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.

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.

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.

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.

Role of cone-beam computed tomography in the evaluation of a paradental cyst related to the fusion of a wisdom tooth with a paramolar: A rare case report

Fusion is an abnormality of tooth development defined as the union of two developing dental germs, resulting in a single large dental structure. This irregular tooth morphology is associated with a high predisposition to dental caries and periodontal diseases. As a result of recurring inflammatory periodontal processes, disorders such as periodontal pocket, pericoronitis, and paradental cysts may develop. A rare mandibular anatomic variation is the retromolar canal, which is very significant for surgical procedures. The fusion of a paramolar and mandibular third molar associated with a paradental cyst co-occurring with the presence of a retromolar canal is rare, and the aim of the present study is to describe the evaluation of this anatomical configuration using cone-beam computed tomography.

Hemisection for the treatment of maxillary lateral incisor fused with a supernumerary teeth---A case report / 实用口腔医学杂志

Fused teeth is defined as the union of enamel and dentin of two or more teeth germs,yielding a single tooth during tooth develop-ment.Their treatment is complex and usually need multidisciplinary approaches.This report presents a case of fused teeth treated by he-misection and discusses the clinical features and treatment options.

Clinical management of a fused upper premolar with supernumerary tooth: a case report

In dentistry, the term 'fusion' is used to describe a developmental disorder of dental hard tissues. In the permanent dentition, fusion of a normal tooth and a supernumerary tooth usually involves the incisors or canines. However, a few cases of fusion involving premolars have also been reported to date. We present a rare case in which fusion of the maxillary left second premolar and a supernumerary tooth in a 13-year-old girl was diagnosed using cone beam computed tomography (CBCT, Alphard-3030, Asahi Roentgen Ind. Co., Ltd.). The tooth was bicuspidized after routine nonsurgical root canal treatment, and the separated teeth underwent appropriate restoration procedures. The second premolar and supernumerary tooth remained asymptomatic without any signs of inflammation after a follow-up period of 9 years. Identification of anatomical anomalies is important for treatment in cases involving fusion with supernumerary tooth, and therefore the microscopic examinations and CBCT are essential for the diagnosis. Fused teeth can be effectively managed by the comprehensive treatment which includes both endodontic and periodontal procedures.

Sarjeev's supernumerary tooth notation system: A universally compatible add-on to the Two-Digit system.

Aim: To give notation for quadrants, tooth position, and the type of supernumerary teeth for both permanent and deciduous dentition. Tooth numbering provides dentists with an essential shortcut in clinical record keeping. Materials and Methods: Three systems are favored worldwide: the Zsigmondy/Palmer system, the Universal system, and the Federation Dentaire Internationale (FDI) Two-Digit system. Histories of all tooth-numbering methods were traced and the strengths and deficiencies of each system were reviewed. The FDI Two-Digit system is widely used throughout the world, except USA, and is the only method that makes the visual sense, cognitive sense, and computer sense. Conclusion: On review it was noticed that all tooth notation systems in vogue have a drawback as they do not provide any information or notations for supernumerary teeth such as paramolar, distomolar, mesiodens, and fused teeth.

Endodontic and post-endodontic management of a fused molar.

Treatment of fused teeth needs special care and attention to the bizarre anatomy. This paper describes root canal treatment of a fused carious tooth presenting with apical periodontitis. It is a rare case of fusion of the mandibular second molar with a paramolar. There is no literature regarding placement of crown over endodontically treated fused teeth. In this case, the fused teeth were endodontically treated and restored by a porcelain fused to metal crown.

Mandibular lateral incisor with four root canals: A unique case of double tooth diagnosed using multidetector computed tomography

Double tooth is a dental anomaly consequent to fusion of two or more teeth or gemination of a single tooth. This report describes a unique case of double tooth in relation to a mandibular lateral incisor exhibiting the presence of four root canals. The role of conventional radiography and advanced three-dimensional imaging techniques in the better assessment of complex root canal systems and their aid in endodontic management has also been highlighted.

Tratamiento endodóntico en dientes geminados o fusionados: reporte de caso / Root canal treatment in geminated or fused teeth: case report

El tratamiento endodóntico en dientes anteriores superiores e inferiores por lo general es un desafío para el endodoncista por la complejidad del sistema de conductos y todas las variaciones encontradas, tanto del propio sistema de conductos como istmos, conductos laterales, deltas apicales o propias del dientes así como también las anomalías dentarias tales como: fusión, geminación, concrescencia, dens in dens etc. Por lo que es necesario al momento de realizar un tratamiento de conducto un análisis propio de cada caso, para plantear una alternativa de tratamiento adecuado y disminuir la tasas de accidentes y fracasos inherentes del tratamiento aun cuando la mayor parte de los casos son relativamente sencillos y pueden ser tratados sin complicaciones. El especialista debe estar al tanto de estas variaciones, modificar los procedimientos de tratamiento como corresponda, e informar al paciente de estas posibles causas de fracaso del tratamiento. El fracaso de un tratamiento endodóntico tiene múltiples factores asociados y no solo del tratamiento del sistema de conducto como tal, también por la estrecha relación que encontramos entre el diente y los tejidos de soporte dental, un foco infeccioso a nivel periodontal puede llevar al fracaso de la terapéutica endodóntica por la relación endo-periodontal

Endodontic treatment in upper and lower anterior teeth are usually a challenge to the endodontist due up to the complexity of the conduct system and all the variations found, both from within the conduct system as isthmus, lateral canals, apical deltas or own the teeth as Dental abnormalities such as fusion, gemination, concrescence, in dens etc. Therefore it is necessary when performing a root canal own analysis of each case to raise an appropriate treatment option and reduce accident rates and the inherent failures of treatment even though most cases are relatively simple and can be treated without complications. The specialist should be aware of these changes, modifying the treatment procedures as appropriate, and inform patients of these possible causes of treatment failure. The failure of endodontic treatment has multiple associated factors and treatment not only through system as such also by the strong relationship we found between the tooth and dental supporting tissues, an infectious periodontal level can lead to failure endodontic therapy for endo-periodontal relationship

Endodontic treatment of dental formation anomalies / Tratamento endodôntico de anomalia dental de formação

PURPOSE: Dental fusion is defined as the union of two dental germs at some stage of their development. The aim of this article is to report the endodontic treatment of two clinical cases of dental fusion. CASE DESCRIPTION: In the first case, the patient was referred by an orthodontist for endodontic treatment of tooth 12, which was fused to 13. Surgical separation and later replacement of the involved elements in the dental arch was indicated. In the second case, the patient sought dental attendance due to spontaneous pain. In the radiographic exam, gemination in tooth 11 and fusion of 21 with a supernumerary tooth was observed. The fused teeth were endodontically treated, and patients were referred to other dental specialties to reestablish esthetics and function. CONCLUSION: The dentist must be able to diagnose, differentiate and treat these dental anomalies adequately, with the goal of maintaining patients' oral health.

OBJETO: Fusão dental é definida como sendo a união de dois germes dentais em algum momento do estágio de desenvolvimento. O objetivo desse artigo foi descrever o tratamento endodôntico de dois casos de fusão dental. DESCRIÇÃO DO CASO: No primeiro caso clínico, o paciente foi orientado pelo ortodontista a realizar tratamento endodôntico do dente 12, o qual estava fusionado ao dente 13. Foi realizada a separação cirúrgica dos elementos dentais e posterior reposicionamento no arco dental. No segundo caso clínico, o paciente procurou atendimento relatando dor espontânea na região anterior superior. Por meio do exame radiográfico, foi observado geminação do dente 11 e fusão do dente 21 com dente extranumerário. Em ambos os casos os dentes fusionados foram tratados endodônticamente e os pacientes encaminhados para restabelecimento da estética e função. CONCLUSÃO: O cirurgião dentista deve ter habilidade de diagnosticar, diferenciar e tratar adequadamente as anomalias dentárias, objetivando a manutenção da saúde oral dos pacientes.

Anomalias dentárias em crianças com fissura de lábio e palato / Dental anomalies in a child with cleft lip and palate

As anomalias dentárias são comuns em indivíduos com fissura de lábio e palato, como as anomalias de número, tamanho, morfologia, época de formação e erupção, podendo afetar tanto a dentição decídua quanto a permanente. O Diagnóstico destas alterações é importante tanto para a orientação do paciente/responsável como também para o estebelecimento do plano de tratamento odontológico. O objetivo deste estudo foi descrever um caso clínico de um paciente com fissura de lábio e palato, que apresenta diferentes anomalias dentárias.

Dental anomalies are common in individuals with cleft lip and palate such as anomalies of number, size, morphology, development, and eruption, affecting both deciduous and permanent dentition. The diagnosis of these alterations is important not only for knowledge of the patient/responsible but also for the establishment of the dental treatment planning. The aim of this study was to describe a clinical case of a patient with cleft lip and palate that presents different dental anomalies.