Bilateral fusion of mandibular primary teeth

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CASE REPORT

Bilateral fusion of mandibular primary teeth Chalakkal P, Thomas AM

Abstract

Department of Pedodontics and Preventive Dentistry, Christian Dental College and Hospital, C.M.C., Ludhiana, India

The aim of the report was to highlight the rarity of occurrence of bilaterally fused mandibular primary lateral incisors and canines by virtue of the number of such cases reported in literature; to identify congenital absence of successor teeth;and to evaluate their pulpal morphologies to understand the type of fusion. Clinical observation along with an orthopantomograph and periapical radiographs were used to arrive at a diagnosis. The pulpal morphologies varied in each of the fused teeth although both were fusions of the Complete type. There was congenital absence of the permanent mandibular lateral incisors, bilaterally. It was a case of bilateral fusion of mandibular primary lateral incisors and canines of the Complete type with congenitally absent mandibular permanent lateral incisors. Only 13 such cases have been previously reported in literature.

Correspondence: Dr. Abi M Thomas, Professor, Department of Pedodontics and Preventive Dentistry, Christian Dental College and Hospital, Brown Road, Ludhiana, Punjab-141 008, India. E-mail: [email protected]

The purpose of this article is to highlight the rarity of the condition and to evaluate the presence of any associated pathology.

Case Report An 8-year-old boy reported to the Department of Pedodontics and Preventive Dentistry with the complaint of having large teeth within his lower jaw. His medical history was irrelevant with his condition.

Key words Canine, fusion, lateral incisor, primary, bilateral, teeth

Intraoral examination revealed bilateral presence of unusually large teeth in the lower incisor canine region. Both sides were strongly suggestive of conjoined primary lateral incisors and canines [Figure 1]. Deep labio-lingual grooves were associated with both the enlarged teeth.

DOI: 10.4103/0970-4388.55336

Introduction A fused tooth can be defined as a single enlarged or joined tooth in which the tooth count reveals a missing tooth when the anomalous tooth is counted as one. Its occurrence is more in the primary dentition (0.5%) compared to the permanent dentition (0.1%), with a rare chance of bilateral involvement in the primary dentition (0.02%).[1] Eighty-three percent of cases of bilateral fusion in the primary dentition are found in the mandible, out of which, 70% show the involvement of the lateral incisors and canines.[2] The most common problem related to fused teeth is hypodontia of the permanent dentition which has been observed in 50% of affected subjects.[3]

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Radiographic evaluation of the left side revealed fused 72 and 73 with a single root and root canal [Figure 2]. On the right side, two distinct roots and root canals were evident of the fused 82 and 83 [Figure 3]. The primary mandibular canines were missing, confirming that it was a case of fusion and not gemination. An orthopantomograph revealed congenital absence of thepermanent mandibular lateral incisors [Figure 4]. The patient was diagnosed to be a case of bilaterally fused mandibular primary lateral incisors and canines of the Complete type with congenitally absent mandibular permanent lateral incisors.

J INDIAN SOC PEDOD PREVENT DENT | Apr - Jun 2009 | Issue 2 | Vol 27 |


Chalakkal, et al.: Bilateral fusion of mandibular primary teeth

Table 1: Differences between complete and incomplete fusion Complete

Incomplete

Fusion begins before calcification

Fusion occurs at a later stage

The crown incorporates features of both participating teeth with regard to their enamel, dentin, cementum, and pulp

The tooth might exhibit separate crowns and fusion may be limited to the roots alone with pulp canals fused or separate

Figure 1: Bilaterally fused primary mandibular lateral incisors and canines Figure 2: Left intraoral periapical radiograph displaying fused 72 and 73 with a single root and root canal

Figure 3: Right intraoral periapical radiograph displaying fused 82 and 83 with two distinct roots and root canals

Discussion It has been thought that some physical force or pressure produces contact between developing teeth resulting in their subsequent fusion. It can occur between normal teeth or between normal and supernumerary teeth.[4] Fusion can be classified into two types, Complete and Incomplete. They can be differentiated as in Table 1. Only 13 cases of bilateral fusion of mandibular primary lateral incisors and canines have been reported in literature since 1940.[5-15] Hagman reported that such

Figure 4: Orthopantomograph displaying congenitally missing 32 and 42 in relation to the fused teeth

patients have a 75% chance of lacking the succedaneous lateral incisor.[16] The presence of fissures or grooves at the union between fused teeth predisposes it to caries and periodontal disease.[17] The greater root surface area of fused primary teeth may delay its resorption.[18] Fused teeth may also contribute to esthetic concerns, space problems, occlusal disturbances, and delayed eruption of the permanent successors. Hence, careful monitoring of the condition is recommended.


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Chalakkal, et al.: Bilateral fusion of mandibular primary teeth

References 1.

Neville BW, Damm DD, Allen CM, Bouquot JE, editors. Abnormalities of teeth. In: Oral and Maxillofacial Pathology. 2nd ed. New Delhi: Elsevier; 2005. p. 49-106. 2. Dunkan WK, Helpin ML. Oral Surg Oral Med Oral Pathol 1987;64:82-7. 3. Guimarães Cabral LA, Firoozmand LM, Dias Almeida J. Double teeth in primary dentition: Report of two clinical cases. Med Oral Patol Oral Cir Bucal 2008;13:E77-80. 4. Rajendran R. Developmental disturbances of oral and paraoral structures. In: Rajendran R, Sivapathasundharam B, editors. Shafer’s Textbook of Oral Pathology. 5th ed. New Delhi: Elsevier; 2006. p. 3-112. 5. Tinn CA. Excess, deficiency and gemination in the deciduous and permanent dentition of school children. Br Dent J 1940;68:236-8. 6. Menczer LF. Anomalies of the primary dentition. J Dent Child 1955;22:57-62. 7. Pogrel H. Case of bilateral gemination of deciduous incisors with congenital absence of permanent successors. Dent Pract 1956;7:13-4. 8. Munro D. Gemination in the deciduous dentition. Br Dent J 1958;104:238-40. 9. Brook AH, Winter GB. Double teeth. Br Dent J 1970;129:123-30. 10. Ravn JJ. Aplasia, supernumerary teeth and fused teeth in the primary dentition. Scand J Dent Res 1971;79:1-6.

11. Nick-Hussein NN. Bilateral symmetrical fusion of primary and permanent mandibular lateral incisors and canines. J Pedod 1989;13:378-83. 12. Prabhu NT, Rebecca J, Munshi AK. Bilaterally fused primary mandibular incisors: A case report. J Indian Soc Pedod Prev Dent 1997;15:31-3. 13. Milano M, Seybold SV, McCandless G, Cammarata R. Bilateral fusion of the mandibular primary incisors: Report of case. ASDC J Dent Child 1999;66:280-2, 229. Review. 14. Alpoz AR, Munanoglu D, Oncaq O. Mandibular bilateral fusion in primary dentition: Case Report. J Dent Child (Chic) 2003;70:74-6. 15. Hagman FT. Fused primary teeth: A documented familial report of case. ASDC J Dent Child 1985;52:459-60. 16. Hagman FT. Anomalies of form and number, fused primary teeth, a correlation of the dentitions. ASDC J Dent Child 1988;55:359-61. 17. Nunes E, de Moraes IG, de Oliviera Novaes PM, de Sousa SMG. Bilateral fusion of mandibular second molars with supernumerary teeth: Case Report. Braz Dent J 2002;13:137-41. 18. Brook AH, Winter GB. Double teeth. A retrospective study of ‘geminated’ and ‘fused’ teeth in children. Br Dent J 1970;129:123-30.

Source of Support: Nil, Conflict of Interest: Nil

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