Esthetic management of fused carious teeth: a case report

A rare case of a carious supernumerary tooth fused to the labial surface of a maxillary right central incisor is reported. Root canal therapy on the maxillary right central incisor was performed owing to the pulpal communication between the supernumerary tooth and the maxillary right central incisor after removing the carious supernumerary tooth structure. The defect was then restored with anterior resin composite and the esthetics reestablished.

CLINICAL SIGNIFICANCE

Clinical significance lies in identifying a rare case of fusion of supernumerary tooth to a permanent tooth and treating the anomaly in the most conservative way.     

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.     

Gingival abscess occurring in maxillary primary central incisor fused to supernumerary tooth

A 5Y7M-old girl was referred to our clinic by a general dentist for detailed examination of a recurrent gingival abscess in the maxillary left primary central incisor region. An intraoral examination revealed a diffuse swelling in the palatal gingiva area of the affected tooth. A periapical radiograph showed that the affected tooth was actually the primary central incisor and a supernumerary tooth, which had fused and been filled with composite resin at the juncture of the 2 tooth crowns. Removal of the filling induced severe bleeding and root canal treatment was performed. Radiographic examinations revealed 2 independent root canals, thus an additional access cavity to the mesial pulp cavity was produced for further root canal treatment. After the lesion had disappeared, root canal filling was performed using iodoform-calcium hydroxide paste and the affected tooth was restored with composite resin to fashion a single crown. However, the canal filling paste was later observed to be resorbed in the cervical area of the root. At 6Y0M, the patient received a traumatic injury in the anterior teeth region and the fused tooth was drastically displaced in a palatal direction, thus we extracted it under infiltration anesthesia. The root was observed to be wide in the mediodistal direction, and a histopathological examination revealed only dentin between 2 independent root canals. Our findings showed that the fused tooth was composed of 2 crowns and 1 root with 2 independent canals, and indicate that each crown and canal should have been treated separately.     

A supernumerary tooth fused to the facial surface of a maxillary permanent central incisor: case report

A case of a supernumerary tooth fused to the facial surface of a maxillary permanent central incisor is reported. Root canal therapy on the maxillary central incisor was performed due to pulpal communication between the supernumerary tooth and the maxillary central incisor after removing the supernumerary tooth structure. The communication was sealed with mineral trioxide aggregate. The difference between fusion and gemination is discussed.     

Uncommon fusion of teeth and lateral periodontal cyst in a Chinese girl: a case report

Fusion is a developmental anomaly of dental hard tissues. Most cases occur in the anterior region of both the primary and permanent dentitions. Occasionally, fusion of permanent and supernumerary teeth may occur in the maxillary anterior region; however, a supernumerary tooth fused with a premolar is a rare case. Developmental lateral periodontal cyst is also an uncommon developmental odontogenic cyst with no clinical symptoms, and the lesion is often discovered on routine radiographic examination. In the present case, we report the uncommon fusion of teeth and lateral periodontal cyst in a Chinese girl. Using cone beam computed tomography we are able to acquire a better understanding of the complicated root canal morphology of the fused tooth and successfully manage the lateral periodontal cyst.     

Hemisection of a fused tooth

Fusion is a developmental anomaly which occurs due to a union of 1 or more adjacent teeth during morphodifferentiation of the dental germs. The present case report presents the hemisection of a maxillary central incisor fused with a supernumerary tooth. A 10-year-old boy was referred to clinic with the chief complaint of the presence of a large anterior tooth. Intraoral and radiographic investigations indicated fusion between the left central incisor and a supernumerary tooth. The fused tooth was separated with a diamond bur, and the supernumerary tooth was extracted. The left central incisor was restored with composite resin and the diastema between the maxillary central incisors was closed with orthodontic treatment. The left central incisor was still healthy after a follow-up examination period of 24 months. An ideal overjet and overbite relation was achieved at the end of the orthodontic treatment. Hemisection can be considered as an appropriate treatment alternative for a permanent tooth fused with a supernumerary tooth.     

Endodontic treatment of a supernumerary tooth fused to a mandibular second molar: a case report

Since abnormal tooth morphology can predispose to caries and periodontal disease, careful management of fused teeth is essential. In this paper we report a rare case of a fused molar and supernumerary tooth and describe its management. Caries was removed from the tooth complex under local anesthesia. The pulp chamber of the supernumerary tooth was exposed without involvement of second molar pulp chamber. The root canal of the supernumerary tooth was prepared using the step back technique and copious irrigation with 2.6% sodium hypochlorite. Obturation using the lateral condensation technique with gutta-percha and AH26 sealer was subsequently performed and final restoration was accomplished with composite resin. Nine months after the treatment, no clinical or radiographic concern is apparent, and the second molar tooth has remained vital.     

Fusion of Central Incisors with Supernumerary Teeth: A 10-year Follow-up of Multidisciplinary Treatment

Introduction

Macrodontia of anterior teeth may occur as an isolated condition or as a result of fusion or gemination and may cause clinical problems such as tooth crowding and esthetic problems. Preliminary planning and careful management are often required by a dental team comprising an orthodontist, an endodontist, a prosthodontist, and an oral surgeon. A multidisciplinary treatment approach in a case with fused teeth is presented.

Methods

A 9-year-old girl presented with macrodontia of a left maxillary central incisor. The patient was referred to the orthodontic department because of a large central incisor as a result of fusion with an unspecific supernumerary tooth. The surgical procedure included sectioning off the mesial segment as far as possible, both apically and subgingivally, and extracting 1 of the fused supernumerary teeth. During the sectioning procedure, the pulp of the remaining tooth was exposed at the middle third of the root. Direct pulp capping was performed by an endodontist using mineral trioxide aggregate. Twelve weeks later, orthodontic treatment was commenced, and finally after a 26-month orthodontic treatment period, the central incisors' crown was restored using composite material.

Results

A 10-year clinical and radiographic follow-up revealed that the remaining resected central incisor kept its vitality, and the patient was pleased with the esthetic result.

Conclusions

Proper interdisciplinary treatment planning of complicated cases such as anomalous teeth, which involve fusion to a supernumerary tooth, may lead to minimal invasive conservative procedures that maintain tooth vitality and result in a pleasing esthetic result.     

Fused upper central incisors: management of two clinical cases

This paper reports the management of two clinical cases, in which the upper right central incisor was fused with a supernumerary tooth and the upper left central incisor was macrodontic. A radiographic examination revealed that the fused teeth had two separate roots. Hemisectioning of the fused teeth was performed, the supernumerary portion was extracted and the remaining part was reshaped to remove any sharp margins and to achieve a normal morphology. The macrodontic central incisors were not treated. At 12-months post-surgery there were no periodontal problems and no hypersensitivity. Orthodontic treatment was performed to appropriately align the maxillary teeth and to correct the malocclusion.     

Conservative treatment of dens evaginatus of anterior teeth

Abstract Dens evaginatus is a developmental malformation characterized by the presence of an extra cusp. In the anterior dentition, dens evaginatus is more commonly found in the maxilla and on the palatal surface of the tooth. Treatment may include root canal therapy followed by either an aesthetic restoration or a full crown coverage. In cases of mesiodens, supernumerary teeth or crowded dentition, extraction is often indicated. Presented is a case of a conservative treatment modality of dens evaginatus in a mandibular central incisor.     

Endodontic and orthodontic treatment of a cross-bite fused maxillary lateral incisor

AIM: To describe combined endodontic and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY: A rare case is presented in which combined endodontic and orthodontic treatment was performed on a cross-bite fused tooth. Clinical and radiographic examination showed the maxillary lateral incisor fused with a supernumerary and an impacted canine. The fused tooth required nonsurgical and surgical endodontic treatment for functional and aesthetic reasons. The root canals were dressed with calcium hydroxide for 2 months before they were obturated with thermoplasticized injectable gutta-percha. Then, the distal part of the fused tooth was removed and the mesial part of the tooth was replanted and fixed. Three months after the completion of orthodontic therapy, the impacted canine erupted between the remaining tooth and the first premolar. Recall examination, 3 years after completion of root canal treatment, showed clinical and radiographic evidence of healing. KEY LEARNING POINTS: Fusion has been described as a development anomaly characterized by the union of two adjacent teeth. Proper combined endodontic and orthodontic treatment resulted in maintaining one tooth half and solving the aesthetic and functional problem of a fused tooth.     

Management of a fused central incisor in association with a macrodont lateral incisor: a case report

Fusion is developmental anomaly of the dental hard tissue and is defined as the joining of 2 developing tooth germs resulting in a single large tooth structure. Different treatment methods can be used according to the requirements of the situation. The purpose of this case report was to present the multidisciplinary treatment of a patient who had a permanent maxillary left central tooth fused with a supernumerary incisor and a macrodont permanent maxillary right lateral incisor. In the radiographic evaluation, it was determined that the fused tooth had 2 separate roots. The supernumerary tooth was extracted after hemisection, and endodontic treatment was performed on the remaining portion. The distal side of the macrodont lateral incisor was recontoured, and the right central incisor was reshaped with a strip crown to provide aesthetic appearance and to gain space for the alignment of teeth. Following the restoration of the incisors, orthodontic treatment was provided.     

Vitality preservation of an anomalous maxillary central incisor after endodontic therapy

Endodontic treatment of a case of fused immature central incisor with a supernumerary tooth with dens in dente is described. Although a chronic dentoalveolar abscess was diagnosed, vitality test signs were positive. Treatment consisted of pulpotomy with calcium hydroxide paste; after 2 1/2 months a permanent root canal filling was placed in the amputated part. Follow-up 2 years postoperatively indicated that the tooth has maintained its vitality. The periapical area is completely healed, and apical closure is evident.     

A fused central incisor. Periodontal considerations in comprehensive treatment

This report details the treatment of a permanent central incisor fused to a supernumerary tooth. The level of fusion was first determined by radiographs, but surgical visibility indicated a more extensive fusion. The two roots were separated, and the supernumerary tooth was removed. At 10 weeks postoperatively, orthodontic treatment was instituted, bringing the retained tooth through the healing socket left by the supernumerary, and into contact with the interdental septum. After endodontic treatment and splinting, a periodontal re-entry procedure was necessitated by the persistence of inflammation caused by incomplete removal of the furcation-like area between the fused teeth. The improved periodontal prognosis of this case at 1-year follow-up can be attributed to careful postsurgical evaluation and subsequent removal of this plaque-retentive area.     

Management of fused supernumerary teeth in children using guided tissue regeneration: long-term follow up of 2 cases

Surgical separation of supernumerary teeth fused to permanent incisor teethhas typically given rise to residual post surgical periodontal defects, induding loss of attachment and deep periodontal pocketing with persistent inflammation. Other complications include devitalisation of the retained tooth section, ankylosis, external and replacement resorption. A unique technique of using guided tissue regeneration has been successfully employed to promote periodontal healing, after 2 cases of surgical removal of a supernumerary tooth fused to a permanent maxillary lateral incisor tooth. In the first case, a 2-stage guided tissue regeneration technique was completed with a nonresorbable Gor-Tex membrane, and was followed up after 9 years. The second case was completed using a resorbable Vicryl membrane, in a single-stage guided tissue regenerative technique; and was followed up after 5 years.     

Multidisciplinary approach to the rehabilitation of a crown fracture with glass-fibre-reinforced composite: a case report

Traumatic tooth injuries are common in children. When permanent teeth are involved, it can be a challenge to save these teeth. This clinical case study describes the multidisciplinary treatment of a complex crown fracture and luxation of a right maxillary incisor along with esthetic management. After periodontal surgery including guided bone regeneration and endodontic treatment, we used a glass-fibre-reinforced composite post to increase retention and distribute stress along the root. The restoration was completed using composite in an incremental technique. During follow-up appointments, clinical and radiographic examinations revealed no root canal or periodontal problems, suggesting the efficacy of the treatment in retaining the fractured tooth. Periodontal surgery with endodontic treatment is an alternative treatment for severe trauma in permanent teeth.     

Reattachment of a fractured maxillary tooth: a case report.

A 14-year-old male patient reported with a horizontal fracture of almost the entire crown of a maxillary incisor, extending subgingivally at the palatal side. After root canal therapy and electrosurgery, the tooth fragment was reattached using a total-etch dentin-bonding system and a hybrid composite. Due to enamel cracks and the necessity for more retention, the labial surfaces of the teeth were veneered with a micro-filled composite. The clinical situation of the reattached teeth was confirmed successful by radiographic and photographic assessment after 1, 3, 6, and 12 months. The restoration of an anterior tooth with original tooth fragment in young patients has advantages over conventional composite or prosthetic restorations. However, reattached teeth with fracture extending subgingivally, require long-term follow-up.     

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.     

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.     

Intentional Replantation with an Atraumatic Extraction System in Teeth with Extensive Cervical Resorption

External cervical resorption (ECR) often renders a tooth nonrestorable, especially if it extends deeply within the dental hard tissue. Intentional replantation is sometimes performed as the last resort to save the tooth but may limit conventional forceps extraction because of the high risk of periodontal ligament cell damage or crown fracture.This case report describes the intentional replantation of an upper central incisor with extensive ECR using an axial, atraumatic extraction system to save the otherwise hopeless tooth. The patient was an asymptomatic 37-year-old man with no contributing medical history. The treatment protocol included atraumatic extraction followed by granulation tissue removal, extraoral root canal treatment, and adhesive restoration of the extensive resorption defect. During extraoral manipulation, the utmost care was taken to prevent root surface drying, contamination with dental adhesive, or heat-induced periodontal ligament damage during curing. Two and a half years after replantation, clinical and radiographic examinations revealed normal healing and no symptoms but a slight reduction of bone level compared with the preoperative level and no signs of root resorption or ankylosis. The successful outcome in this case supports the idea of performing intentional replantation with an atraumatic extraction system to save teeth with extensive cervical root resorption and a high risk of fracture during extraction.