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.

Fusión del tercer molar inferior con un cuarto molar: reporte de tres casos / Fusion of the lower third molar with a fourth molar: report of three cases

Los dientes supernumerarios y la fusión dental son anomalías del desarrollo dental cuyas causas aún no se han dilucidado con certeza. El cuarto molar inferior, también denominado distomolar, es uno de los dientes supernumerarios con menor frecuencia de aparición clínica y su fusión con el tercer molar es una condición todavía menos común. A continuación, se reportan los casos clínicos de tres pacientes masculinos que presentaron fusión del tercer molar inferior derecho con un distomolar tratados mediante odontectomía (AU)

Supernumerary teeth and dental fusion are abnormalities of dental development whose causes have not yet been elucidated with certainty. The lower fourth molar, also called distomolar, is one of the supernumerary teeth with the least frequency of clinical appearance and its fusion with the third molar is an even less common condition. Next, the clinical cases of three male patients who presented fusion of the right lower third molar with a distomolar treated by odontectomy are reported (AU)

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.

Caracterización de la Impactación de Segundos Molares Mandibulares Permanentes en una Población Sudamericana / Characterization of Permanent Mandibular Second Molars Impaction in a Southamerican Population

El objetivo de este estudio fue describir las características epidemiológicas de segundos molares mandibulares permanentes impactados unilateralmente en una muestra de la ciudad de Medellín, Colombia. Se trató de un estudio retrospectivo en el cual se evaluaron radiografías panorámicas de 6785 pacientes, de las cuales se analizaron un total de 28 radiografías en la muestra final. Fueron correlacionados el segundo molar mandibular impactado (grupo de estudio) y el contralateral no impactado (grupo control) con respecto a tres ángulos de referencia (intermolar, del plano oclusal e interplanar), el sexo y lado de impactación. Se encontró una prevalencia de 3,5 por cada 1000 radiografías evaluadas. El lado de mayor impactación fue el derecho; dos de los tres ángulos analizados (intermolar e interplanar) fueron los que arrojaron las diferencias más grandes entre el grupo de estudio y el grupo control. No se encontraron diferencias estadísticamente significativas según el sexo. Se concluyó que la prevalencia de segundos molares mandibulares permanentes impactados es baja, siendo mayor en el lado derecho, sin diferencias por sexo, y de preferencia el uso del ángulo interplanar como medida para la evaluación del riesgo de impactación (>7,9°).

The objective of this study was to describe the epidemiological characteristics of unilateral permanent mandibular second molars impacted, in a sample from Medellín, Colombia. It was a retrospective study in which we evaluated panoramic radiographs of 6785 patients, for a total of 28 radiographs analyzed in the final sample. The mandibular second molar impacted (study group) and the contralateral not impacted (control group) were correlated, with respect to three reference angles (intermolar, of the oclussal plane and interplanar), sex and impaction side. We found a prevalence of 3.5 for every 1000 radiographs evaluated. The most frequent side of impaction was the right side; two of the three angular measurements (intermolar and interplanar) had the biggest differences between the study and control group. We did not find significant statistical differences between males and females. It was concluded that the prevalence of impacted permanent mandibular second molars is low, there is a highest impaction in the right side, there are no differences between genders, and the use of the interplanar angle is preferable as a measurement to predict the impaction of permanent mandibular second molars (>7.9°).

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.

Anomalías dentarias de unión: A propósito de un caso y posibilidades de tratamiento / Union dental anomalies: a case report and treatment possibilities

El objetivo del presente artículo es describir las anomalías de unión, y para ello presentamos un raro caso de fusión - geminación y sus consecuencias tanto a nivel estético, pulpar así como las posibilidades de tratamiento

The aim of this article is to discuss the union anomalies and we present a rare case of a fusion - germination, the consequences in the aesthetic level as pulp level and treatment possibilities

Management of non-syndromic double tooth affecting permanent maxillary central incisors: a systematic review.

To assess management of non-syndromic double tooth affecting permanent maxillary central incisors, we performed a systematic review and also present 2 case reports. We searched MEDLINE via PubMed and the reference lists of included reports. Eligible studies were any type of clinical studies describing the management of non-syndromic double tooth affecting the crown of a permanent maxillary central incisor. We included 68 studies corresponding to 72 relevant case reports. Therapeutic options in descending order of priority were restorative dentistry (35%), hemisection (33%), abstention (17%) or extraction (15%). Orthodontic management resulted in 57% of cases. We report an 11-year-old boy with bilateral fusion of the two maxillary central incisors and a 9-year-old boy with a double left central incisor and a supernumerary lateral right incisor. A multidisciplinary approach is key to management of permanent maxillary central incisors affected by coronary anomalies.

Unusual finding of concrescence.

Concrescence is a rare dental anomaly whereby adjacent teeth are united by cementum. It has been reported to occur in around 0.8% of permanent dental extractions and a correct diagnosis prior to surgical intervention is important to ensure that patients can make an informed decision about their treatment and to reduce the potential for dentolegal action against the responsible clinician. An 83-year-old woman was referred to the Oral and Maxillofacial Surgery Department at the Wirral University Teaching Hospital, for extraction of her upper left first molar tooth. The operator noted that, when the upper left first molar was extracted, the upper left second molar tooth was also removed. Clinically, the roots of the adjacent teeth appeared fused and a diagnosis of concrescence was established. The patient was informed of the complication and provided with a 1-week review appointment, at which stage she was discharged.

Quiste radicular asociado a diente geminado: tratamiento endodóntico-quirúrgico / Radicular cyst associated with a geminated tooth: endodontal-surgical treatment

El tratamiento endodóntico-quirúrgico en dientes con quistes inflamatorios radiculares es un desafío clínico debido a su complejidad, y más aún si están en piezas con anomalías de desarrollo dental, como lo es la geminación dentaria. A continuación se presenta un caso clínico en el que se logra la reparación de una lesión apical mediante una necropulpectomía de la pieza geminada y enucleación del quiste adyacente.

The surgical-endodontic treatment of teeth with an inflammatory radicular cyst is a clinical challenge due to its great complexity. Even more so, if they are in teeth with development anomalies such as gemination. The case below shows the repair of an apical lesion by a necro-pulpectomy of the geminated tooth and the enucleation of the adjacent cyst.

Unilateral fusion of a supernumerary tooth to a maxillary permanent lateral incisor: a report of a rare case.

A supernumerary tooth is an additional entity to the normal series of teeth that may occur in isolation or may be fused to a normal counterpart. Diagnosis and delineation of an accurate treatment plan in cases involving supernumerary teeth are often a challenge. This report describes a case of unilateral fusion of a supernumerary tooth to a maxillary permanent lateral incisor in which a conservative approach was used to reach a favorable outcome.

Fusion of central incisors with supernumerary teeth: a 10-year follow-up of multidisciplinary treatment.

INTRODUCTION: Macrodontia of anterior teeth may occur as an isolated condition or as a result of fusion or gemination and may cause clinical problems such as tooth crowding and esthetic problems. Preliminary planning and careful management are often required by a dental team comprising an orthodontist, an endodontist, a prosthodontist, and an oral surgeon. A multidisciplinary treatment approach in a case with fused teeth is presented. METHODS: A 9-year-old girl presented with macrodontia of a left maxillary central incisor. The patient was referred to the orthodontic department because of a large central incisor as a result of fusion with an unspecific supernumerary tooth. The surgical procedure included sectioning off the mesial segment as far as possible, both apically and subgingivally, and extracting 1 of the fused supernumerary teeth. During the sectioning procedure, the pulp of the remaining tooth was exposed at the middle third of the root. Direct pulp capping was performed by an endodontist using mineral trioxide aggregate. Twelve weeks later, orthodontic treatment was commenced, and finally after a 26-month orthodontic treatment period, the central incisors' crown was restored using composite material. RESULTS: A 10-year clinical and radiographic follow-up revealed that the remaining resected central incisor kept its vitality, and the patient was pleased with the esthetic result. CONCLUSIONS: Proper interdisciplinary treatment planning of complicated cases such as anomalous teeth, which involve fusion to a supernumerary tooth, may lead to minimal invasive conservative procedures that maintain tooth vitality and result in a pleasing esthetic result.

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.

Treatment of a fused/geminated tooth: a multidisciplinary conservative approach.

OBJECTIVE: To report a multidisciplinary treatment of gemination/fusion of the left maxillary first incisor. CASE REPORT: An 11-year-old boy presented to our clinic with the chief complaint of an unpleasant appearance of his anterior teeth. Clinical and radiographic evaluation revealed gemination/fusion of the left maxillary first incisor combined with an Angle's Class II relationship (skeletal), retruded mandible, deep bite, short lower face height, and proclinaion of the maxillary incisors. The multidisciplinary approached treatment included orthodontic treatment engaged with root canal treatment of the left maxillary first incisor followed by periodontal surgical separation of the mesial root of the left maxillary first incisor and restoration of the crown using resin restoration. CONCLUSION: Tooth shape anomalies in general dental practice may be rare, but the dentist should be aware of the nature of the problems encountered and the specific treatment needs. The treatment may be complex and contain various treatment protocols that may include interdisciplinary endodontic, surgical, and periodontal interventions.

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).

The challenges of treating a fused tooth.

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.

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.

The multidisciplinary management of a fused maxillary central incisor with a talon cusp.

BACKGROUND: A fused maxillary incisor required complex multidisciplinary treatment to preserve health and restore aesthetics. This report presents a rare case of a dental fusion between the maxillary right central incisor and a supernumerary tooth of a 9-year-old male patient with the chief complaint of the presence of a large anterior tooth. METHODS: Radiographic investigation and computerized tomography indicated there was no connection between pulp chambers. After dividing the crown with a diamond bur, the supernumerary tooth was removed and the diastema between the maxillary central incisors was closed by orthodontic treatment. The tooth was then restored with composite resin. RESULTS: The maxillary right central incisor was still healthy after a follow-up examination period of 24 months. CONCLUSIONS: A multidisciplinary approach with the cooperation of different practitioners can contribute to the success of a treatment plan.

The challenges of treating a fused tooth

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.

Este caso descreve o tratamento multidisciplinar de um incisivo lateral superior permanente fusionado a um dente supranumerário, ambos apresentando necrose pulpar e lesão periapical. Paciente compareceu ao consultório se queixando de dor, edema e mobilidade do incisivo lateral superior. O preparo endodôntico foi realizado no sentido coroa-ápice e foi colocada pasta de hidróxido de cálcio como medicação intra-canal por 15 dias. A seguir, a obturação foi realizada pela termoplastificação da guta-percha. Após 18 meses, foram realizados exames clínicos e radiográficos indicando ausência de dor e edema. Dois anos após o tratamento endodôntico, o paciente retornou para o tratamento periodontal e estético. Nove meses depois, foi realizada tomografia computadorizada e observou-se presença de defeito periodontal e lesão periapical. Foi então indicada e planejada a cirurgia paraendodôntica. O dente supranumerário foi removido e a área de comunicação com o canal radicular do incisivo lateral foi preenchida; a loja cirúrgica foi preenchida com vidro bioativo e osso orgânico bovino desmineralizado. O tecido patológico da lesão periapical foi submetido à análise histopatológica sendo diagnosticado como cisto periapical. Um ano após a cirurgia parendodôntica, uma nova tomografia computadorizada mostrou neoformação óssea na região periapical do dente em questão. Doi anos após a cirurgia, a restauração foi trocada devido à motivos estéticos e uma radiografia periapical mostrou sucesso do tratamento (5 anos após o tratamento inicial). Um correto diagnóstico e plano de tratamento multidisciplinar é essencial para o sucesso do tratamento de dentes fusionados à dentes supranumerários.