Korean J Orthod.  2017 Nov;47(6):384-393. 10.4041/kjod.2017.47.6.384.

Multidisciplinary management of a fused maxillary central incisor moved through the midpalatal suture: A case report

• Bulut H
• Pasaoglu A

• KMID: 2392185
• DOI: http://doi.org/10.4041/kjod.2017.47.6.384

Abstract

Fusion of teeth is a developmental anomaly. It occurs at the stage of tooth formation, which determines the shape and size of the tooth crown, when one or more teeth fuse at the dentin level during the morphodifferentiation of the dental germs. Such teeth show macrodontia and may cause crowding, as well as esthetic and endodontic problems. In this article, we report a rare case of a maxillary central incisor fused to a supernumerary tooth showing labial and palatal talon cusps, which was orthodontically moved across the midpalatal suture. A 13-year-old Caucasian boy sought treatment for the unesthetic appearance of his maxillary central incisor and anterior crowding. He was rehabilitated successfully via a multidisciplinary approach involving orthodontic, nonsurgical endodontic, periodontal, and prosthodontic treatments. After a 26-month treatment period, the patient's macroesthetics and microesthetics were improved. The overall improvement of this macrodontic tooth and its surrounding tissues through multidisciplinary treatment was documented using cone-beam computed tomography.

Keyword

Fusion; Macrodontia; Talon cusp; Midpalatal suture; Midline crossing

MeSH Terms

Adolescent
Cone-Beam Computed Tomography
Crowding
Dentin
Humans
Incisor*
Male
Sutures*
Tooth
Tooth Crown
Tooth, Supernumerary

Figure

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  Figure 1 Pretreatment photographs.

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  Figure 2 Pretreatment dental casts.

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  Figure 3 Pretreatment panoramic radiograph.

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  Figure 4 Pretreatment cone-beam computed tomography image.

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  Figure 5 Pretreatment and post-treatment lateral cephalometric radiographs.

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  Figure 6 Treatment progress. A, Leveling and aligning phase of treatment with 0.014-inch preformed Damon Copper NiTi archwire. B, Movement of the fused teeth through the midpalatal suture by using a 0.019 × 0.025-inch stainless steel wire and open coil springs. C, Class II intermaxillary elastics (5/16-inch, 6 oz) are used for correcting the dental Class II relationship. D, Prosthetic restoration application after bracket removal.

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  Figure 7 Post-treatment photographs.

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  Figure 8 Post-treatment dental casts.

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  Figure 9 Post-treatment panoramic radiograph.

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  Figure 10 Post-treatment cone-beam computed tomography image.

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  Figure 11 Photographs, panoramic radiograph, and occlusal radiograph at 1-year retention.

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