Volume 2 - Issue 4 (Aug-Oct) Download Pdf - IJMD

Unilateral Fu s i o n o f Lateral In c i s o r w i t h Supernumerary Teeth- A c a s e reportBaishali Saha*, S.C.Chandrasekharan @ , Md.Nazish Alam # , Subbiya ~A Case ReportAbstractFusion is a developmental anomaly characterized by the union of two adjacent teeth. This paper reports a rare caseof unilateral fusion of maxillary left lateral incisor with supernumerary element which was misdiagnosed as palatogingivalgroove and surgically accessed for treatment of the same after root canal treatment, and then the fusion cameto forefront..Keywords: Fusion, Supernumerary Tooth, Palatogingival Groove, Anomaly, Germination.IntroductionWhen nature diverts from normal it givesrise to abnormal or anomalies. Dentalanomalies can affect either primaryor secondary dentition and can cause aesthetic,spacing, or periodontal problem. Among themfusion is a commonly identified anomaly. In 1963Tannenbaum and Alling defined fusion as a unionof two separate tooth buds at some stage in theirdevelopment. They have joined dentin but the pulpchambers can be joined or separated depending onthe stage when union occurs. This process involvesepithelial and mesenchymal germ layer resulting inirregular morphology 1 . Review of literature revealsgreat difficulty in correctly differentiating betweengermination and fusion. The etiology can be:(a) Excessive pressure and physical force betweento developing tooth. 2(b) Genetic predisposition and racial difference.Mostly seen in deciduous teeth and most prevalentin anterior region 3 bilateral fusion are even lessfrequent. 6 Few cases of fusion involving molarand premolar teeth have been reported. 3-5 Turelland Zmener described a case of fusion involving 2 ndand 3 rd molar 3 . Unfortunately they require surgicalremoval because of excessive width and alignmentand function problem. 6,8 Anterior region, unpleasant*Post Graduate, Department of Periodontology & Implantology@Professor & Head, Department Of Periodontology & Implantology#Senior Lecturer, Department of Periodontology &Implantology~Professor, Department Of Conservative Dentistry & EndodonticsSree Balaji Dental College & Hospital, Pallikaranai, ChennaiCorresponding Author :Dr. Baishali Saha,email: dr.baishalisaha@gmail.comaesthetic tooth shape predisposing them to caries,periodontal disease and complicated endodontictreatment. 7,10Fusion can occur between teeth of same dentitionor mixed dentition and between normal andsupernumerary teeth. 3,7-9,11,12 In these cases numberof teeth in dental arch is also normal making thedifferentiation of germination from fusion difficultor almost impossible.Case ReportA 22 year old female reported to Departmentof Endodontics, Sree Balaji Dental College andHospital with the complaint of pain in upper left fronttooth region for the last 6 months which aggravateson intake of hot and cold. Clinical examinationrevealed the presence of an irregular morphology oflateral incisor with an increased mesiodistal widthand mild caries in the palatal aspect of same teethwith pain on percussion. The remaining maxillaryand mandibular permanent teeth were normal in size,shape and no tooth was absent. The examinationrevealed the presence of deep palatogingival groovebelow the gingival margin but no pocket depth wasnoticed in association and no attachment loss.Radiographic examination showed a wider diameterof tooth throughout the length with two pulp canaland a periapical abscess in relation to tooth no. 22.Two root canals were located (mesial and distal)in tooth number 22 and treated with RCT sent toDepartment of Periodontology for the managementof palatogingival groove.Under local anaesthesia, with the help ofcrevicular and interdental incison, a full thicknessmucoperiosteal flap is elevated palatally, where itwas found out that it was actually a fusion of 22Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 4, August-October 2012 583