Restor Dent Endod.  2014 Nov;39(4):319-323. 10.5395/rde.2014.39.4.319.

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

• Cho KM
• Jang JH
• Park SH

• KMID: 2316914
• DOI: http://doi.org/10.5395/rde.2014.39.4.319

Abstract

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.

Keyword

Bicuspidization; Cone-beam computed tomography; Fused teeth; Supernumerary tooth

MeSH Terms

Adolescent
Bicuspid*
Cone-Beam Computed Tomography
Dental Pulp Cavity
Dentistry
Dentition, Permanent
Diagnosis
Female
Follow-Up Studies
Fused Teeth
Humans
Incisor
Inflammation
Tooth
Tooth, Supernumerary*

Figure

• 

  Figure 1 (a) Intraoral photograph showing fusion between the maxillary left second premolar and a supernumerary tooth; (b) Asterisk indicates the fused teeth placed slightly buccally; (c) Periapical radiograph showing abnormal crown morphology of the maxillary left second premolar with a supernumerary tooth.

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  Figure 2 Cone beam computed tomography images showing the continuity between the supernumerary tooth and the second premolar (white arrow) and complete separation of the pulp cavities of each tooth.

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  Figure 3 (a) A white arrow indicates electro-cauterization of the interdental gingiva between fused teeth; (b) Periapical radiographs obtained after nonsurgical root canal treatment; (c) Tooth preparation after bicuspidization; (d) After double crown placement.

• 

  Figure 4 (a) Postoperative panoramic radiograph obtained after 9 years; (b) Postoperative periapical radiograph shows an uneventful healing state.

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