Case Report/Clinical TechniquesEndodontic and Esthetic Management of Maxillary Lateral Incisor Fused to a Supernumerary Tooth Associated with a Talon Cusp by Using Spiral Computed Tomography as a Diagnostic Aid: A Case Report
Section snippets
Case Report
A 22-year-old male patient presented to the Department of Conservative Dentistry and Endodontics with pain to hot and cold food in the left maxillary anterior region. On clinical examination, the maxillary left lateral incisor exhibited abnormal crown morphology. The tooth was wider mesiodistally and had a talon cusp on the lingual side (Fig. 1A, B). Caries in the developmental groove on the distal side of the talon's cusp was evident.
There was no history of trauma or any hereditary conditions.
Management
Local anesthesia was administered, and a rubber dam was applied. Endodontic access cavity was done on the palatal surface by using a no. 2 round bur and EX 24 bur (non end cutting tapered fissure; Mani, Tochigi, Japan). Pulp extirpation was performed by using a barbed broach (Dentsply Maillefer, Ballaigues, Switzerland) and K-files (Mani Inc, Tochigi, Japan). The canal was thoroughly debrided with copious irrigation of sodium hypochlorite (2.5%), followed by saline (0.9%). Coronal flaring of
Discussion
A malformed tooth often is a challenge to the dentist. Fused teeth afford a striking clinical manifestation of the differentiable and morphogenetic processes of tooth development. Clinically, it might be difficult to differentiate between fusion and gemination when a supernumerary tooth is fused with a permanent tooth. Fusion between supernumerary and permanent teeth occurs less frequently than fusion between other types of teeth. The incidence of unilateral occurrence is estimated in the
Conclusion
With the advent of newer tomographic scanners like cone beam computed tomography (CBCT) or digital volume tomography specifically for maxillofacial and dental use, conventional scanners like SCT will be less preferred for dental imaging purposes. CBCT is advantageous in that it has a low effective dose in the same order of magnitude as conventional dental radiographs (37). Nevertheless, the value of SCT as a diagnostic tool cannot be undermined. This case discussed above uses SCT as a
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Intentional partial pulpotomy to talon cusp for tooth crown morphology correction in orthodontic treatment
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2015, Journal of EndodonticsCitation Excerpt :It is well-accepted that the frequency of tooth fusion is extremely low, in particular, fusion with a supernumerary tooth (2, 4, 5, 14, 15). When pulpal pathosis affects a fused tooth and communication between the root canal systems exists, nonsurgical root canal treatment of both systems is required to obtain treatment success (5, 6). If the fusion poses an aesthetic problem, the supernumerary tooth may be surgically removed if the level at which the fusion occurred permits such an approach.
Resolution of complex esthetic problems in abnormal anterior teeth: A clinical report
2014, Journal of Prosthetic DentistryCitation Excerpt :That decision was the key to a conservative treatment for this esthetically challenging situation, because it provided lower outcome risks than irreversible procedures such as tooth extraction and implant placement. The endodontic treatment of fused teeth as a prerequisite for surgical intervention has been reported in several situations, such as crown or root hemisection, because these abnormal teeth may have twinned crowns and root and pulp chamber connections.6 In the patient presented, endodontic treatment was performed as a strategic procedure to allow for orthodontic extrusion, because the preparation of the incisal portion of the tooth would lead to dentin and even pulp exposure.