Objective. Fusion is a dental anomaly that arises through the union of two adjacent teeth. The case report presents multidisciplinary management of a fused maxillary anterior tooth. Case Report. A 10-year-old boy was referred to the pediatric dental clinic with the chief complaint of a large upper anterior tooth. Intraoral and radiographic examinations indicated fusion between the permanent maxillary right central incisor and a supernumerary tooth. According to the treatment plan, the fused tooth was sectioned, and the mesial portion was removed. The remaining tooth section was restored with composite resin, and the diastema between the central incisors was closed with orthodontic treatment. After an 18-month followup period, the tooth showed no sign of pathosis. Conclusion. The technique described here offers a simple and effective method for restoring a fused tooth that reestablishes function, shape, and esthetics. 1. Introduction Tooth fusion is a rare developmental anomaly that stems from the embryogenic union of two teeth originating from two or more tooth germs [1, 2]. Although the exact etiology of fusion is unclear, pressure or physical force producing close contact between two developing tooth buds has been reported as a possible cause, and trauma, genetic and environmental factors have also been implicated as contributing factors [3–6]. Moreover, fused teeth may form part of syndromes such as achondrodysplasia, chondroectodermal dysplasia, focal dermal hypoplasia, and osteopetrosis [7–11]. The literature suggests fusion has a higher incidence in deciduous dentition (0.5%–2.5%) than in permanent dentition (0.1%–1.0%) [7, 12, 13]. Fused teeth are found predominantly in the anterior region, with incisors and canines the most frequently affected [14, 15]. These anomalies may be bilateral or unilateral [14, 16]. The incidence of fusion does not vary by sex [7, 12]. Fused teeth may occur in both the maxilla and mandible, but they are more frequently present in the mandible [17]. The majority of fused teeth show an anomalous broad crown and two distinct root canals. Clinically, the crowns appear melded together, with a small groove between the mesial and distal parts. Fused teeth may be characterized by one pulp chamber divided into two root canals, two independent endodontic systems, or one common pulp canal [5, 15, 18]. This case report presents the surgical separation and orthodontic treatment of a maxillary central incisor fused with a supernumerary tooth. 2. Case Report A 10-year-old boy was referred to the paediatric dental clinic with the
References
[1]
A. Kne?evi?, S. Travan, Z. Tarle, J. ?utalo, B. Jankovi?, and I. Ciglar, “Double tooth,” Collegium Antropologicum, vol. 26, no. 2, pp. 667–672, 2002.
[2]
M. K. Caroll, “Fusion and Gemination in alternate dentitions,” Oral Surgery Oral Medicine and Oral Pathology, vol. 69, no. 5, p. 655, 1990.
[3]
R. J. Lowell and A. L. Solomon, “Fused teeth,” Journal of the American Dental Association, vol. 68, p. 762, 1964.
[4]
W. G. Shafer, M. K. Hine, and B. M. Levy, A Textbook of Pathology, WB Saunders, Philadelphia, Pa, USA, 4th edition, 1983.
[5]
C. L. Mader, “Fusion of teeth,” The Journal of the American Dental Association, vol. 98, no. 1, pp. 62–64, 1979.
[6]
E. Moody and L. B. Montgomery, “Hereditary tendencies in tooth formation,” The Journal of the American Dental Association, vol. 21, pp. 1774–1776, 1934.
[7]
A. H. B. Schuurs and C. van Loveren, “Double teeth: review of the literature,” Journal of Dentistry for Children, vol. 67, no. 5, pp. 313–325, 2000.
[8]
N. L. Crawford, S. North, and L. E. Davidson, “Double permanent incisor teeth: management of three cases,” Dental update, vol. 33, no. 10, pp. 608–610, 2006.
[9]
T. Cetinbas, S. Halil, M. O. Akcam, S. Sari, and S. Cetiner, “Hemisection of a fused tooth,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 104, no. 4, pp. e120–e124, 2007.
[10]
S. Kara?ay, U. Gurton, H. Olmez, and G. Koymen, “Multidisciplinary treatment of “winned” permanent teeth: two case reports,” Journal of Dentistry for Children, vol. 71, no. 1, pp. 80–86, 2004.
[11]
G. Oliván Rosas, J. López Jiménez, M. J. Giménez Prats, and M. Piqueras Hernández, “Considerations and differences in the treatment of a fused tooth,” Medicina Oral, vol. 9, no. 3, pp. 224–228, 2004.
[12]
C. Schulze, “Developmental abnormalities of the teeth and the jaws,” in Thoma's Oral Pathology, R. J. Gorlin and H. M. Goldman, Eds., pp. 96–183, Mosby, St. Louis, Mo, USA, 6th edition, 1970.
[13]
T. D. Blaney, G. R. Hartwell, and R. Bellizzi, “Endodontic management of a fused tooth: a case report,” Journal of Endodontics, vol. 8, no. 5, pp. 227–230, 1982.
[14]
G. M. Delany and L. I. Goldblatt, “Fused teeth: a multidisciplinary approach to treatment,” The Journal of the American Dental Association, vol. 103, no. 5, pp. 732–734, 1981.
[15]
M. Hülsmann, R. Bahr, and U. Grohmann, “Hemisection and vital treatment of a fused tooth—literature review and case report,” Endodontics and Dental Traumatology, vol. 13, no. 6, pp. 253–258, 1997.
[16]
C. S. Budd, D. E. Reid, J. C. Kulild, and R. N. Weller, “Endodontic treatment of an unusual case of fusion,” Journal of Endodontics, vol. 18, no. 3, pp. 133–137, 1992.
[17]
A. H. Brook and G. B. Winter, “Double teeth. A retrospective study of “geminated” and “fused” teeth in children,” British Dental Journal, vol. 129, no. 3, pp. 123–130, 1970.
[18]
E. S. Reeh and M. ElDeeb, “Root canal morphology of fused mandibular canine and lateral incisor,” Journal of Endodontics, vol. 15, no. 1, pp. 33–35, 1989.
[19]
C. Gadimli and Z. Sari, “Interdisciplinary treatment of a fused lower premolar with supernumerary tooth,” European Journal of Dentistry, vol. 5, no. 3, pp. 349–353, 2011.
[20]
B. Ozden, K. Gunduz, S. Ozer, A. Oz, and F. O. Ozden, “The multidisciplinary management of a fused maxillary central incisor with a talon cusp,” Australian Dental Journal, vol. 57, no. 1, pp. 98–102, 2012.
[21]
T. Demir, U. Ates, B. Cehreli, and Z. C. Cehreli, “Autotransplantation of a supernumerary incisor as a replacement for fused tooth: 24-month follow-up,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 106, no. 4, pp. e1–e6, 2008.
[22]
H. Kayalibay, M. Uzamis, and A. Akalin, “The treatment of a fusion between the maxillary central incisor and supernumerary tooth: report of a case,” Journal of Clinical Pediatric Dentistry, vol. 20, no. 3, pp. 237–240, 1996.
[23]
J. O. Andreasen and L. Kristerson, “The effect of limited drying or removal of the periodontal ligament. Periodontal healing after replantation of mature permanent incisors in monkeys,” Acta Odontologica Scandinavica, vol. 39, no. 1, pp. 1–13, 1980.