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In the light of own cases the authors present congenital dental anomalies--fused teeth. This abnormality was present in three boys aged 9, 10, 11 years, involving upper permanent incisors. In all these cases extraction was done for orthodontic indications. Various methods of management are discussed in these often difficult cases, and the results of orthodontic treatment.
Seeking an evaluation pattern for periodontal wounds following the surgical section of two fused teeth healing, the authors caused in an animal a similar lesion. After that, they valued the undergoing to pressure or traction periodontal re-organizing and the histological-clinical data showed a tissues favourable repair.
A two-step surgical procedure for separating a central incisor fused to a supernumerary tooth with a 4-year follow-up is described. The fusion was between the crowns and 3/4 of the root length. The roots were connected by web-like radio-opaque tissue. The periodontal ligament could be followed along the lateral aspect of the roots and was continuous along the base of the web. In the first surgical phase, a full-thickness semilunar flap was raised; a fissure bar was cut along and through the web up to the approximate location of the junctional epithelium and the flap was sutured. It was assumed that cells from the bone surrounding the web and/or connective tissue cells from the flap had migrated into contact with the web hard tissue. This resulted in replacement resorption of the web. The connective tissue replacing the web acted as a septum separating the 2 parts of the root. The distal root was extracted. Resorption continued until most of the web disappeared from the wound. At this point, the remaining layer of web tissue was thin enough to allow repopulation of the resorbed surface with periodontal cells from the buccal and palatal sides of the web. The successful clinical outcome supports the assumption that new attachment consisting of periodontal ligament and cementum was formed following the 2-step surgical procedure. Application of the technique is limited by the width of the fusion rather than by its length.
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A case is reported documenting successful treatment of suppurative periradicular periodontitis involving a maxillary central incisor fused with a supernumerary tooth. Endodontic therapy was performed and partial resolution of the lesion was evident at the 1-yr recall and further resolution at the 16-month recall.
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In permanent and deciduous dentitions, the frequency of congenitally missing teeth, supernumerary teeth, conical teeth, fused teeth, germinate teeth, abnormal tubercles (basal ridge of incisor or canine, central cusps of molars, Carabelli's cusp, protostylid, and para-molar tubercles), and enamel hypoplasia (white spots, pigmentation, and enamel defects) were surveyed. Furthermore, mesio-distal and bucco-lingual dimensions of the crowns were measured and the relationship between developmental disturbances of dental hard tissue and tooth size was examined. For the deciduous dentition, the frequency of children with congenitally missing teeth, conical teeth and fused teeth was 7.2%, 1.1% and 5.3%, respectively. Enamel hypoplasia appears with the following frequency; white spots (16.0%), pigmentation (6.4%), and enamel defects (5.2%). Mesio-distal widths of the upper canine and lower lateral incisors of the children with congenitally missing teeth was significantly smaller than the standard values. For the permanent dentition, congenitally missing teeth, conical teeth and fused teeth were detected in 5.7%, 3.0%, and 0.5% of the children, respectively. The frequency of children with basal ridge, central cusps, Carabelli's cusp, protostylid, and para-molar tubercles was respectively, 1.1%, 2.6%, 7.1%, 0.3% and 1.3%. Children with central cusps or Carabelli's cusp tended to have larger crowns, while children with congenitally missing teeth or conical teeth tended to have smaller teeth. As for enamel hypoplasia, white spots were detected in 24.9% of the children, and pigmentation was in 8.1%, and enamel defects were in 9.2%. These results indicate that abnormality of tooth number and tooth morphology correlate with the tooth size and this tendency is more striking in permanent dentition than in deciduous dentition.
On the basis of results from animal experiments, the authors emphasize a series of factors interfering considerably with tooth eruption. It is dealt with tooth eruption disorders and dental malformations due to premature loss of teeth, fused deciduous teeth, certain dystrophies, submersion of deciduous teeth, dysembryoplasias, and rickets.
Fusion is rare in the primary dentition (range .14 percent to 3 percent). Patients with fused primary lateral incisors and canines have about a 75 percent chance of lacking the succedaneous lateral incisor. Patients with fused incisors have less than a 20 percent chance of having a missing permanent tooth.
Three case reports of fusion are presented. Clinical problems relating to fusion may be unacceptable appearance or alignment of teeth, and periodontal conditions. It is suggested that all succedaneous teeth that are joined or fused together by dentin be referred to as fused teeth because of the frequent difficulty in differentiating fusion and gemination in the adult dentition.
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A fused mandibular lateral incisor and canine tooth were examined histologically at various levels. A composite reconstruction of the fused mass was compiled and the vascular supply indicated. Light microscopic examination revealed a common pulp chamber and discrete root canals. In the interstitium between the root canals an irregular type of secondary dentin was found. This was characterized by numerous vascular spaces and was termed "vasodentin." A notable feature of the histological examination was the paucity of odontoblasts in the interstitial root canal wall of the minor root canal, while the odontoblast layer was continuous throughout the remainder of the tooth. A theory is presented for the formation of fused teeth.
This clinical report briefly describes the appearance, frequency, and treatment of fused teeth. Presented is a tooth showing the unusual canal morphology and root lengths of a unilateral mandibular canine and lateral incisor fusion.
Four cases of tooth fusion are presented. Three of the patients were female and one male. Radiographic examination revealed union of calcified tissues with discrete root canals and a common pulp chamber in Case 3 and the converse in Case 4. The finding of fused mandibular incisors and canines in both the deciduous and permanent dentitions is described in Case 1, while in two others unilateral fused tooth masses are described which are not repeated in the permanent dentition. The dentist should be aware of the possibility of finding fused teeth on routine dental inspection and once diagnosed the patient should be informed of the potential hazards as regards plaque accumulation and varied root canal morphology.
A case of VACTERL association has been presented in conjunction with possible hemifacial microsomia and fused teeth. Although the etiology of VACTERL association and hemifacial microsomia is unclear, the similarity of symptoms would suggest a common cause. A retrospective study of patients previously diagnosed with VACTERL association might reveal additional symptoms of dental and/or facial anomalies and warrant changing the acronym to VACTERL-DF in recognition of these dentofacial findings.
Dental and bone abnormalities of the maxilla and mandible are present in approximately 80% of patients with familial polyposis coli. The dental abnormalities include impacted teeth (other than third molars), supernumerary teeth, congenitally missing teeth, fused roots of first and second molars, and unusually long and tapered roots of posterior teeth. The bone lesions consist mostly of osteomas, either isolated or in clusters, in the maxilla and mandible or of exostoses with lateral and/or lingual extensions. Since dental and bone abnormalities are already present early in life there is a strong suggestion that they may be used as diagnostic features in the recognition of familial polyposis coli.