Analysis of congenital deciduous teeth absence and its permanent teeth phenotype.

OBJECTIVES: This study aimed to investigate the clinical characteristics of congenital deciduous teeth absence and its permanent teeth performance type by using panoramic radiographs. METHODS: A total of 15 749 panora-mic radiographs of 3-6-year-old children with deciduous dentition were collected from January 2020 to December 2021. The incidence of congenital deciduous teeth absence was observed, and the abnormality of permanent teeth was recor-ded. SPSS 24.0 software was used for statistical analysis. RESULTS: The incidence of congenital deciduous teeth absence was 2.54% (400/15 749), which was found in 217 girls and 183 boys, and the difference between the genders was statistically significant (P=0.003). The absence of one and two deciduous teeth accounted for 99.75% (399/400) of the subjects. In addition, 92.63% (490/529) of mandibular deciduous lateral incisor was congenitally absent, 44.80% (237/529) of deciduous teeth was absent in the left jaw, and less than 55.20% (292/529) was absent in the right; the difference between them was statistically significant (P=0.017). The absence of 96.41% (510/529) deciduous teeth in the mandibular was significantly more than that of 3.59% (19/529) in the maxillary, and the difference between was statistically significant (P=0.000). Furthermore, 68.00% (272/400) and 32.00% (128/400) of deciduous teeth were absent in unilateral and bilateral, respectively, and the difference was statistically significant (P=0.000). Four types of congenital deciduous teeth absence with permanent teeth were observed as follows: 1) 73.91% (391/529) of permanent teeth was absent; 2) 20.60% (109/529) of permanent teeth was not absent; 3) the number of fused permanent teeth accounted for 4.91% (26/529); 4) the number of supernumerary teeth was 0.57% (3/529). CONCLUSIONS: Although the absence of congenital deciduous teeth is less common than that of permanent teeth, it affects deciduous and permanent teeth to some extent. Dentists should pay attention to trace and observe whether abnormalities are present in the permanent teeth and take timely measures to maintain children's oral health.

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.

Reabilitação do incisivo central decíduo fusionado ao supranumerário: relato de caso clínico / Primary maxillary right central incisor fused to supernumerary: case report

diagnosticadas precocemente. Este trabalho teve como finalidade relatar o caso clínico de uma paciente de três anos, gênero feminino, cuja queixa principal era a estética dos dentes anteriores superiores,devido ao tamanho desproporcional de um elemento dentário, que se apresentava também com coloração alterada. Ao exame clínico e radiográfico diagnosticou-se uma anomalia denominada fusão dentária, união de dois dentes adjacentes, na região anteros superior. O tratamento consistiu na secção dos dois dentes e exodontia do supranumerário, seguida do tratamento restaurador do incisivo central direito que apresentava lesão de cárie. Concluiu-se que, por meio de adequado diagnóstico e planejamento, o tratamento proposto foi efetivo na reabilitação da função e da estética,assim como na prevenção de complicações clínicas e ortodônticas que poderiam advir da anomalia dentária descrita, caso não tratada. A autoestima da criança foi restabelecida.

Dental anomalies can cause serious disorders in the development of teeth if not diagnose dearly. This study aimed to report a case of a three-year-old patient, female, who together with her responsible, whose main complaint was the aesthetics of the upper front teeth due to disproportionatesize and altered staining. During the clinical and radiographic examinations, ananomaly called teeth merger, which is the union of two adjacent teeth, was diagnosed in the upper anterior region. The treatment included the sectioning of the two teeth and extraction of the super numerary, followed by restorative treatment of the right central incisor that had caries lesions. It was concluded that, through proper diagnosis and planning, the proposed treatment was effective in the rehabilitation of function and aesthetics, as well as in the prevention of clinical and orthodontic complications that could result from the dental anomaly described, ifuntreated. The child’s self-esteem was re-established.

Concrescencia clínica pero no histológica: presentación de un caso clínico / Fused roots does not imply concrescence: a case report with histological analysis

La concrescencia es una anomalía dentaria poco frecuente que se define como la unión de las raíces de dos dientes adyacentes a través del cemento. Aunque en la práctica clínica el término "concrescencia" es utilizado para referirse a todos los casos de unión entre las raíces de dos dientes adyacentes, para confirmar el diagnóstico de concrescencia es necesario un estudio histológico que demuestre la unión a nivel del cemento. Esta anomalía se ha identificado en el 0,8% de los casos de exodoncia de dientes permanentes, siendo su incidencia mayor en la región posterior del maxilar superior. La detección previa de la concrescencia mediante la exploración clínica y radiográfica es, la mayoría de las ocasiones, casi imposible, por lo que el diagnostico suele hacerse después de la extracción. No obstante, es conveniente que el clínico evalúe cada paciente y cada diente de forma exhaustiva para poder planificar, caso de que exista concrescencia, la técnica quirúrgica adecuada para la extracción. Por lo tanto, deben conocerse la incidencia e implicaciones de esta anomalía para llevar a cabo un diagnóstico y plan de tratamiento correcto. En este artículo se presenta un caso clínico de aparente concrescencia diagnosticado post-extracción y cuyo estudio histológico no mostró unión de cemento entre ambas raíces. Por lo tanto, en la práctica clínica es más conveniente utilizar el término "raíces fusionadas" que "concrescencia", el cual sólo debería ser utilizado después del examen histológico de la pieza extraída

Concrescence is a rare dental anomaly defined as the cemental union of two adjacent teeth. Concrescence diagnosis requires histological confirmation, but in the clinical practice the term "concrescence" is used to refer to all the cases of union of the roots of two adjacent teeth. The anomaly has been reported in extraction cases with an incidence of 0.8% in the permanent dentition. Also has been reported a higher incidence of concrescence in the posterior maxilla. It is prudent for the clinician to evaluate carefully each patient and each tooth to be removed for the possibility and desirability of a surgical extraction technique. Therefore, consideration should be given to the possible occurrence, recognition, and implications of this anomaly in diagnosis and treatment planning. Clinically and radiographically is nearly impossible to detect concrescent teeth, and most of these cases are diagnosed post extraction. The purpose of this article is to report a case of clinical concrescence between a retained third molar and an erupted second molar identified during the extraction, which histological study did not show cementum union between both roots. Thus, in the clinical practice is better to use the term "fused roots" than "concrescence", which would be used only after the histological examination of the specimen

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.

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.

Reimplante intencional en diente geminado con lesión endoperio tipo IV. Reporte de caso / Intentional replantation gemina injured in tooth type IV endoperio. Case report

En los dientes con geminación y lesiones periapicales no resueltas después de un tratamiento endodóntico se debe pensar no solo en un diagnostico endodóntico sino también periodontal, ya que estos dientes en el intento de separación pueden presentar surcos o fisuras que van desde el borde incisal hasta la raíz convirtiéndose en un canal de comunicación entre la zona apical y la cavidad oral. Para realizar el plan de tratamiento se debe tener en cuenta: sintomatología persistente, posterior a la terapia endodóntica, persistencia de fístula, lesión periapical de gran tamaño, bolsa periodontal, anatomía radicular palatina del órgano dentario (presunto canal palatino), y que la anatomía del diente sea favorable para realizar el procedimiento. La extracción y reimplante intencional es el tratamiento indicado en casos donde el tratamiento endodóntico fracasa y por la anomalía dental, la cirugía periapical también fallaría porque solo se eliminaría la lesión momentáneamente más no la que lo causa que es la comunicación entre la cavidad oral y la zona apical. Sin embargo, se sabe que esta opción de tratamiento puede traer riesgos y beneficios, incluyendo pérdida del diente o una posible anquilosis y con una de tasa de éxito del 42,9%. El presenta caso clínico describe la extracción y reimplante intencional en un diente geminado con una lesión periapical persistente de origen periodontal, con sintomatología y fístula, posterior a tratamiento endodóntico complejo, su evolución y éxito (AU)

In teeth with gemination and unresolved periapical lesions after endodontic treatment we must think not only in diagnosis but also periodontal endodontic, as these teeth in the attempt of separation may have grooves or cracks that go from the incisal edge to root becoming a channel of communication between the apical and oral cavity. To make the treatment plan should take into account: persistent symptoms, after endodontic therapy, persistent fistula, large periapical lesions, periodontal pocket, root anatomy of the tooth organ palate (palatine canal alleged) and that the anatomy tooth is favorable to perform the procedure. The extraction and intentional replantation is the treatment in cases where the endodontic treatment fails and the anomaly dental periapical surgery also fail because only temporarily remove the lesion but not the cause it is the communication between the oral cavity and apical area. However, it is known that this treatment option can have risks and benefits, including tooth loss or possible ankylosis and with a success rate of 42.9%. The present case report describes the extraction and intentional replantation geminate tooth with a persistent periapical lesion of periodontal origin, with symptoms and fistula, after endodontic treatment complex, its evolution and success (AU)

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.

Interdisciplinary management of dental anomalies: fusion and supernumerary teeth.

A 16-year-old boy presented with a fused permanent maxillary left central incisor with a supplemental tooth and an additional supplemental tooth lingual to the permanent maxillary right central incisor. Following leveling, alignment, and endodontic therapy, the maxillary fused left central incisor was sectioned and the mesial portion extracted as planned. Fixed orthodontic treatment commenced after 10 days to align the maxillary anterior segment. After completion, the midline diastema was closed with veneers. This case highlights the treatment options of a fused tooth and the need for multidisciplinary planning and treatment.

Van der Woude syndrome with an unusual intraoral finding.

Orofacial manifestations of Van der Woude syndrome (VWS) include cleft lip or palate, lower lip pits, hypodontia, hypernasal voice, cleft or bifid uvula, syngnathia, narrow high arched palate, and ankyloglossia. Extraoral manifestations include limb anomalies, popliteal webs, accessory nipples, congenital heart defects, and Hirschsprung disease. We report an interesting case of VWS with characteristic orofacial features along with an unusual additional finding of fusion of primary mandibular left lateral incisor and canine in a 7-year-old boy.

Management of crown root fracture in primary 'double tooth': a case report.

The term 'double tooth' is used to describe two developmental dental anomalies of shape: gemination and fusion. Traumatic episodes involving a fused or geminated primary tooth are rare. This report describes an unusual case of crown root fracture in a primary double tooth.

An unusual triplication of primary teeth-a rare case report.

Odontogenic anomalies can occur as a result of conjoining or twinning defects. This article reports the case of fusion in a 10-year-old boy in relation to the primary maxillary right incisors. Clinicoradiographic examination revealed the presence of triple teeth, ie, fusion between the maxillary right incisors along with a supernumerary tooth on the labial surface. The offending triple tooth was extracted under local anesthesia. The extracted tooth was sectioned using a hard tissue microtome at three levels-the coronal, middle root, and apical levels, respectively-and these sections were visualized under a stereomicroscope. Based on the histologic findings, a final diagnosis of fusion was confirmed. A brief review of the literature on triple teeth is also presented.

Maxillary first molar agenesis and other dental anomalies.

OBJECTIVE: To explore the association of maxillary first molar agenesis with other dental anomalies in Japanese orthodontic patients. MATERIALS AND METHODS: A total of 32 subjects with one or two congenitally missing maxillary first molars (group M) were selected and divided into group 1M (12 subjects with one maxillary first molar missing) and group 2M (20 subjects with two maxillary first molars missing). As controls, 32 sex-matched subjects without agenesis of maxillary first molars were collected (group C). Panoramic and periapical radiographs, cephalograms, study models, intraoral photographs, and anamnestic data were used to identify anomalies of permanent teeth. Chi-square, Fisher's exact, Kruskal-Wallis, and Steel-Dwass tests were used to make statistical comparisons. RESULTS: The prevalence rates of tooth agenesis other than the maxillary first molars and advanced tooth agenesis, with third molars excluded, were significantly higher in group 2M than in group C. The absence of second premolars was most common. The prevalence rate of third molar agenesis was significantly higher in groups 1M and 2M than in group C. The occurrence of symmetrical agenesis of the mandibular third molars was particularly notable in group 2M as compared to group 1M, in which maxillary third molar agenesis was predominant. There was no significant association between maxillary first molar agenesis and other dental anomalies, except for agenesis of teeth other than maxillary first molars. CONCLUSION: Agenesis of maxillary first molars is associated with a higher prevalence of other permanent tooth agenesis and advanced tooth agenesis.

Bilateral fusion of mandibular primary teeth.

The aim of the report was to highlight the rarity of occurrence of bilaterally fused mandibular primary lateral incisors and canines by virtue of the number of such cases reported in literature; to identify congenital absence of successor teeth;and to evaluate their pulpal morphologies to understand the type of fusion. Clinical observation along with an orthopantomograph and periapical radiographs were used to arrive at a diagnosis. The pulpal morphologies varied in each of the fused teeth although both were fusions of the Complete type. There was congenital absence of the permanent mandibular lateral incisors, bilaterally. It was a case of bilateral fusion of mandibular primary lateral incisors and canines of the Complete type with congenitally absent mandibular permanent lateral incisors. Only 13 such cases have been previously reported in literature.

Bilateral twinned teeth and multiple supernumerary teeth: a case report.

Dental twinning can result from the fusion of the developing dental germinal elements or the gemination of a single germ. In bilateral anterior and posterior dental twinning, problems such as poor esthetics, dental caries, arch-length problems, and periodontal disease often occur as a result of the irregular morphology. Several treatment methods have been described in the literature with respect to the different types and morphologic variations of twinned teeth, including endodontic, restorative, surgical, periodontal, and orthodontic treatment. This report documents the case of a young patient with an exceedingly rare phenomenon of permanent twinned teeth and multiple supernumerary teeth in both sides of the mandibular and maxillary arches, as a result of combined fusion and gemination.

Autotransplantation of a supernumerary incisor as a replacement for fused tooth: 24-month follow-up.

This case report describes the technique and 24-month follow-up of autotransplantation of a well-shaped, healthy supernumerary maxillary central incisor as a replacement for a fused maxillary incisor. Because the alignment of the teeth neighboring the fused incisor was not suitable as an abutment for post-transplantation splinting, a custom palatal splint that took anchorage from permanent first molars was fabricated. Following extraction of both teeth, the supernumerary incisor was immediately autotransplanted into the extraction site of the fused incisor. The autotransplanted tooth was secured to the custom splint with acid-etch composite, and the splint was removed 2 weeks later. Closure of the apex was observed at 18 months. Both the esthetics and function were restored to an ideal level in the absence of postoperative complications, as evidenced by 24-month clinical and radiographic findings.

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.

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.

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.

Endodontic management of a fused maxillary lateral incisor with a supernumerary tooth: a case report.

Fusion is a rare occurrence and its definitive diagnosis is of prime importance for successful root canal treatment. This case report discusses the endodontic and esthetic management of fused maxillary lateral incisor with a supernumerary tooth that presented with spacing between the fused tooth and the adjacent central incisor. Nonsurgical endodontic treatment was performed on the fused teeth followed by postendodontic esthetic restoration. The patient remained symptom-free and there was a reduction in the size of periapical radiolucency after 1 year.