Restor Dent Endod.  2016 May;41(2):148-153. 10.5395/rde.2016.41.2.148.

Nonsurgical endodontic retreatment of fused teeth with transposition: a case report

• Cardoso MA
• Noites RB
• Martins MA
• Paulo MP

• KMID: 2163298
• DOI: http://doi.org/10.5395/rde.2016.41.2.148

Abstract

Tooth transposition is a disorder in which a permanent tooth develops and erupts in the normal position of another permanent tooth. Fusion and gemination are developmental disturbances presenting as the union of teeth. This article reports the nonsurgical retreatment of a very rare case of fused teeth with transposition. A patient was referred for endodontic treatment of her maxillary left first molar in the position of the first premolar, which was adjacent to it on the distobuccal side. Orthopantomography and periapical radiography showed two crowns sharing the same root, with a root canal treatment and an associated periapical lesion. Tooth fusion with transposition of a maxillary molar and a premolar was diagnosed. Nonsurgical endodontic retreatment was performed. At four yr follow-up, the tooth was asymptomatic and the radiolucency around the apical region had decreased, showing the success of our intervention. The diagnosis and treatment of fused teeth require special attention. The canal system should be carefully explored to obtain a full understanding of the anatomy, allowing it to be fully cleaned and obturated. Thermoplastic techniques were useful in obtaining hermetic obturation. A correct anatomical evaluation improves the set of treatment options under consideration, leading to a higher likelihood of esthetically and functionally successful treatment.

Keyword

Endodontic treatment; Fusion; Gemination; Retreatment; Transposition

MeSH Terms

Bicuspid
Crowns
Dental Pulp Cavity
Diagnosis
Follow-Up Studies
Fused Teeth*
Humans
Molar
Radiography
Radiography, Panoramic
Retreatment*
Tooth

Figure

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  Figure 1 Preoperative evaluation. (a) Preoperative orthopantomography; (b - d) Preoperative periapical radiographs with different angulations.

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  Figure 2 Complexity of anatomy. (a) Access cavities; (b) Communication between the canal systems of the molar and premolar; (c) Fusion between distobuccal and palatal canals; (d) The remaining two canals after shaping.

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  Figure 3 Filling procedure and postoperative evaluation. (a) Cement application; (b) Root canal filling with Thermafill and BeeFill; (c) Postoperative periapical radiography; (d) Four year follow-up radiography.

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  Figure 4 Permanent restoration. (a) Initial intraoral lateral view of the patient in occlusion; (b) Intraoral lateral view of the patient in occlusion after restoration; (c) Initial intraoral occlusal view; (d) Intraoral occlusal view after restoration.

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