Fusion of a maxillary third molar with a supernumerary fourth molar: A case report.

Key Clinical Message: Dental fusion should be included in differential diagnosis when panoramic radiograph reveals changes in tooth shape or size. The use of specialized dental photographic techniques can augment the dentists' knowledge and awareness of such conditions. Abstract: Dental fusion of impacted teeth may show up as a change in tooth shape and size on the first radiographic examination. This report presents an impacted maxillary third molar fused with a peg-like distomolar in a 20-year-old male. The patient presented with symptoms of localized periodontitis distal to the second molar, and radiographic examination revealed abnormal dental structure of the third molar. Surgical extraction of the impacted molar was the treatment of choice. The final diagnosis of fusion was based on data from ex vivo CBCT, photographs of the extracted tooth, and extracted tooth's sections using polarizing filters. Two-dimensional radiographs may conceal special dental anatomies. Visualization of such cases using CBCT and dental photography serves to educate dentists and reduce postoperative complications. Knowledge and awareness of possible dental abnormalities are of utmost importance for successful treatment planning.

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

Key Clinical Message: Management of supernumerary teeth fused to the labial surface of permanent maxillary central incisors would require a multidisciplinary approach comprising of endodontic treatment, periodontal recontouring, and cosmetic composite restoration. Abstract: The reported cases of supernumerary teeth fused to the labial surface of maxillary central incisors are rare. Such cases need multidisciplinary approaches. Herein, management of a supernumerary tooth fused to the labial surface of a maxillary central incisor is reported. Due to the presence of a communication path between the root canal systems of the two fused teeth, root canal therapy was performed first for the maxillary left central incisor and the supernumerary tooth. The crown of the supernumerary tooth was then removed in a surgical setting while preserving the root to maintain the thin covering of alveolar bone and prevent future periodontal problems. Subsequently, an esthetic composite restoration was performed.

Conservative management of double teeth in molar teeth with pulp or periapical disease: a report of five cases and literature review.

BACKGROUND: Double teeth are usually the result of an abnormality in the developing tooth germ. Double teeth can occur in either the primary or permanent dentition, with the majority of cases concerning permanent teeth reported in the anterior teeth and less frequently in the molar teeth. CASE PRESENTATION: This report illustrates five cases of double teeth in molars with pulp and periapical disease, including one case of geminated teeth and four cases of fused teeth. Radiographic findings revealed the presence of extra teeth on the buccal aspect of the molar in five cases, with or without communication between the two root canal systems. Root canal treatment was performed by using CBCT and a dental operating microscope. The treatment outcome was good in all five cases. CONCLUSION: The diagnosis and treatment of double teeth requires special attention. The root canal system should be carefully explored to obtain a full understanding of the anatomy, allowing it to be fully cleaned and obturated. Proper anatomical structure analysis prior to treatment facilitates the development of an appropriate treatment plan, thereby increasing the likelihood of successful treatment both aesthetically and functionally.

Presentation of infrequent clinical case of dental gemination of the permanent upper left lateral incisor

Introduction: Gemination is the division of a dental follicle that results in a tooth with two crowns, where the number of teeth in the arch does not vary. It constitutes an anomaly that is little diagnosed due to its presentation and therefore little treated, which requires an adequate study. Objective: To present an infrequent clinical case of dental gemination of the permanent upper left lateral incisor. Clinical case: 20-year-old patient with 30 weeks of gestational status treated for periodic review by appointment of her dentist. The intraoral examination revealed: the permanent upper left lateral incisor (tooth 22) with two crowns, one of which had lost the gingival wall and the other had second degree dental caries on the mesial side. Periapical radiography performed 1 year earlier showed tooth 22 with a partially divided pulp chamber and a broad, bifid, well-defined crown. Dental gemination of the permanent maxillary left lateral incisor was diagnosed. The geminated tooth was extracted, and the patient was referred to a dental prosthesis for rehabilitation. Conclusions: Dental gemination of the permanent upper left lateral incisor in a pregnant patient, constitutes an anomaly of the shape of the teeth that is infrequent in consultations.

Introducción: La geminación es la división de un folículo dentario que resulta en un diente de dos coronas, pero la cantidad de dientes de la arcada no varía. Constituye una anomalía poco diagnosticada por su presentación y por ende poco tratada, lo que necesita de un adecuado estudio. Objetivo: Presentar un caso clínico infrecuente de geminación dentaria del incisivo lateral superior izquierdo permanente. Caso clínico: Paciente de 20 años de edad, con 30 semanas de estado gestacional atendida para revisión periódica por citación de su estomatólogo. Al examen intraoral se detectó: el incisivo lateral superior izquierdo permanente (diente 22) con dos coronas, una de las cuales había perdido la pared gingival y la otra presentaba caries dental de segundo grado en cara mesial. La radiografía periapical realizada 1 año antes mostró el diente 22 con cámara pulpar parcialmente dividida y una corona ancha, bífida y bien definida. Se diagnosticó una geminación dentaria del incisivo lateral superior izquierdo permanente. Se realizó exodoncia del diente geminado y se remitió a la paciente a prótesis estomatológica para rehabilitación. Conclusiones: La geminación dentaria del incisivo lateral superior izquierdo permanente en una paciente embarazada es una anomalía de forma de los dientes poco frecuente en las consultas.

Large-Scale Survey of Missing Deciduous Anterior Teeth on Medical Examination at the Age of 3.5 Years.

Tooth anomalies in childhood may negatively affect the healthy development of the dentition and occlusion; hence, it is important to examine the actual oral condition at an early stage. The present study was performed to understand the state of missing deciduous anterior teeth in children aged 3.5 years who underwent dental checkups in Matsubara City. In total, 3508 children received oral examinations, and items such as erupted deciduous teeth and teeth anomalies were recorded. Among these children, those with missing anterior deciduous teeth were selected, and their details were analyzed. In the 216 children, there were 266 missing anterior deciduous teeth. Congenitally missing anterior deciduous teeth were observed in 80 children, and fused teeth were observed in 128 children. The missing teeth were predominantly located in the mandible and occurred more frequently on the right side. The most common reason for acquired missing teeth was trauma, and no cases of spontaneous loss due to systemic disease were found in this study. Screening for various tooth anomalies is expected to play an important role in cultivating a better understanding of the oral cavity of children, developing healthy dentitions, and contributing to the early detection of some systemic diseases.

Imaging characteristics of the gubernaculum tracts in successional teeth related to deciduous fused teeth on computed tomography.

The purpose of this study was to elucidate the imaging characteristics of the gubernaculum tracts in successional teeth related to fused deciduous teeth on computed tomography. The imaging findings of 15 gubernaculum tracts in successional teeth related to fused deciduous teeth were retrospectively analyzed using cone-beam computed tomography or multidetector computed tomography. In cases without a congenitally defected successor, the two gubernaculum tracts of two successional teeth related to fused deciduous teeth were fused into one. Gubernaculum tracts (GTs) in mesial successors were vertical, but in distal successors they were inclined to mesial. The major abnormalities of the successional teeth related to fused deciduous teeth were delayed eruption and delayed formation. No inclined mesial successors were found, whereas most of the distal successors were inclined to mesial along with the inclined GT. The gubernaculum tracts of successors with a congenital defect of the other successors were vertical, and such successors had no abnormalities. The present study showed the imaging characteristics of gubernaculum tracts in successional teeth related to fused deciduous teeth. The abnormal eruption of successional teeth related to fused deciduous teeth may be associated with the characteristics of their gubernaculum tracts.

Prevalence of Dental Anomalies Assessed Using Panoramic Radiographs in a Sample of the Turkish Population.

OBJECTIVE: To determine the prevalence, frequency and distribution of dental anomalies that were detectable on panoramic radiographs in a large sample Turkish population, and the associations among the anomalies. METHODS: This study was conducted retrospectively on panoramic radiographs of 43,880 patients who were admitted to the Faculty of Dentistry at Trakya University, Edirne, Turkey. Patients' files were examined by two observers and radiographic images of 2265 patients with at least one dental anomaly were included. Dental anomalies were classified as anomalies in the number, structure, position and shape of teeth. The interactions between the groups were analysed using chi-square tests. RESULTS: The study group consisted of 1336 women (59%) and 929 men (41%) with a mean age of 33.3 ± 14.4 years. A total of 2265 patients, with a prevalence of 5.2% (2265/43880), had at least one dental anomaly. The most frequent anomalies were in position (2.7%) and number (2.1%). Structure anomalies were least common, affecting 0.02% of patients. Among the study group of patients with dental anomalies, 12.2% presented more than one kind of anomaly. CONCLUSION: Position anomalies were the most common dental anomaly, whereas structural anomalies were least common in a Turkish sample. The prevalence of anomalies varies between populations, confirming the role of racial factors.

Management of Fused Anterior Teeth: Review and Clinical Report.

The phenomenon of fusion is a type of tooth dysplasia, but few studies have systematically described the treatment of this kind of abnormality. This paper summarizes the treatment methods for fused teeth and classifies the management schemes according to whether the pulp is fused. Then, the treatment for a patient with bilateral anterior tooth fusion is reported. After orthodontic treatment, porcelain veneers were used to restore the normal shape and aesthetic appearance of the anterior teeth.

Activated Epithelial FGF8 Signaling Induces Fused Supernumerary Incisors.

FGF8, which is specifically expressed in the dental epithelium prior to the E12.5 bud stage, is a key player during odontogenesis, being responsible for the initiation of tooth development. Here, to investigate the impact of persistent FGF8 signaling on tooth development, we forcibly activated FGF8 signaling in the dental epithelium after the bud stage by generating K14-Cre;R26R-Fg8 mice. We found that a unique type of fused supernumerary incisors is formed, although morphologically resembling the features of type II dens invaginatus in humans. Further analysis revealed that ectopically activated epithelial FGF8 alters the cell fate of the incisor lingual outer enamel epithelium, endowing it with odontogenic potential by the activation of several key tooth genes, including Pitx2, Sox2, Lef-1, p38, and Erk1/2, and induces de novo formation of an extra incisor crown lingually in parallel to the original one, leading to the formation of an extra incisor crown and fused with the original incisor eventually. Meanwhile, the overdosed epithelial FGF8 signaling dramatically downregulates the expression of mesenchymal Bmp4, leading to severely impaired enamel mineralization. Based on the location of the extra incisors, we propose that they are likely to be rescued replacement teeth. Our results further demonstrate the essential role of FGF8 signaling for tooth initiation and the establishment of progenitor cells of dental epithelial stem cells during development.

Fusion of Unerupted Mesiodens with a Regular Maxillary Central Incisor: a Diagnostic and Therapeutic Challenge.

The mesiodens is the most frequent type of supernumerary tooth which can appear in the maxillary midline area. The etiology of mesiodentes is not fully understood. This report shows a case of incomplete fusion of an unerupted mesiodens with a permanent maxillary central incisor, aligned in the dental arch. Intraoral and radiographic examinations indicated fusion of the crown and cervical part of the root of the supernumerary tooth with the permanent incisor. The clinical situation was further complicated by the presence of another supernumerary tooth located palatally. The treatment approach has included two phase surgical therapy to extract the supernumerary teeth. Early diagnosis and appropriate surgical treatment of mesiodentes are important to decrease the risk of clinical complications. Pre-operative 3D imaging is strongly advisable since it allows accurate data to be obtained, and reduces the extent of surgery and the possibility of procedural complications. In most cases, a multidisciplinary collaboration is necessary for precise diagnosis and predictable treatment outcome.

Cone-beam CT diagnosis and differential diagnosis of germinated mandibular second molar / 中国基层医药

Objective:To report a case of germinated teeth of the left mandibular second molar diagnosed by cone-beam CT (CBCT), and to investigate its differential diagnosis, pathogenesis, and the application value of CBCT in the diagnosis of oral and maxillofacial diseases.Methods:One case of germinated teeth of the left mandibular second molar diagnosed according to oral general examination ad CBCT findings in Zhenjiang Stomatological Hospital, China in March, 2019 was included in this study. The characteristics and differential points of supernumerary cusp, fused teeth, geminated teeth and concresence of teeth were analyzed based on literatures.Results:CBCT examination showed that the number of mandibular dentition teeth was normal, there was a large area of low-density transmission area around the root of the left mandibular second molar. Three-dimensional reconstruction results revealed that the suspected supernumerary teeth were fused with the root of the left mandibular second molar. Sagittal projections showed that the suspected supernumerary teeth were located in the buccal side of the left mandibular second molar. Axial projections showed three separate root canal orifices at the level of pulp chamber floor, and the dentin of the two was connected. The suspected supernumerary teeth had an independent pulp cavity and a clear root canal, and fused with the distal root canal of the left mandibular second molar in the middle of the root to form a root canal. A "Y"-shaped structure was displayed on the sagittal projections. CBCT showed that the left mandibular second molar was a fused root. Based on oral clinical examination, the left mandibular second molar was confirmed to be a germinated tooth.Conclusion:CBCT is one of the most important means of oral auxiliary examination. It has significant advantages in the diagnosis of tooth abnormalities. It can help clinicians to make correct diagnosis and choose the appropriate treatment scheme. It has certain clinical significance and innovation.

Simultaneous occurrence of triple teeth and double teeth in primary dentition: A rare case report and review of the literature.

This paper reports the case of a 3-year-old male patient with triple teeth in the right maxillary incisor region and double teeth in the left mandibular incisor region. He had pre-existing medical conditions. The triple teeth were extracted and examined using micro-computed tomography. A literature review was performed to discuss this abnormality.

Management of Bilateral Mandibular Fused Teeth.

Tooth fusion is a developmental dental anomaly that may affect both the deciduous and permanent dentition. Such anomalies may cause problems such as caries, periodontal disease or even esthetic impairments, which will require intervention. In the present case, a young patient was referred to the periodontal clinic for management of bilateral mandibular fused teeth as part of the orthodontic treatment. On the lower right, the teeth involved were incompletely fused involving only the cervical region. On the lower left, the two teeth were completely fused from the crown to the apex. A surgical resection was carried out on the fused teeth on the right, while the fused teeth on the left was undisturbed. Orthodontic treatment was later carried out to align both the upper and lower arch. The patient was satisfied with treatment outcome.

Association between Endodontically Treated Maxillary and Mandibular Molars with Fused Roots and Periapical Lesions: A Cone-beam Computed Tomography Cross-sectional Study.

INTRODUCTION: Fused root variations of the root canal system increase the complexity of the inner root canal system anatomy. The aim of the present study was to determine, in in vivo conditions, the proportion of periapical lesions in association with endodontically treated maxillary and mandibular molars with fused roots presenting previous root canal treatment by assessing preexisting data via cone-beam computed tomographic volumes. METHODS: A total of 1160 CBCT scans with an overall sample of 20,836 teeth were screened. A global count of 3701 maxillary molars and mandibular second molars were included in the study. The Cohen kappa test and interclass correlation coefficient tested the intra- and interrater reliability, respectively. The percentage of periapical lesions associated with molars with or without root fusion was determined. Proportions were expressed with 95% confidence intervals (CIs). The z test for proportions was used to analyze differences between subgroups, and an odds ratio was calculated in order to understand the association between periapical lesions and root configuration. RESULTS: Fused molars presented a prevalence of periapical lesions in endodontically treated teeth of 74.0% (95% CI, 65.2%-82.8%), whereas nonfused molars had a proportion of periapical lesions in root canal-treated teeth of 69.5% (95% CI, 65.2%-73.8%; P > .05). Endodontically treated molars with fused roots presented with 1.3 higher odds of being associated with periapical lesions than endodontically treated molars with nonfused roots. CONCLUSIONS: A tendency of a higher proportion of periapical lesions was found in the fused rooted molars with a history of root canal treatment when compared with nonfused teeth; however, no statistically significant difference was noted.

Fused teeth in the primary dentition: clinical case report / Fusão dentária em dentição decídua: estudo de caso clínico

ABSTRACT Fused teeth are a developmental anomaly involving the union of two dental germs at the crown, root or pulp. This type of anomaly occurs during intraosseous development, resulting in a morphologically irregular tooth that can affect both the primary and permanent dentition. Clinical problems involving esthetics, a lack of space and greater susceptibility to caries are often associated with fused teeth. This type of anomaly is easily confused with dental twinning, which has similar clinical features but emerges from a single dental germ. The aim of the present study was to report a clinical case of the fusion of two deciduous mandibular incisors, describe prospects for treating this anomaly and discuss its repercussions during the development of the dentition. Extraction of the fused tooth was performed and orthodontic treatment was recommended for esthetic and functional improvements. Integrated planning involving both Pediatric Dentistry and Orthodontics provided a better treatment option.

RESUMO A fusão dentária é classificada como uma alteração de desenvolvimento referente à união de dois germes dentários, podendo incluir coroa, raiz e polpa. Este tipo de alteração ocorre durante o desenvolvimento intraósseo, resultando em um dente morfologicamente irregular, podendo acometer tanto a dentição decídua quanto a permanente. Frequentemente são associados problemas clínicos como alterações estéticas, falta de espaço e maior susceptibilidade a lesões cariosas. É importante ressaltar que a fusão é comumente confundida com a geminação dentária, que apresenta o mesmo aspecto clínico em boca, porém é resultante de um único germe dentário. O objetivo deste estudo é apresentar um caso clínico de fusão de dois incisivos inferiores decíduos, as perspectivas de tratamento da anomalia e discutir sua repercussão durante o desenvolvimento da dentição. Realizou-se a exodontia do elemento citado e o planejamento do tratamento ortodôntico recomendado foi discutido visando a melhora dos aspectos funcional e estético. Um planejamento integrado entre a Odontopediatria e Ortodontia proporcionou uma melhor alternativa de tratamento.

Fused roots of maxillary molars: characterization and prevalence in a Latin American sub-population: a cone beam computed tomography study.

OBJECTIVES: The upper molars generally have three roots; therefore, different combinations of fusion can occur, increasing the possibility of finding more complex root canal systems. The purpose of this study was to evaluate the prevalence and characterization of fused roots in first and second maxillary molars using cone-beam computed tomography (CBCT) in a Colombian population. MATERIALS AND METHODS: A total of 1274 teeth were evaluated, of which 534 were maxillary first molars and 740 were maxillary second molars. Axial sections were made at the cervical, middle, and apical levels to determine the prevalence of root fusion and the types of fusion. RESULTS: Overall, 43% of the molars (n = 551) presented some type of fused root. Root fusion was present in 23.4% of the maxillary first molars. The most frequent type of fused root was type 3 (distobuccal-palatal; DB-P) (58.9%). Root fusion was observed in 57.6% of the maxillary second molars, and the most prevalent type of fused root was type 6 (cone-shaped) (45.2%). Of the maxillary molars, 12.5% were classified as C-shaped. CONCLUSION: Within the limitations of this study, there was a high prevalence of fused roots in maxillary molars in the Colombian population, mainly in the maxillary second molars. In first molars, the most common type of fused root was type 3 (DB-P) and in second molars, the most common type was type 6 (cone-shaped). Additionally, molars with root fusion presented variation at different levels of the radicular portion, with implications for treatment quality.

Fused roots of maxillary molars: characterization and prevalence in a Latin American sub-population: a cone beam computed tomography study

OBJECTIVES: The upper molars generally have three roots; therefore, different combinations of fusion can occur, increasing the possibility of finding more complex root canal systems. The purpose of this study was to evaluate the prevalence and characterization of fused roots in first and second maxillary molars using cone-beam computed tomography (CBCT) in a Colombian population. MATERIALS AND METHODS: A total of 1274 teeth were evaluated, of which 534 were maxillary first molars and 740 were maxillary second molars. Axial sections were made at the cervical, middle, and apical levels to determine the prevalence of root fusion and the types of fusion. RESULTS: Overall, 43% of the molars (n = 551) presented some type of fused root. Root fusion was present in 23.4% of the maxillary first molars. The most frequent type of fused root was type 3 (distobuccal-palatal; DB-P) (58.9%). Root fusion was observed in 57.6% of the maxillary second molars, and the most prevalent type of fused root was type 6 (cone-shaped) (45.2%). Of the maxillary molars, 12.5% were classified as C-shaped. CONCLUSION: Within the limitations of this study, there was a high prevalence of fused roots in maxillary molars in the Colombian population, mainly in the maxillary second molars. In first molars, the most common type of fused root was type 3 (DB-P) and in second molars, the most common type was type 6 (cone-shaped). Additionally, molars with root fusion presented variation at different levels of the radicular portion, with implications for treatment quality.

Endodontic management of central incisor associated with large periapical lesion and fused supernumerary root: a conservative approach.

Fusion and gemination are developmental anomalies of teeth that may require endodontic treatment. Fusion may cause various clinical problems related to esthetics, tooth spacing, and other periodontal complications. Additional diagnostic tools are required for the diagnosis and the treatment planning of fused tooth. The present case report describes a case of unilateral fusion of a supernumerary root to an upper permanent central incisor with large periapical lesion in which a conservative approach was used without extraction of supernumerary tooth and obturated with mineral trioxide aggregate to reach a favorable outcome.

Primary Fused Teeth and Findings in Permanent Dentition.

OBJECTIVE: The aim of this study was to investigate the characteristics of primary fused teeth (PFT) and their effect on permanent dentition in a group of Turkish children. SUBJECTS AND METHODS: Dental records of 13,450 pediatric patients who attended the Pediatric Dental Clinic in northern Turkey between 2015 and 2017 were reviewed. Forty patients had been diagnosed with PFT and were included in the study. Clinical and radiographic examinations were conducted, and the distribution of PFT was calculated by type, sex, affected jaw, associated dental anomalies, and clinical complications. Data analysis involved descriptive statistics. RESULTS: A total of 50 PFT were detected in the 40 patients. The mean age of patients was 6.7 ± 0.3 years (range 3-10 years). The most common PFT were the mandibular lateral incisors and canines (34, 68%). The most prevalent type of PFT was type III (20, 40%). Of the 40 patients with PFT, 34 (85%) also ex-hibited other dental anomalies such as tooth aplasia, peg-shaped incisors, talon cusps, ectopic eruption, and delayed eruption in both related and unrelated areas. The most common complications of PFT were fusion-related tooth aplasia (n = 26 [76%]) and caries formation in the affected teeth (24 [48%]). CONCLUSION: In this study, PFT were frequently observed in the mandibular anterior region. Caries formation and dental anomalies, especially permanent tooth aplasia, were often encountered in areas where PFT were seen. Hence, parents should be informed about possible dental problems associated with PFT and be encouraged to schedule regular follow-up appointments.

Endodontic management of central incisor associated with large periapical lesion and fused supernumerary root: a conservative approach

Fusion and gemination are developmental anomalies of teeth that may require endodontic treatment. Fusion may cause various clinical problems related to esthetics, tooth spacing, and other periodontal complications. Additional diagnostic tools are required for the diagnosis and the treatment planning of fused tooth. The present case report describes a case of unilateral fusion of a supernumerary root to an upper permanent central incisor with large periapical lesion in which a conservative approach was used without extraction of supernumerary tooth and obturated with mineral trioxide aggregate to reach a favorable outcome.