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Bilateral double teeth involving permanent mandibular molars
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MODEL
Journal of Dental Sciences (2014) xx, 1e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.e-jds.com
CORRESPONDENCE
Bilateral double teeth involving permanent mandibular molars A double tooth is a developmental anomaly in which two teeth appear joined together. Such anomalies of tooth shape occur following disturbances in the morphodifferentiation stage of tooth development.1,2 Here we report a rare case of bilateral double teeth involving the permanent mandibular molars. A 46-year-old woman presented with bilateral large teeth in the mandibular second molar region. Each of these teeth had two crowns resembling the molars that were united along the buccolingual surfaces (Fig. 1A). The tooth in the 37 region had a large amalgam filling and its fissures were stained browneblack (Fig. 1B), while the tooth in the 47 region was free from caries with two distinct crowns
separated by a groove on the distal aspect (Fig. 1C). Teeth 38 and 48 were missing. The patient gave no history of previous extractions. Orthopantomograph and periapical radiographs were taken to evaluate the teeth of interest (Fig. 1DeF). The large teeth present bilaterally were diagnosed as double teeth. Based on the pathogenesis, two types of double teeth exist: fusion and gemination. Fusion is the union of two separate developing teeth, whereas gemination is the partial development of two teeth from a single tooth bud.1,2 Differentiating the two anomalies may be difficult and may require careful clinical examination with radiographic projections at different angles for accurate
Figure 1 Clinical and radiographic photographs. (A) Bilateral large teeth involving mandibular molars. (B) Large tooth with amalgam filling in the left mandibular second molar region. (C) Large tooth in the right mandibular second molar region. (D) Orthopantomograph. (E) Periapical radiograph of the left side double teeth showing two crowns (white arrows) and an extra root (black arrow). (F) Periapical radiograph of the right side double teeth showing two crowns (white arrows) and an extra root (black arrow).
http://dx.doi.org/10.1016/j.jds.2013.12.006 1991-7902/Copyright ª 2014, Association for Dental Sciences of the Republic of China. Published by Elsevier Taiwan LLC. All rights reserved.
Please cite this article in press as: Kannan S, et al., Bilateral double teeth involving permanent mandibular molars, Journal of Dental Sciences (2014), http://dx.doi.org/10.1016/j.jds.2013.12.006
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MODEL
2 diagnosis. The number of teeth in the arch, the morphology, and the location of double teeth are all considered to discriminate the two anomalies. In fusion, the overall tooth count is less than normal, whereas in gemination it is more than normal. According to Ekambaram et al,1 gemination results in a bifid crown with each coronal half appearing as a mirror image, whereas fusion takes place at an angle causing the entire fused tooth to have a crooked appearance. Radiographically, geminated teeth usually have a single pulp chamber with normal root and canal morphology, whereas fused teeth have separate pulp chambers and root canals. Gemination presents predominantly in the maxillary anterior teeth, whereas fusion commonly occurs in the mandibular anterior teeth.3 In our patient, the large teeth in the 37 and 47 regions had two asymmetrical crowns. The routine orthopantomograph showed normal pulp chamber and root morphology, but periapical radiographs showed overlapping extra crowns (white arrows) and roots (black arrows) in both double teeth (Fig. 1). Considering the absence of the third molar teeth and the morphology of the double teeth, we came to a conclusion of bilateral fusion. The double teeth appeared as two teeth fused along the buccolingual aspect, rather than an incomplete splitting of a tooth. In addition, root morphology is normal in gemination, unlike the double teeth presented here which had multiple roots. Based on these findings, the fusion could be between the mandibular second and third molars. However, another possibility is the fusion of second molars with supernumerary paramolars with concurrent congenitally missing wisdom teeth. Such bilateral presentations of double teeth and their occurrence in the posterior region are less common.1,3 A literature review showed only a few reported cases with bilateral presentation4,5 and to our knowledge this case is the first of its kind where mandibular molars were involved. Treatment usually involves vigilant observation and periodic follow-up coupled with preventive measures to limit decay or periodontal problems that are usually difficult to
Correspondence treat. In our patient, the amalgam filling was replaced, fissures were treated conservatively with fissure sealants, and periodic follow-up was indicated.
Conflict of interest All contributing authors declare no conflicts of interest.
References 1. Ekambaram M, Yiu CKY, King NM. An unusual case of double teeth with facial and lingual talon cusps. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e63e7. 2. Schuurs AH, van Loveren C. Double teeth: review of the literature. ASDC J Dent Child 2000;67:313e25. 3. Duncan WK, Helpin ML. Bilateral fusion and gemination: a literature analysis and case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1987;64:82e7. 4. Nunes E, Moraes IG, Novaes PMO, Sousa SMG. Bilateral fusion of mandibular second molars with supernumerary teeth: case report. Brazil Dent J 2002;13:137e41. 5. Liang RZ, Wu JT, Wu YN, et al. Bilateral maxillary fused second and third molars: a rare occurrence. Int J Oral Sci 2012;4: 231e4.
Sathya Kannan* Preena Sidhu Balamanikandasrinivasan Chandrasekaran Senthilkumar Muthusamy Faculty of Dentistry, AIMST University, Kedah, Malaysia *Corresponding author. Faculty of Dentistry, AIMST University, Bedong 08100, Kedah, Malaysia. E-mail address: [email protected] (S. Kannan) Received 31 October 2013 Final revision received 19 December 2013 Available online - - -
Please cite this article in press as: Kannan S, et al., Bilateral double teeth involving permanent mandibular molars, Journal of Dental Sciences (2014), http://dx.doi.org/10.1016/j.jds.2013.12.006
MODEL
Journal of Dental Sciences (2014) xx, 1e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.e-jds.com
CORRESPONDENCE
Bilateral double teeth involving permanent mandibular molars A double tooth is a developmental anomaly in which two teeth appear joined together. Such anomalies of tooth shape occur following disturbances in the morphodifferentiation stage of tooth development.1,2 Here we report a rare case of bilateral double teeth involving the permanent mandibular molars. A 46-year-old woman presented with bilateral large teeth in the mandibular second molar region. Each of these teeth had two crowns resembling the molars that were united along the buccolingual surfaces (Fig. 1A). The tooth in the 37 region had a large amalgam filling and its fissures were stained browneblack (Fig. 1B), while the tooth in the 47 region was free from caries with two distinct crowns
separated by a groove on the distal aspect (Fig. 1C). Teeth 38 and 48 were missing. The patient gave no history of previous extractions. Orthopantomograph and periapical radiographs were taken to evaluate the teeth of interest (Fig. 1DeF). The large teeth present bilaterally were diagnosed as double teeth. Based on the pathogenesis, two types of double teeth exist: fusion and gemination. Fusion is the union of two separate developing teeth, whereas gemination is the partial development of two teeth from a single tooth bud.1,2 Differentiating the two anomalies may be difficult and may require careful clinical examination with radiographic projections at different angles for accurate
Figure 1 Clinical and radiographic photographs. (A) Bilateral large teeth involving mandibular molars. (B) Large tooth with amalgam filling in the left mandibular second molar region. (C) Large tooth in the right mandibular second molar region. (D) Orthopantomograph. (E) Periapical radiograph of the left side double teeth showing two crowns (white arrows) and an extra root (black arrow). (F) Periapical radiograph of the right side double teeth showing two crowns (white arrows) and an extra root (black arrow).
http://dx.doi.org/10.1016/j.jds.2013.12.006 1991-7902/Copyright ª 2014, Association for Dental Sciences of the Republic of China. Published by Elsevier Taiwan LLC. All rights reserved.
Please cite this article in press as: Kannan S, et al., Bilateral double teeth involving permanent mandibular molars, Journal of Dental Sciences (2014), http://dx.doi.org/10.1016/j.jds.2013.12.006
+
MODEL
2 diagnosis. The number of teeth in the arch, the morphology, and the location of double teeth are all considered to discriminate the two anomalies. In fusion, the overall tooth count is less than normal, whereas in gemination it is more than normal. According to Ekambaram et al,1 gemination results in a bifid crown with each coronal half appearing as a mirror image, whereas fusion takes place at an angle causing the entire fused tooth to have a crooked appearance. Radiographically, geminated teeth usually have a single pulp chamber with normal root and canal morphology, whereas fused teeth have separate pulp chambers and root canals. Gemination presents predominantly in the maxillary anterior teeth, whereas fusion commonly occurs in the mandibular anterior teeth.3 In our patient, the large teeth in the 37 and 47 regions had two asymmetrical crowns. The routine orthopantomograph showed normal pulp chamber and root morphology, but periapical radiographs showed overlapping extra crowns (white arrows) and roots (black arrows) in both double teeth (Fig. 1). Considering the absence of the third molar teeth and the morphology of the double teeth, we came to a conclusion of bilateral fusion. The double teeth appeared as two teeth fused along the buccolingual aspect, rather than an incomplete splitting of a tooth. In addition, root morphology is normal in gemination, unlike the double teeth presented here which had multiple roots. Based on these findings, the fusion could be between the mandibular second and third molars. However, another possibility is the fusion of second molars with supernumerary paramolars with concurrent congenitally missing wisdom teeth. Such bilateral presentations of double teeth and their occurrence in the posterior region are less common.1,3 A literature review showed only a few reported cases with bilateral presentation4,5 and to our knowledge this case is the first of its kind where mandibular molars were involved. Treatment usually involves vigilant observation and periodic follow-up coupled with preventive measures to limit decay or periodontal problems that are usually difficult to
Correspondence treat. In our patient, the amalgam filling was replaced, fissures were treated conservatively with fissure sealants, and periodic follow-up was indicated.
Conflict of interest All contributing authors declare no conflicts of interest.
References 1. Ekambaram M, Yiu CKY, King NM. An unusual case of double teeth with facial and lingual talon cusps. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e63e7. 2. Schuurs AH, van Loveren C. Double teeth: review of the literature. ASDC J Dent Child 2000;67:313e25. 3. Duncan WK, Helpin ML. Bilateral fusion and gemination: a literature analysis and case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1987;64:82e7. 4. Nunes E, Moraes IG, Novaes PMO, Sousa SMG. Bilateral fusion of mandibular second molars with supernumerary teeth: case report. Brazil Dent J 2002;13:137e41. 5. Liang RZ, Wu JT, Wu YN, et al. Bilateral maxillary fused second and third molars: a rare occurrence. Int J Oral Sci 2012;4: 231e4.
Sathya Kannan* Preena Sidhu Balamanikandasrinivasan Chandrasekaran Senthilkumar Muthusamy Faculty of Dentistry, AIMST University, Kedah, Malaysia *Corresponding author. Faculty of Dentistry, AIMST University, Bedong 08100, Kedah, Malaysia. E-mail address: [email protected] (S. Kannan) Received 31 October 2013 Final revision received 19 December 2013 Available online - - -
Please cite this article in press as: Kannan S, et al., Bilateral double teeth involving permanent mandibular molars, Journal of Dental Sciences (2014), http://dx.doi.org/10.1016/j.jds.2013.12.006