain the treatment management.

Clinical management of a unique case of fusion between supernumerary canine and maxillary first premolar.

Fusion is one of the few developmental disorders that may account for alteration in morphology and number of teeth in the dental arch. This case report presents a unique case of fusion between supernumerary canine and maxillary first premolar, the associated problems, and their comprehensive clinical management.

Gemination or fusion? - challenge for dental practitioners (case study).

Gemination and fusion are anomalies in size, shape and structure of teeth. Gemination more frequently affects the primary teeth, but it may occur in permanent dentitions, usually in the incisor region. Geminated teeth are typically disfigured in appearance due to irregularities of the enamel. Fused teeth can have separated pulpal space, one pulp chamber and two canals or take the form of a large bifid crown with one pulpal space. It is hard to differentiate between fusion and gemination, especially if the supernumerary tooth bud is fused with the adjacent one. Usually, fusion may be differentiated from germination by a reduced number of teeth. An exception is in the unusual case in which the fusion is between a supernumerary tooth and normal tooth. A 20-year-old male referred to us at - "UniDent" - Dental Clinic, Training and Research Center. The patient complained about the large, unusual maxillary central incisors, lip irritation and aesthetic problems. According clinical examination and radiological findings, clinical diagnose was - bilateral germination of central incisors. Several treatment methods have been described in the literature with respect to the different types and morphological variations of fused and geminated teeth, including endodontic, direct\indirect restorative, surgical, periodontal and/or orthodontic treatment. Our patient has demanded for better aesthetics and he choose the treatment option to make two separate PFM crowns. In the beginning of treatment, the length of tooth 11 was 9.5mm, after prosthodontic treatment it has become 11.5mm. For tooth 21, it was 9.9 millimeter and became - 10.8 mm, while the primary width of right central incisor appeared 13.2 millimeter and was narrowed until 10.8 mm. 12.8 mm was the - width of left central incisor, which finally became - 10.4 mm. Despite the considerable number of cases reported in the literature, the differential diagnosis between these abnormalities is very difficult, as well as, to find guideline of proper outcome of treatment therapy of abovementioned abnormalities. That's why, the aesthetic rehabilitation of doubled teeth, has been suggested, to depend upon the patient's desires, but at the same time, avoid treatment plans with aggressive management.

Double Gemination or Fusion of a Permanent Mandibular Second Molar: A Case Report.

Gemination and fusion are developmental conditions affecting the shape of teeth in both primary and permanent dentition. A 12-year-old girl presented for clinical assessment and the examination revealed an unusually shaped mandibular right second molar with irreversible pulpitis. Correlation of the intraoral and radiological appearance of this tooth suggested a diagnosis of either double gemination or fusion. The favourable position of the developing third molar supported early extraction of the abnormal second molar. The present report documents the clinical and radiological presentation of a mandibular second molar with an unusual developmental alteration in shape. Well-timed extraction therapy and good communication may reduce the need for unnecessary, complex treatment.

Management of a supernumerary tooth fused to a permanent maxillary central incisor.

A supernumerary tooth fused to a normal tooth often causes malocclusion and esthetic problems because of malformation and large crown. This requires treatment such as sectioning and extraction of the supernumerary tooth, modification of crown shape by contouring and restoration, or extraction. Moreover, endodontic treatment is often required as part of the procedure since pulp exposure occurs frequently during sectioning and modification of crown shape. The purpose of this paper was to report the case of a supernumerary tooth fused to the permanent maxillary left central incisor in a 9-year-old boy with unilateral (left side) cleft lip and palate and describe its management. After a thorough examination employing X-ray Computed Tomography (CT), the supernumerary tooth was separated from the central incisor at the fusion site and extracted under local anesthesia. No endodontic treatment was performed on the conserved central incisor. The central incisor's rotation was corrected by orthodontic treatment, followed by modification of the crown shape with composite resin. More than 4 years have passed since the first operative treatment, and the central incisor still remains vital. This case shows that a precise diagnosis is important in sectioning a fused tooth, and that CT-based data are very useful in planning treatment.

Orthodontic extrusion in the transitional dentition: a simple technique.

Extrusion of teeth may be necessary in cases of delayed eruption, primary retention, traumatically intruded teeth, or subgingivally fractured teeth. Removable appliances are advantageous, as anchorage is not as tooth-dependant as in the case of fixed appliances. They are cost-effective, operator friendly, and a valuable treatment option to consider in cases where extrusion of anterior teeth in the transitional dentition is necessary. The purpose of this paper was to describe a simple, cost-effective technique using a removable appliance for extrusion of incisors in the transitional dentition.

Concrescence of a maxillary second and third molar.

BACKGROUND: Concrescence is a rare dental anomaly that may be inadvertently diagnosed during a tooth extraction. CASE DESCRIPTION: While extracting a maxillary second and third molar, it became evident that the teeth were attached between the roots. Both teeth were extracted atraumatically and healing was uneventful. CLINICAL IMPLICATIONS: Concrescence may increase the likelihood of certain complications to occur during a tooth extraction. Practitioners should consider concrescence prior to surgery when obtaining informed consent from patients.

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

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.

Endodontic and orthodontic treatment of fused maxillary central incisors: a case report.

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.

[Aplication of demineralized human bone matrix in the surgical dental fusion treatment. Report of a case]. / Aplicación de matriz de hueso humano desmineralizado en el procedimiento quirúrgico de la fusión dentaria. Reporte de un caso.

The purpose of this work is to present a surgical alternative in the treatment of the dental fusions through the placement of demineralized human bone matrix (DHBM) (Grafton Putty)*, immediately after the separation and extraction of the fused tooth to the permanent one. The dental fusion is a dental anomaly of union, that consists in the union of two dental germs during development. It could happen at any of the dental germ evolution stages from the dental sheet or from more advanced processes of differentiation. For the clinical treatment, an allograft of DHBM with osteoinductive and osteoconductive properties was used. This had several factors of bone growth, it allowed the gradual growth of a new bone that helped to correct the bone defects post-extraction and to cover the exposed distal wall of the remaining permanent tooth. The clinic evaluation and the periapical and panoramic radiographies images were used for the clinical control. It can be concluded that the surgical separation and the extraction of the tooth with less anatomical likeness to the contralateral and the placement of the DHBM, represent a surgical treatment alternative of the dental fusion.

A report of treatment of a fused permanent central incisor and supplemental lateral incisor.

UNLABELLED: A 9-year-old boy presented with a fused maxillary right permanent central incisor and displacement of the right permanent lateral incisor palatally. An unerupted supplemental maxillary left permanent lateral incisor was noted radiographically. The maxillary fused right permanent central incisor was sectioned under general anaesthesia. The distal portion was extracted as planned; a vital partial pulpotomy was carried out on the distal aspect of the retained portion. Fixed orthodontic treatment commenced after 28 months to align the maxillary anterior segment. After completion, the maxillary right permanent central incisor was built up with composite to resemble the adjacent incisor. CLINICAL RELEVANCE: This case highlights the treatment options of a fused tooth and the need for multidisciplinary planning and treatment.

Targeted Endodontic Microsurgery: A Novel Approach to Anatomically Challenging Scenarios Using 3-dimensional-printed Guides and Trephine Burs-A Report of 3 Cases.

Endodontic microsurgery (EMS) techniques have increased success rates over traditional approaches. Despite surgical advances, anatomically challenging scenarios can preclude EMS in certain cases. The aim of this article was to introduce targeted EMS, which uses 3-dimensional-printed surgical guides (3DSGs) and trephine burs to achieve single-step osteotomy, root-end resection, and biopsy in complex cases. In each of 3 cases, a 3DSG with a trephine port was printed using computer-aided design/computer-aided manufacturing implant planning software. The osteotomy site, angulation, and depth of preparation were defined preoperatively to avoid sensitive anatomic structures. The 3DSG was inserted at the target site to achieve precise osteotomy and root-end resection during surgery. A hollow trephine rotated within the 3DSG port produced single-step osteotomy, root-end resection, and biopsy. Root-end preparation and fill were accomplished, and tissues were sutured in place. Targeted EMS potentiated successful surgical treatment in 3 anatomically challenging scenarios: (1) a palatal approach to the palatal root of a maxillary second molar, (2) a facial approach to a fused distofacial-palatal root of a maxillary first molar, and (3) a mandibular second premolar in close proximity to the mental foramen. Trephine burs guided by 3DSGs produce efficient targeted osteotomies with a predictable site, angulation, and depth of preparation. Apical surgery in challenging anatomic cases such as the palatal root of the maxillary second molar, fused molar roots, and root ends in approximation to the mental nerve are possible with targeted EMS.

Dens invaginatus on a geminated tooth: a case report.

AIM: To present a case of a concomitant occurrence of dens invaginatus (DI) and gemination in a mandibular left lateral incisor. BACKGROUND: DI is a developmental anomaly resulting from the invagination of a portion of a crown in the enamel organ stage of odontogenesis. It is commonly found in the maxillary lateral incisors but also occurs in the central incisors, premolars, canines, and molars in descending order of frequency. The occurrence of DI in the mandible is extremely rare. Gemination results from one tooth bud attempting to split into two. Geminated teeth present with a single root structure and rarely occur in mandibular teeth. REPORT: A 13-year-old girl presented with a chief complaint of spontaneous nocturnal pain in the mandibular left lateral incisor tooth. Intraoral examination revealed the tooth was enlarged with a notch on the incisal edge extending to the coronal 1/3 of the crown. The radiological examination revealed a Type 2 DI in a Type I geminated mandibular left lateral incisor. SUMMARY: DI is clinically significant due to the possibility of the pulpal involvement; pulpitis, necrotic pulps, and chronic periapical lesions are often associated with this anomaly without clinical symptoms. Clinicians should be mindful of the possibility of DI when a tooth presents pulpitis without history of trauma or caries and examine the suspicious tooth and the periodontium radiographically.

Bilateral supplemental maxillary central incisors with double-tooth like appearance.

BACKGROUND: Supplemental teeth refer to extra teeth that resemble the normal tooth series. Bilateral supplemental central incisors in a healthy individual are rare and bilateral supplemental incisors with double-tooth like appearance are exceptionally rare and has not been previously reported in the dental literature. CASE REPORT: This clinical report describes an 8-year old healthy Indian boy referred for the management of delayed eruption of his permanent maxillary incisor teeth. Following clinical and radiographic examination the two supplemental incisors closer to the midline were extracted under local analgesia and both of them exhibited double-tooth like appearance. CONCLUSIONS: The present case refutes the conventional wisdom that "supplemental teeth are usually smaller than the normal tooth type they resemble and occur distal to the normal tooth series", illustrates that the unusual can occur and that the clinician should be aware of such variations.

Management of a fused central incisor in association with a macrodont lateral incisor: a case report.

Fusion is developmental anomaly of the dental hard tissue and is defined as the joining of 2 developing tooth germs resulting in a single large tooth structure. Different treatment methods can be used according to the requirements of the situation. The purpose of this case report was to present the multidisciplinary treatment of a patient who had a permanent maxillary left central tooth fused with a supernumerary incisor and a macrodont permanent maxillary right lateral incisor. In the radiographic evaluation, it was determined that the fused tooth had 2 separate roots. The supernumerary tooth was extracted after hemisection, and endodontic treatment was performed on the remaining portion. The distal side of the macrodont lateral incisor was recontoured, and the right central incisor was reshaped with a strip crown to provide aesthetic appearance and to gain space for the alignment of teeth. Following the restoration of the incisors, orthodontic treatment was provided.