Dental fusion of a supernumerary tooth to a mandibular incisor: A case report

Aim: To detect dental fusion of supernumerary teeth and to define an adequate therapeutic strategy. Material and Methods: Dental fusion of two dental elements is defined an embryological union of two normally separate structures: Dental fusion is usually more frequent in deciduous than in permanent dentition. The fusion process give origin to an anomalous anatomy that is responsible of an augmented frequency of carious lesions, periodontal defects, eruption disturbances, ectopic, eruptions and anterior aesthetical problems. The therapeutical approach to dental fusion is multidisciplinary, requiring endodontic, parodontale and orthodontical skills. In this case report, an accurate analysis of dental arches detects fusion of 32 with an adjacent supernumerary tooth and consequential ectopic position of 33. Periapical Rx can detects a macrodontic tooth with a bigger pulpal chamber that arises from the fusion of two separate chambers. Results: RC 10 years old child came to our observation for ortodontical evaluation: the girl showed adenoid facies characterised by incompetent lips, open bite, and oral breathing. Clinical evaluation showed maxillary transversal discrepancy, ogival palate, bilateral cross-bite and severe dental crowding in both arches; Rx panoramic, Lateral and P-A telerx and cephalometric analysis showed skeletal III class, high-angle open bite and contraction of maxillary arch. At first patient underwent to maxillary expansion for 12 mouths, after she underwent to fixed multibracket appliance and lastly, she was subjected to tooth extractions of 14,24,34,45 and 32. The last element showed a macrodontic aspect with a winder pulp chamber that arises from fusion of 32 with a supernumerary tooth. This is the reason why was not possible to proceed with separation of macrodontic tooth but rather it was necessary its extraction and then aligning, levelling of the arches and closing spaces mechanics. Conclusions: Detecting dental fusion of supernumerary teeth and to define an adequate therapeutic strategy is a primary task of the specialist on orthodontics.