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A Case ReportCLINICAL PHOTOGRAPHS:Figure 1 : Mucoperiosteal Flap ElevationFigure 2: Incomplete Fusion of Lateral Incisor withSupernumerary TeethFigure 3:CompletedEndodonticProcedureand a supernumerary tooth and not a palatogingivalgroove. No bone loss or attachment loss is observed.The flap as sutured back with the help of interruptedsuture with 3-0 silk. Post operative instruction andmedication was given. Suture removal and postoperative revaluation was done 1 week after surgeryand satisfactory healing was noticed. (Figure 1-3)DiscussionThe differential diagnosis between germination and fusionhas always been difficult. The clinical and radiographicexamination of the lateral incisor showed a clear caseof palatogingival groove and was sent to departmentof periodontology for conventional management of thesame. So, when the site was surgically accessed, to oursurpise the tooth revealed two separate roots provingthe presence two different teeth and not a palatogingivalgroove. Since all the teeth in the arch were present, wecan confirm the presence of supernumerary tooth whichcaused the union with the lateral incisor. Definitely, teethwith this type of anomalies are un-aesthetic due to theirincreased mesiodistal width and also tend to land up inperiodontal complication due to grooves in the unionarea and at the same time plaque accumulation tendsto be very high. Furthermore, fusion in the primarydentition may have an adverse effect on occlusioncausing deviation and delayed eruption of secondarydentition. Again trauma from this type of occlusion maybe the reason for pulp necrosis, subsequent resorptionand periradicular lesion. Proper understandings of theanatomy are very important for better managementof such case and at the same time the technical skills.Locating the canals and maintenance of oral hygienewas a difficult job in such case. Nerwich et al 13 reportedthe use of calcium hydroxide as root canal dressingwhich helped in subsiding the lesion. These problemsneed cosmetic and orthodontic consideration.References1. Tannenbaum AK, Alling EE. Anomalous toothdevelopment: case reports of gemination and twinning.Oral Surg Oral Med Oral Pathol 1963;16:883-888.2. Shafer WG, Hine MK, Levy BM. A textbook of pathology.4 th ed. Philadelphia: WB Saunders Company, 1983.3. Turell IL, Zmener O. Endodontic therapy in a fusedmandibular molar. J Endo 1999;25: 208-209.4. Beltes P, Huang G. Endodontic treatment of an unusualmandibular second molar. Endod Dent Traumatol1997;13:96-98.g5. Caceda JH, Creath CJ, Thomas JP, Thornton JB.584Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 4, August-October 2012
A Case ReportUnilateral fusion of primary molars with the presence ofa succedaneous supernumerary tooth: case report.PaediatDent 1994;16:53-55.6. Delany GM, Goldblatt LI. Fused teeth: a multidisciplinaryapproach to treatment. J Amer Dent Assoc 1981;103:732-734.7. Peyrano A, Zmener O. Endodontic management ofmandibular lateral incisor fused with supernumerarytooth. Endod Dent Traumatol 1995;11:196-198.8. Hülsmann M, Bahr R, Grohmann U. Hemisection andvital treatment of a fused tooth – literature review andcase report. Endod Dent Traumatol 1997;13:253-258.9. Velasco LF de, Araujo FB, Ferreira ES, Velasco LE.Esthetic and functional treatment of a fused permanenttooth: a case report. Quintessence Int 1997;28:677-680.10. Pereira AJA, Fidel RAS, Fidel SR. Maxillary lateralincisor with two root canals: fusion, gemination or densinvaginatus? Braz Dent J 2000;11:141-146.11. Camm HJ, Wood JA. Gemination, fusion andsupernumerary tooth in the primary dentition: report ofcase. J Dent Child 1989;56:60-61.12. Spatafore CM. Endodontic treatment of fused teeth. JEndod 1992;18:628-631.13. Nerwich A, Figdor D, Endo D, Messer HH. pH changes inroot dentin over a 4-week period following root canal dressingwith calcium hydroxide. J Endod 1993;19: 302-306.Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 4, August-October 2012 585
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