Fusion of a supernumerary tooth to right mandibular second molar: a case report and literature review

Abstract

Gemination or fusion is a rare occurrence in the mandibular posterior teeth. The aim of this article is to describe the problems encountered and the strategy employed in treating such cases. A 34 years old patient came with the complaint of spontaneous and radiating pain in the right mandibular posterior region. The tooth in concern was an anomalous 'double' second mandibular molar diagnosed as having necrotic pulp with chronic apical abscess of endodontic origin. The present case emphasizes the importance of identifying anatomical anomalies during treatment of fused teeth with supernumerary tooth, and the need for the use of advanced imaging modalities like CBCT which is a critical aid in the diagnosis of such cases. Fused teeth can be managed quite efficiently by an overall combined treatment including both endodontic and periodontal therapy.

Keywords: Fusion; cone-beam computed tomography; endodontic treatment; supernumerary teeth.

Figure 1

A, B. Pre-operative photograph: Intraoral clinical occlusal view. C. Pre-operative periapical radiograph: the right mandibular second molar.

Figure 2

CBCT Images of the right mandibular second molar. A. Three dimensional reconstruction of the coronal position. B. Three dimensional reconstruction of the horizontal position. C. Three dimensional reconstruction of the tooth.

Figure 3

A. Three-dimensional bending of the instrument for the preparation of the mesiobuccal root. B. Operative photograph: Occlusal view. C. Working length determination.

Figure 4

Postoperative photograph: A. Immediate postoperative radiograph. B. Clinical image of restored 46, 47.