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Desai SK, Shetye OA, Kamat RD, Mandrekar PN, Sinai Khandeparker RV, Dhupar V. Geminated Supernumerary Premolar Impacted in the Palate: A Report of a Rare Case and Review of the Literature. Cureus 2023; 15:e46244. [PMID: 37908926 PMCID: PMC10613930 DOI: 10.7759/cureus.46244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
Supernumerary teeth are dental anomalies characterized by the presence of an excessive number of teeth in relation to normal dentition. Among these, the supernumerary premolars have a prevalence of 0.29% to 0.64%, making it a very rare finding. On the other hand, gemination is a developmental disturbance in the shape of the teeth where a partial cleavage of a single tooth germ results in the formation of a singular root and a singular pulp chamber but two partially or totally separated crowns. Although these anomalies as individual entities are fairly common in clinical practice, the occurrence of both anomalies in a single tooth is an extremely rare occurrence. We hereby report a rare case of impacted geminated supernumerary premolar in a 45-year-old female patient. A thorough search of the literature revealed that only four cases listing this anomaly have been reported in the literature thus deserving a mention. In addition to the case presentation, the authors have also reviewed the existing literature on this anomaly.
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Affiliation(s)
- Sayali K Desai
- Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, IND
| | - Omkar A Shetye
- Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, IND
| | - Rahul D Kamat
- Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, IND
| | - Pooja N Mandrekar
- Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, IND
| | | | - Vikas Dhupar
- Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, IND
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Cardoso MABP, Noites RB, Martins MAD, Paulo MPDF. Nonsurgical endodontic retreatment of fused teeth with transposition: a case report. Restor Dent Endod 2016; 41:148-53. [PMID: 27200284 PMCID: PMC4868879 DOI: 10.5395/rde.2016.41.2.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/08/2016] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
| | - Rita Brandão Noites
- Department of Endodontics, Health Sciences Institute of Universidade Católica Portuguesa, Viseu, Portugal
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James EP, Johns DA, Johnson K, Maroli RK. Management of geminated maxillary lateral incisor using cone beam computed tomography as a diagnostic tool. J Conserv Dent 2014; 17:293-6. [PMID: 24944458 PMCID: PMC4056406 DOI: 10.4103/0972-0707.131810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 12/06/2013] [Accepted: 12/10/2013] [Indexed: 11/04/2022] Open
Abstract
Geminated teeth are consequences of developmental anomalies leading to joined elements, due to incomplete attempt of one tooth germ to divide into two. This case report describes successful endodontic treatment of an unaesthetic geminated permanent maxillary lateral incisor tooth and its esthetic rehabilitation using all ceramic crowns. Newer imaging technique like cone beam computed tomography was taken for the better understanding of the complicated root canal morphology.
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Affiliation(s)
- Elizabeth Prabha James
- Department of Conservative Dentistry and Endodontics, Government Dental College, Calicut, India
| | - Dexton Antony Johns
- Department of Conservative Dentistry and Endodontics, Government Dental College, Calicut, India
| | - Ki Johnson
- Department of Oral Medicine, MES Dental College, Perinthalmana, Malappuram, Kerala, India
| | - Ramesh Kumar Maroli
- Department of Conservative Dentistry and Endodontics, Government Dental College, Calicut, India
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A fused maxillary central incisor and its multidisciplinary treatment: an 18-year follow-up. Case Rep Dent 2014; 2014:503478. [PMID: 24738034 PMCID: PMC3967802 DOI: 10.1155/2014/503478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 12/24/2013] [Indexed: 01/18/2023] Open
Abstract
Fused teeth may cause aesthetic, spacing, periodontal, eruption, and caries problems. The present case report describes a 7-year-old boy patient with a chief complaint of unerupted maxillary incisor. Radiographic examination indicated a fused tooth which had two fused roots but two independent root canals. A complex management of a fused tooth is really difficult to standardize. In this case an orthodontic, endodontic, and surgical treatment (intentional replantation) allowed the tooth to be retained until 18 years following intervention. Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective.
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Root anatomy and root canal configuration of human permanent mandibular premolars: a systematic review. ANATOMY RESEARCH INTERNATIONAL 2013; 2013:254250. [PMID: 24455268 PMCID: PMC3881342 DOI: 10.1155/2013/254250] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 11/17/2022]
Abstract
Introduction. Mandibular premolars have been reported with complex anatomical aberrations, making them one of the most difficult teeth to manage endodontically. Methodology. An exhaustive search was undertaken to identify associated anatomic studies of mandibular premolars through MEDLINE/PubMed database using keywords, and a systematic review of the relevant articles was performed. Chi-square test with Yates correction was performed to assess the statistical significance of any anatomic variations between ethnicities and within populations of the same ethnicity. Documented case reports of variations in mandibular premolar anatomy were also identified and reviewed. Results. Thirty-six anatomic studies were analyzed which included 12,752 first premolars and nineteen studies assessing 6646 second premolars. A significant variation in the number of roots, root canals, and apical foramen was observed between Caucasian, Indian, Mongoloid, and Middle Eastern ethnicities.The most common anatomic variation was C-shaped canals in mandibular first premolars with highest incidence in Mongoloid populations (upto 24%) while dens invaginatus was the most common developmental anomaly. Conclusions. A systematic review of mandibular premolars based on ethnicity and geographic clusters offered enhanced analysis of the prevalence of number of roots and canals, their canal configuration, and other related anatomy.
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Use of cone-beam computed tomography in diagnosis of an otherwise undetected periapical lesion in an anomalous tooth. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0130-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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7
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Supernumerary teeth and gemination. Br J Oral Maxillofac Surg 2011; 50:e15. [PMID: 21855186 DOI: 10.1016/j.bjoms.2011.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Accepted: 07/06/2011] [Indexed: 11/22/2022]
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Lucey S, Heath N, Welbury RR, Wright G. Case report: Cone-beam ct imaging in the management of a double tooth. Eur Arch Paediatr Dent 2010; 10 Suppl 1:49-53. [PMID: 19863901 DOI: 10.1007/bf03262702] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnosis and management strategies of double teeth have largely relied on clinical examination and conventional radiographic findings. Cone-Beam Computed Tomography (Cone-beam CT) was developed in the late 1990's and, therefore, is a relatively recent addition to the imaging armamentarium for use in Maxillofacial Radiology. There have been no publications in the dental literature demonstrating the use of Cone-beam CT or 3D stereolithography in the diagnosis and surgical planning of the management of double teeth. CASE REPORT An 11 year old girl presented with a double left lateral maxillary incisor. Conventional plain film radiography failed to provide the requisite information for pre-operative planning. Cone-beam Computed Tomography (Cone-beam CT) allowed determination of location of fusion, three-dimensional (3D) visualisation of pulpal anatomy and the construction of a 3D stereolithographic model for surgical planning. The double tooth was surgically divided in situ under local analgesia. The redundant distal unit was extracted and the residual mesial unit built up in composite resin following physiological mesial drift of displaced maxillary left canine. No endodontic therapy was required. FOLLOW-UP At a 10-month follow-up visit, clinical and radiographic vitality and success was noted. CONCLUSION The great amount of radiological information which Cone-beam CT can offer not only improves pre-operative and surgical planning, but the 3D models provided can be used to further educate and inform patients and guardians in the management of double teeth.
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Affiliation(s)
- S Lucey
- Dept. Paediatric Dentistry, University of Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow, Scotland
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Schulz M, Reichart PA, Stich H, Lussi A, Bornstein MM. Bilateral malformation of maxillary third molars. ACTA ACUST UNITED AC 2009; 108:e25-31. [PMID: 19615641 DOI: 10.1016/j.tripleo.2009.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 04/10/2009] [Indexed: 11/19/2022]
Abstract
A case of bilateral compound odontomas in the region of the third molars in the maxilla is reported. The differential diagnosis for this case is discussed.
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MESH Headings
- Adolescent
- Cone-Beam Computed Tomography
- Diagnosis, Differential
- Female
- Functional Laterality
- Fused Teeth/diagnostic imaging
- Fused Teeth/pathology
- Humans
- Maxilla
- Molar, Third/abnormalities
- Molar, Third/diagnostic imaging
- Molar, Third/pathology
- Neoplasms, Multiple Primary/diagnostic imaging
- Neoplasms, Multiple Primary/pathology
- Odontoma/diagnostic imaging
- Odontoma/pathology
- Radiography, Panoramic
- Tooth Abnormalities/diagnostic imaging
- Tooth Abnormalities/pathology
- Tooth Crown
- Tooth, Impacted/diagnostic imaging
- Tooth, Impacted/pathology
- Tooth, Supernumerary/diagnostic imaging
- Tooth, Supernumerary/pathology
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Affiliation(s)
- Malte Schulz
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Demir T, Ates U, Cehreli B, Cehreli ZC. Autotransplantation of a supernumerary incisor as a replacement for fused tooth: 24-month follow-up. ACTA ACUST UNITED AC 2008; 106:e1-6. [PMID: 18718784 DOI: 10.1016/j.tripleo.2008.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 05/25/2008] [Accepted: 06/02/2008] [Indexed: 01/20/2023]
Abstract
This case report describes the technique and 24-month follow-up of autotransplantation of a well-shaped, healthy supernumerary maxillary central incisor as a replacement for a fused maxillary incisor. Because the alignment of the teeth neighboring the fused incisor was not suitable as an abutment for post-transplantation splinting, a custom palatal splint that took anchorage from permanent first molars was fabricated. Following extraction of both teeth, the supernumerary incisor was immediately autotransplanted into the extraction site of the fused incisor. The autotransplanted tooth was secured to the custom splint with acid-etch composite, and the splint was removed 2 weeks later. Closure of the apex was observed at 18 months. Both the esthetics and function were restored to an ideal level in the absence of postoperative complications, as evidenced by 24-month clinical and radiographic findings.
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Affiliation(s)
- Tahsin Demir
- Department of Pediatric Dentistry, Baskent University, Ankara, Turkey
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Sivolella S, Bressan E, Mirabal V, Stellini E, Berengo M. Extraoral endodontic treatment, odontotomy and intentional replantation of a double maxillary lateral permanent incisor: case report and 6-year follow-up. Int Endod J 2008; 41:538-46. [PMID: 18363700 DOI: 10.1111/j.1365-2591.2008.01391.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY Double tooth is a dental irregularity consequent to fusion of two or more teeth or dental gemination. The teeth most commonly involved are deciduous, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, functional and periodontal problems can result. This paper reports a clinical case of a double tooth in the position of the maxillary right lateral permanent incisor. Combined orthodontic, endodontic and surgical treatment (intentional replantation) allowed the tooth to be retained without periodontal compromise and with a positive orthodontic result both immediately and 6 years following intervention. *A conservative approach that addresses periodontal, pulpal and tooth tissues, can result in the retention of a double tooth. *Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective.
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Affiliation(s)
- S Sivolella
- Department of Oral Surgery, University of Padova, Institute of Clinical Dentistry, Padova, Italy.
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Cleghorn BM, Christie WH, Dong CCS. The Root and Root Canal Morphology of the Human Mandibular First Premolar: A Literature Review. J Endod 2007; 33:509-16. [PMID: 17437863 DOI: 10.1016/j.joen.2006.12.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 11/20/2006] [Accepted: 12/13/2006] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to undertake a comprehensive literature review of the root and root canal morphology of the mandibular first premolar. Published studies citing the anatomy and morphology of mandibular premolars report data for over 6,700 teeth. These studies were divided into anatomical studies reporting number of roots, number of canals, and apical morphology. Variations because of sex and ethnic background have also been reported, along with case reports of anomalies. Approximately 98% of the teeth in these studies were single-rooted. The incidence of two roots was 1.8%. Three roots when reported were found in 0.2% of the teeth studied. Four roots were rare and were found in less than 0.1% of the teeth studied. Studies of the internal canal morphology revealed that a single canal was present in 75.8% of the teeth. Two or more canals were found in 24.2% of the teeth studied. A single apical foramen was found in 78.9% of the teeth, whereas 21.1% had two or more apical foramina. The role of genetics and racial variation may result in differences of incidence of root number and canal number in human populations. The dental literature is not unique in studying ethnicity and sex variations. Higher incidences of teeth with additional canals and roots have been reported in Chinese, Australian, and sub-Sahara African populations. Physical anthropology studies seem to show the lowest incidence in Western Eurasian, Japanese and American Arctic populations. The root and root canal morphology of this tooth can be complex and requires careful evaluation prior to root canal therapy.
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Affiliation(s)
- Blaine M Cleghorn
- Department of Dental Clinical Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
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Torabinejad M, Kutsenko D, Machnick TK, Ismail A, Newton CW. Levels of Evidence for the Outcome of Nonsurgical Endodontic Treatment. J Endod 2005; 31:637-46. [PMID: 16123698 DOI: 10.1097/01.don.0000153593.64951.14] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The purpose of this systematic review was (a) to search for clinical articles pertaining to success and failure of nonsurgical root canal therapy, and (b) to assign levels of evidence to these studies. Electronic and manual searches were conducted to identify studies published between January 1966 and September 2004 with information on the success and failure of nonsurgical root canal therapy. Articles were reviewed and graded for strength of level of evidence (LOE) from one (highest level) to five (lowest level). This review resulted in the identification of 306 clinical studies related to this topic area. Six articles were randomized controlled trials (RCTs, LOE 1). This search also identified 12 low-quality RCTs (LOE 2), 14 cohort studies (LOE 2), five case-control and eight cross sectional studies (LOE 3), four low-quality cohort studies (LOE 4), and five low-quality case-control studies (LOE 4). The majority (73) of the often-quoted "success and failure" studies were case series (LOE 4). The rest of the articles were descriptive epidemiological studies (42), case reports (114), expert opinions (18), literature reviews (4), and one meta-analysis. Based on these findings, it appears that a few high-level studies have been published in the past four decades related to the success and failure of nonsurgical root canal therapy. The data generated by this search can be used in future studies to specifically answer questions and test hypotheses relevant to the outcome of nonsurgical root canal treatment.
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Affiliation(s)
- Mahmoud Torabinejad
- Department of Endodontics of the School of Dentistry, Loma Linda University, Loma Linda, California 92350, USA.
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