Geminación y fusión: un desafío en la práctica clínica / Gemination and fusion: a challenge for clinical practice

Los términos geminación y fusion dentaria son utilizados para describir dos anomalías dentarias por unión en las que se afectan el número, la estructura, la forma, y el tamaño dentario. Su diagnóstico diferencial es muy complicado, a pesar de los numerosos casos que se pueden encontrar en la literatura. Es por ello, que muchos autores denominan a este grupo de anomalías como «diente doble» o «diente gemelo», considerándolos así como términos sinónimos. El diagnóstico y tratamiento del «diente doble» es un desafío para el dentista, así como su nomenclatura. Debe llevarse a cabo un diagnóstico diferencial con la macrodoncia. Los dientes afectados representan frecuentemente un problema estético, siendo más susceptibles a la caries y a la enfermedad periodontal. Es necesario llevar a cabo un examen clínico y radiográfico exhaustivo, para obtener un diagnóstico correcto que permita alcanzar un tratamiento temprano, en caso de que sea necesario. La opción de tratamiento del «diente doble» depende del tipo de dentición afectada, la repercusión estética, la morfología del arco dental y el patrón de oclusión. Cuando se requiere tratamiento endodóncico, es obligatorio prestar más atención durante determinadas fases, especialmente en el diagnóstico radiológico, y en el acceso y localización de conductos. Este artículo discute la prevalencia, etiología, patogenia, diagnóstico diferencial y tratamiento del diente doble mediante cuatro casos clínicos

Gemination and fusion are terms used to describe two dental anomalies by union, where number, shape, structure and tooth size are affected. Differential diagnosis is complicated, in spite of numerous cases described in literature. Thereby, many authors describe this group of anomalies as «double teeth» or «twin-teeth», considering them as synonymous terms. «Double teeth» diagnosis and treatment are a challenge for dentist, as well as its nomenclature. Differential diagnosis with macrodontia must be carried out. Affected tooth frequently show poor aesthetic, being more susceptible to caries and periodontal disease. It is necessary to carry out an exhaustive clinical and radiographic examination to provide a correct diagnosis for achieving an early treatment, if necessary. Treatment choice in double-teeth depends upon the type of affected dentition, aesthetic involvement, dental arch morphology and occlusion pattern. When requiring endodontic treatment, more attention during certain stages, especially in diagnostic radiology, and in access, and location of roots canals are compulsory. This article discuss the prevalence, etiology, pathogenesis, differential diagnosis and treatment of double-teeth through four clinical cases

Herencia autosómica recesiva en paciente no sindrómico con múltiples dientes supernumerarios / Autosomal recessive inheritance in a non-syndromic patient with multiple supernumerary teeth

La hiperdoncia es una condición caracterizada por la presencia de un número de dientes superior al normal en el arco dentario. Su etiología es incierta, aunque factores genéticos y ambientales así como varias teorías han sido propuestas para explicarlo. Describir las características clínicas y radiográficas presentes en un paciente no sindrómico con múltiples supernumerarios, heredados de manera autosómica recesiva. Se presenta el caso de un hombre de 27 años de edad que acudió a consulta para evaluación odontológica. Al examen físico y extrabucal no reveló deformidades, retardo mental ni presencia de ningún síndrome. Al examen intrabucal se evidenció la presencia de irritantes locales y maloclusión dentaria, ocasionada por el aumento del número dientes en los arcos dentarios. Radiográficamente se observaron múltiples imágenes radiopacas compatibles con 9 unidades dentarias incluidas y 2 erupcionadas. Los exámenes de laboratorio no revelaron alteraciones ni relación con algún síndrome. Se solicitaron radiografías panorámicas a los padres, hermanos e hija del paciente, para descartar la presencia de dientes supernumerarios, encontrándose 9 dientes supernumerarios incluidos en un hermano varón, determinándose la trasmisión del rasgo de manera autosómica recesiva. El hallazgo de la trasmisión de manera autosómica recesiva de múltiples supernumerarios en un paciente no sindrómico encontrado en este caso, no es común, lo cual indica que el examen clínico y estudio de cada paciente debe ser llevado a cabo de manera exhaustiva, para determinar este tipo de trastorno o cualquier otro sin evidencias o manifestaciones clínicas.

Hyperdontia is a condition characterized by the presence of a higher number of teeth than normal in the dental arch. Even though genetic and environmental factors as well as a series of theories have been proposed to explain hyperdontia, its etiology is uncertain. To describe clinical and radiographical characteristics found in a non-syndromic patient with multiple supernumerary teeth by autosomal recessive inheritance. A 27-year-old male referred for dental assessment. Physical and extraoral examinations did not reveal deformities, mental retardation or the presence of syndromes. Intraoral examination evidenced the presence of local irritants and dental malocclusion produced by the increased number of teeth in both dental arches. Radiographs revealed multiple radiopaque images compatible with 9 unerupted and 2 erupted teeth. Laboratory tests did not show alterations or a connection to any syndromes. Panoramic radiographs were requested from parents, siblings and daughter of the patient to rule out the presence of supernumerary teeth. Nine supernumerary unerupted teeth were found in one brother, which determined the transmission of characteristics by autosomal recessive inheritance. The incidental finding of the autosomal recessive transmission of multiple supernumerary teeth in a non-syndromic patient observed in this case is not a common result, indicating that clinical examinations and the study of each patient must be carried out thoroughly in order to determine this or any other type of disorders without evidence or clinical manifestations.

Dental findings in a child with osteopathia striata with cranial sclerosis (OS-CS): a case report.

The dental management of an 8-year-old girl with osteopathia striata with cranial sclerosis (OS-CS) is described. The girl presented with various oral abnormalities. The aim of this case report was to describe in detail the dental findings in a patient with OC-CS and the precautions to be taken when planning treatment. In the present case, many dental anomalies, such as delayed eruption of the permanent teeth, obliteration of the dental pulp, short roots, fused roots and taurodontism, were detected. In patients with OS-CS, routine dental care from an early stage is recommended to manage this anomaly properly.

The association between prune belly syndrome and dental anomalies: a case report.

BACKGROUND: Prune belly syndrome is a rare condition produced by an early mesodermal defect that causes abdominal abnormalities. However, the literature indicates that disturbances related to ectodermal development may also be present. This is the first case report in the literature to suggest that dental abnormalities are part of the broad spectrum of clinical features of prune belly syndrome. Because the syndrome causes many serious medical problems, early diagnosis of abnormalities involving the primary and permanent dentitions are encouraged. CASE PRESENTATION: The authors report the clinical case of a 4-year-old Caucasian boy with prune belly syndrome. In addition to the triad of abdominal muscle deficiency, abnormalities of the gastrointestinal and urinary tracts, and cryptorchidism, a geminated mandibular right central incisor, agenesis of a mandibular permanent left incisor, and congenitally missing primary teeth (namely, the mandibular right and left lateral incisors) were noted. CONCLUSION: This original case report about prune belly syndrome highlights the possibility that dental abnormalities are a part of the broad spectrum of clinical features of the syndrome. Therefore, an accurate intra-oral clinical examination and radiographic evaluation are required for patients with this syndrome in order to provide an early diagnosis of abnormalities involving the primary and permanent dentitions.

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

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

Fate of developing tooth buds located in relation to mandibular fractures in three infancy cases.

The fate of developing tooth buds located in relation to mandibular fractures was investigated in three infancy cases. Three infants, 2 girls and a boy, aged from 1 year and 5-months old to 2 years and 6-months old, were treated for dislocated mandibular fracture in the symphyseal region by manual reduction and fixation with a thermoforming splint and circumferential wiring under general anesthesia. Fracture healing was uneventful in all cases. A few years later, no obvious deformity of the jaw or malocclusion was observed; however, malformation of the crown was found in one of the permanent teeth on the fracture line in the first case. In the second case, no abnormality was observed in one of the permanent teeth on the fracture line, but the effect on the other tooth could not be evaluated due to abnormality of the tooth probably not related to the injury. In the third case, root formation was arrested in one of the permanent teeth on the fracture line and the tooth was lost early after eruption. The development of tooth buds on the fracture line is not predictable and therefore, should be monitored by regular follow up.

Anomalías de forma: fusión y geminación / Form abnormalities: tooth fusion and gemination

La fusión y la geminación son anomalías de forma que presentan las piezas dentales. La fusión es la unión de dos piezas en desarrollo y la geminación es el nacimiento de un segundo diente a partir de un único brote. Las radiografías panorámicas son de utilidad para establecer un diagnóstico diferencial. Si bien no se conoce cuál es la etiología de estas anomalías, se les confieren múltiples causas. Como conclusión, es importante la elaboración de un plan de tratamiento individualizado para cada caso.

New dental findings in the median cleft facial syndrome.

BACKGROUND: The main features of median cleft facial syndrome are hypertelorism, cranium bifidum occultum, widow's peak, and midine clefting of the nose, upper lip and palate. Since this pathology was first described in 1967, many cases have been reported in the literature, but none of these reports has addressed oral anomalies in depth. CASE DESCRIPTION: The authors present the case of a female patient aged 4 years and 7 months who was diagnosed with median cleft facial syndrome. In this case, the patient had an abnormal number of teeth, owing to fusion or agenesis of teeth, supernumerary teeth and ectopic eruption of some teeth. These oral anomalies had not been described before in the literature as being associated with this syndrome. CLINICAL IMPLICATIONS: Median cleft facial syndrome is a rare pathology; however, dentists should know its possible alterations at an oral level, because children with this syndrome need dental treatment to achieve good esthetics and correct occlusion.

[Double teeth]. / Dubbeltanden.

Double teeth are not really rare, but it is still enigmatic why and how they develop. Based upon the clinical, morphological and anatomical appearance and the number of teeth in mouths with double teeth, the double teeth are labelled as products of 'fusion' and 'clefting', but the criteria to attach such etiological names are lacking. It is assumed that heredity is involved in the development of double teeth. Therefore it is attempted to explain why only one of a homozygotic twin had a double tooth.

Oral-facial-digital syndrome, Type I: a case report.

Oral-facial-digital syndrome is a group of congenital anomalies, which affects the face, oral structures and digits. There are nine subtypes. OFDS type I, is x-linked dominant trait mostly affecting females. Reports of OFDS type 1 in Asians are extremely rare. This paper shows a case of OFDS type 1, in a southern Chinese girl, who in addition to most of the classic features, had fusion of the mandibular canine and lateral incisor teeth.

Double tooth.

The form of primary and permanent teeth can differ morphologically from that which is considered normal, completely or in some parts. The changes in tooth form can be hereditary or caused by some disease or trauma. Fusion is a union of one or more teeth during development. Gemination means that two separate morphological units were created by division of the tooth germ. The intention of this study was to state the prevalence of double teeth (fusion and gemination) among the persons tested, as to gender, distribution in the maxilla or mandible, and whether the anomaly occurred bilaterally or unilaterally. The results of this investigation have shown that in a total of examined 3,517 plaster models, a prevalence of double teeth was 0.2%. 57.2% of them were fusioned and 42.9% geminated.

Fusäo dentária: revisäo de literatura e apresentaçäo de caso radiográfico / Fused teeth: literature review and a case report

Foram abordados aspectos pertinentes à fusäo dentária no que tange à etiologia, aspectos clínicos e radiograficos e eventuais tratamentos, bem como a apresentaçäo de um caso radiográfico

Meningococcal septicemia and disseminated intravascular coagulation affecting the premaxillary permanent tooth germs.

The following case describes the dental effects resulting from a case of meningococcal septicemia which caused a disseminated intravascular coagulation and premaxillary osteomyelitis at age two years. The effects went unnoticed for eight years when delayed development of the maxillary incisors was noted. Treatment involved surgical removal of the dental remnants and provision of a removable partial denture. Implants and ridge augmentation will be considered in early adulthood.

Anomalies of tooth form and number in the permanent dentition: report of two cases.

Two cases of bilateral double teeth involving the permanent maxillary central incisors are described. The difficulties in establishing the precise diagnosis are considered. The treatment plans also are discussed. The etiology and nomenclature of these dental formations and number of anomalies are reviewed.

Traumatic gemination--triple tooth. Survey of the literature and report of a case.

Gemination and twinning are two rarely encountered developmental abnormalities. Although the precise etiology remains unknown, genetic predisposition is often suggested in the process. In the present study a maxillary incisor with three crowns of conical shape and three roots which were presumed to be the gemination of the tooth due to trauma, is reported.