Esthetic management of fused incisors with ceramic veneers.

This clinical report describes a patient for whom single veneers with pink staining were used on fused maxillary incisors to camouflage and improve dental appearance.

Conservative endodontic management of a fused tooth: A case report.

OBJECTIVE: To report a conservative treatment of a rare developmental anomaly. CASE REPORT: A 73-year-old patient with previously initiated therapy and acute apical abscess of a maxillary right central incisor fused with the supernumerary tooth sought treatment. The conservative approach included nonsurgical root canal treatment and composite restoration. CONCLUSION: This case illustrates the importance of an individual approach when treating anomalous teeth. Priorities in pain and infection management to properly and functionally restore teeth should be unaffected by age.

Multidisciplinary approach to the treatment of double bilateral upper permanent incisors in a young boy.

BACKGROUND: A double tooth is a rare developmental anomaly referring to the fusion of two adjacent tooth buds or the gemination of a single bud. CASE REPORT: This case report describes the multidisciplinary approach to an 11-year-old patient with two double upper permanent incisors. The clinical intraoral examination showed a mixed dentition with bilateral double maxillary central incisors, molar Class I malocclusion and palatal ectopy of two lateral upper incisors. Computed tomography of the upper dental arch revealed the presence of double central incisors with two distinct roots. The clinical choice consisted of an innovative treatment including surgical, endodontic, orthodontic and restorative treatments. This management protocol produced good aesthetic, healthy and functional results that were stable also two years post-treatment.

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

AIM: The purpose of this report is to present a case of endodontic management of a dilacerated maxillary central incisor fused to supernumerary tooth unusually appearing as a labial tubercle using cone beam computed tomography (CBCT) as a diagnostic aid. BACKGROUND: Anterior teeth are commonly encountered with aberrant anatomical variations in the crown, number of roots, and root canals. Fusion is an infrequent developmental abnormality in shape of the tooth caused by the union of two adjacent tooth germs. A complete knowledge of such complex anatomies is mandatory for a successful root canal treatment. It highlights the endodontic and restorative approach in the functional and esthetic rehabilitation of the involved tooth. CASE REPORT: Three-dimensional imaging using CBCT was used in this case to differentiate single labial canal and palatal C-shaped canal. The endodontic treatment was performed with the aid of dental operating microscope, and the root canals were obturated with a combination of single cone, carrier based, and cold flowable gutta-percha obturation system. The tooth remained asymptomatic without reinfection and symptoms of failure for 18 months. CONCLUSION: Cone beam computed tomography is indispensable in treatment planning for cases where the radiographs cannot reveal useful information regarding the root canal shape. Postobturation CBCT has helped in avoiding further retreatment of the tooth, which otherwise is a challenging task. CLINICAL SIGNIFICANCE: The use of sophisticated equipment, such as dental operating microscope and CBCT has helped in accurate diagnosis and treatment planning of fused central incisor respectively.

Prosthodontic Rehabilitation for a Patient with Ellis-Van Creveld Syndrome: A Case Report.

Patients suffering from Ellis-Van-Creveld syndrome are a challenge for dental management. Aesthetics are a major concern with limited manual dexterity, making choice of treatment critical. A 38 year old female diagnosed with Ellis-Van-Creveld syndrome presented with stained teeth and un-aesthetic smile and related that to her low self-esteem and depression. Intra-oral examination revealed mal-aligned megadont central incisors in the maxillary arch, fused mandibular canines with laterals and missing central incisors with space discrepancy and pronounced reverse over jet and overbite. Treatment involved non-surgical periodontal management, fabrication of veneers and dentine bonded crowns for maxillary anteriors and fixed-fixed resin retained bridge for mandibular arch.

Concurrence of Gemination and Fusion in Maxillary Central Incisors: A Case Report.

This case reports the concurrence of gemination and fusion affecting the maxillary central incisors of a twelve-year-old patient and the collaboration of the pediatric dentist, endodontist, orthodontist and oral and maxillofacial surgeon. Developmental dental anomalies can occur in both primary and permanent dentitions as a result of conjoining defects. Double teeth, or cases of gemination or fusion, are not exceedingly rare, but the presence of both anomalies in a single patient is a rarity. Gemination is the division of a single tooth bud, resulting in a large single tooth with a bifid crown and common root and root canal. Fusion is the union of two separate tooth buds, resulting in a joined tooth with confluence of dentin and separate root canals. Labial apexogenesis with MTA, composite resin placement, re-contouring and orthodontic care allowed proper alignment with long-term monitoring of growth and development for possible incisor replacement.

Diagnosis and Endodontic Management of Fused Mandibular Second Molar and Paramolar with Concrescent Supernumerary Tooth Using Cone-beam CT and 3-D Printing Technology: A Case Report.

Supernumerary teeth in the molar area are classified as paramolars or distomolars based on location. They occur frequently in the maxilla, but only rarely in the mandible. These teeth are frequently fused with adjacent teeth. When this occurs, the pulp cavities may also be connected. This makes diagnosis and planning of endodontic treatment extremely difficult. Here we report a case of a mandibular second molar fused with a paramolar, necessitating dental pulp treatment. Intraoral and panoramic radiographs were obtained for an evaluation and diagnosis. Although the images revealed a supernumerary tooth-like structure between the posterior area of the mandibular second molar and mandibular third molar, it was difficult to confirm the morphology of the tooth root apical area. Subsequent cone-beam computed tomography (CBCT) revealed that the supernumerary tooth-like structure was concrescent with the root apical area of the mandibular second molar. Based on these findings, the diagnosis was a fused mandibular second molar and paramolar with a concrescent supernumerary tooth. A 3-dimensional (3-D) printer was used to produce models based on the CBCT data to aid in treatment planning and explanation of the proposed procedures to the patient. These models allowed the complicated morphology involved to be clearly viewed, which facilitated a more precise diagnosis and better treatment planning than would otherwise have been possible. These technologies were useful in obtaining informed consent from the patient, promoting 3-D morphological understanding, and facilitating simulation of endodontic treatment.

Impacted Mandibular "Double" Third Molar: Fusion or Gemination? A Case Report.

Dental fusion is defined as an abnormality in tooth shape caused by developmental tooth disturbances that produce an intimate union of dental tissues. This case report discusses treatment of a mandibular impacted "double" third molar in a 21-year-old patient that could have been related to either gemination or tooth fusion. Radiological examination allowed for careful analysis of the tooth's shape and root development, relation to the inferior alveolar nerve, and 3-dimensional position. After evaluation of therapeutic options and risks, and with the patient's consent, the authors opted to extract the tooth in question. Such favorable conditions as the incomplete development of the roots and the relatively young age of the patient, combined with the use of an antibiotic and antiseptic prophylaxis as well as a standard surgical approach, enabled a successful result to be achieved with no related complications.

Esthetic management of a primary double tooth using a silicone putty guide: a case report.

The term double tooth is often used to describe fusion and gemination. The development of isolated large or joined teeth is not rare, but the literature is confusing when the appropriate terminology is presented. The objective of this paper is to present a case of a primary double tooth in a 5-year-old girl with a history of trauma. The tooth was endodontically treated and esthetic management was carried out using a silicone putty guide.

[Considerations of the classification and treatment for fused teeth].

Fused teeth were a phenomena of teeth anomalies in shape, which can affect the dental teeth both in primary and permanent dentition. Fused teeth do not only cause problems on crowding of dentition, abnormal occlusion and aesthetic, but also increase risks of dental caries, endodontics diseases, periapical diseases and periodontal diseases. Fusion of deciduous teeth may lead to abnormality of subsequent permanent teeth. Treatment of fused teeth may require multidisciplinary approach in endodontics, periodontics, oral and maxillofacial surgery, prosthodontics and orthodontics. The aim of the present article is to review the etiology, classification, clinical manifestations and treatment of fused teeth in order to provide dental clinicians with a reference of clinical management for fused teeth.

Endodontic management of mandibular central incisor fused to a supernumerary tooth associated with a talon cusp: a case report.

AIM: To report the successful non-surgical endodontic management of a mandibular central incisor fused to a supernumerary tooth associated with a talon cusp. SUMMARY: Fusion and gemination are developmental anomalies of teeth that may require endodontic treatment. In this article, a case of successful endodontic management of a permanent mandibular right central incisor fused to its supernumerary counterpart associated with a talon cusp is reported. The incidence of fusion in mandibular anteriors is rare. A search of the literature failed to reveal any reports on the fusion of a permanent mandibular central incisor with its supernumerary counterpart associated with a talon cusp. Successful non-surgical endodontic management of a case is reported. KEY LEARNING POINTS: • Fused and geminated teeth requiring endodontic treatment present diagnostic and technical challenges. • An exact differentiation between fusion and gemination may not be critically important for treatment. • The use of an operating microscope for detection of additional root canal orifices in complicated cases is recommended.

Management of 'double teeth' in children and adolescents.

BACKGROUND: Abnormally, large teeth are often referred to as 'double teeth'. These can pose numerous challenges for the clinician. There is no published protocol on the management of double teeth. AIM: To review the published literature and also patients managed at the Eastman Dental Hospital (EDH) and to develop a clinical protocol for the management of double teeth in children and adolescents. DESIGN: Literature was searched (Medline and Embase) and data collated. Patient notes of cases managed at the EDH were reviewed. RESULTS: Eighty-one teeth from 53 papers and 22 patients were included in the review. Success criteria were only reported in 32 papers and were variable. Twenty-three papers had no follow-up period. The main factor in determining the management of a double tooth was root and root canal system morphology. The treatment of choice in teeth with separate roots was hemisection and in those with a single root was crown modification or extraction. CONCLUSION: It was not possible to determine the best management strategies because of the variable reporting in the literature. The authors have proposed a protocol for management and a data collection sheet for essential information needed when reporting on double teeth cases.

Crown-root fracture of fused primary teeth--a case report.

In the primary dentition, traumatic injuries affecting the tooth-supporting structures are common due to increased bone resilience in children. Crown-root fracture, defined as a fracture involving enamel, dentin, and cementum, is uncommon in the primary dentition, comprising only 2% of dental traumas. This article reports the treatment and follow-up of a 2-year-old boy who suffered a traumatic crown-root fracture involving a primary anterior incisor that was fused to a supernumerary tooth.

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.

Endodontic treatment of a geminated maxillary second molar using an endoscope as magnification device.

AIM: To describe endodontic treatment for a rare case of gemination. SUMMARY: A case of complex endodontic treatment in a geminated tooth is presented. With the assistance of microinstruments and magnification devices, a geminated maxillary second molar was successfully treated. In such a case, ultrasonic tips and the use of an endoscope were essential to detect the peculiar anatomy of the tooth involved. KEY LEARNING POINTS: Knowledge of anomalies concerning fused teeth is essential. Using an endoscope as a magnification device is useful during the inspection of pulp chambers. Ultrasonic tips are safe and useful to detect canal orifices.

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.

'Double-veneers'--a novel approach to treating macrodontia.

UNLABELLED: Macrodontia is a relatively rare but cosmetically challenging dental anomaly with different aetiologies. Where surgical interventions are inappropriate, minimal restorative interventions may be indicated. A case is described of a teenager with macrodontic central incisors who was treated with indirect composite 'double veneers'. The aesthetic outcome was excellent without unnecessary loss of teeth. CLINICAL RELEVANCE: Knowledge of the use of indirect composite veneers provides another treatment option for aesthetic problems in the management of tooth anomalies, including macrodontia.

Endodontic management of a fused mandibular second molar and paramolar with the aid of spiral computed tomography: a case report.

Fusion and gemination are developmental anomalies of the dental hard tissues that might require endodontic and surgical treatment for functional, orthodontic, or esthetic reasons. In this article, we report a rare case of successful endodontic management of unilateral fused mandibular second molar with a paramolar. The rarity with which this entity appears, along with its complex characteristics, often makes it difficult to diagnose and treat. The use of high-end diagnostic imaging modalities such as spiral computed tomography can help the clinician in making a confirmatory diagnosis and determining the treatment plan before undertaking the actual treatment. This case report highlights the usefulness of spiral computed tomography in accurate diagnosis and endodontic management of these unusual cases.