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Fused supernumerary central incisor
Journal of Dentistry, 2, 63-64
Fused supernumerary central incisor Yehoshua Shapira, D.M.D. 1 14 Herzl Boulevard, Jerusalem, Israel ABSTRACT
A supernumerary tooth fused to a maxillary permanent left central incisor is reported in a 9-year-old girl.
INTRODUCTION
small and cone-shaped. However, supernumerary incisors may be of normal size and shape and resemble the adjacent teeth (Howard, 1967). Although supernumerary teeth in the incisor region occur frequently, fused supernumerary teeth are rather rare.
THE occurrence of supernumerary teeth in the population is fairly frequent and the reported incidence varies from 0.3 per cent (Macphee, 1935; Poulton and Pruzansky, 1958) to 3.1 per cent (Grahnen and Lindahl, 1961).
A 9-year-old girl was referred for orthodontic consultation because of a supernumerary tooth
Fig. /.--Radiograph of the maxillary left central
Fig. Z--Radiograph of the maxillary left central
incisor showing the fused supernumerary tooth.
incisor filled with amalgam after removal of the supernumerary tooth.
It is well recognized that there are different types of supernumerary teeth in the premaxilla. The most common supernumerary tooth irl the maxillary incisor region, the mesiodens, is
which caused the maxillary left central incisor to be in labioversion. There was no difference in the size, shape, or labial appearance of the maxillary right and left central incisors. However, clinical
CASE
REPORT
64
examination showed a supernumerary tooth in close contact to the palatal surface of the maxillary left central incisor. It seemed that the crown of the supernumerary tooth was fused to the central incisor at the cingulurn, and a thin ligature wire which was inserted between the supernumerary tooth and the permanent incisor could not be moved further gingivally at the cingulum. Radiographic examination of the maxillary left central incisor (Fig. 1) revealed the presence of an additional tooth fused to the palatal side of the permanent incisor with one joined root canal. Treatment A local anaesthetic was infiltrated over the apex of the maxillary left central incisor. After a palatal flap had been elevated the supernumerary tooth was ground away using a diamond instrument with a water spray at ultraspeed. The small opening into the root canal of the central incisor, resulting from the removal of the additional crown, suggested that the nerve-supply to the supernumerary tooth came from the permanent incisor. This opening was sealed with calcium hydroxide and zinc-oxideeugenoi, and filled with amalgam (Fig. 2). The surgical flap was then sutured. Periodically, vitality tests of the maxillary left central incisor, have been made using an electric pulp tester. On each occasion the tooth responded within normal limits.
Journal of Dentistry, Vol. 2/No. 2
DISCUSSION A l t h o u g h the literature on s u p e r n u m e r a r y teeth is quite extensive there are only a very few case reports o f fused s u p e r n u m e r a r y teeth. Luten (1967) f o u n d no fused s u p e r n u m e r a r y teeth in the p e r m a n e n t dentition when he studied the prevalence o f s u p e r n u m e r a r y teeth in a p o p u l a t i o n o f 1558 children. However, H a r r i s (1971) reported a maxillary central incisor with two r o o t canals a n d suggested this to be a result o f fusion between a mesiodens and a n o r m a l central incisor. Similarly, the case r e p o r t e d here seemed to be a s u p e r n u m e r a r y t o o t h fused to a maxillary central incisor. F u s i o n p r o b a b l y t o o k place at the onset o f r o o t d e v e l o p m e n t o f the n o r m a l central incisor, explaining the f o r m a t i o n o f one j o i n e d root. REFERENCES
GRAHNEN, H., and LINDAHL,B. (1961), Odont. Rev.v, 12, 290.
HARRIS, W.
E. (1971), J. Am. dent. Ass. dent. Cosmos, 83, 643. HOWARD, R. D. (1967), Dent. Practnr dent. Rec., 17, 332. LUTEN, J. R. (1967), J. Dent. Child., 34, 346. MACPHEE, G. G. (1935), Br. dent. J., 58, 59. POULTON, D. R., and PRUZANSKY, S. (1958), J. Dent. Child., 25, 212.
Fused supernumerary central incisor Yehoshua Shapira, D.M.D. 1 14 Herzl Boulevard, Jerusalem, Israel ABSTRACT
A supernumerary tooth fused to a maxillary permanent left central incisor is reported in a 9-year-old girl.
INTRODUCTION
small and cone-shaped. However, supernumerary incisors may be of normal size and shape and resemble the adjacent teeth (Howard, 1967). Although supernumerary teeth in the incisor region occur frequently, fused supernumerary teeth are rather rare.
THE occurrence of supernumerary teeth in the population is fairly frequent and the reported incidence varies from 0.3 per cent (Macphee, 1935; Poulton and Pruzansky, 1958) to 3.1 per cent (Grahnen and Lindahl, 1961).
A 9-year-old girl was referred for orthodontic consultation because of a supernumerary tooth
Fig. /.--Radiograph of the maxillary left central
Fig. Z--Radiograph of the maxillary left central
incisor showing the fused supernumerary tooth.
incisor filled with amalgam after removal of the supernumerary tooth.
It is well recognized that there are different types of supernumerary teeth in the premaxilla. The most common supernumerary tooth irl the maxillary incisor region, the mesiodens, is
which caused the maxillary left central incisor to be in labioversion. There was no difference in the size, shape, or labial appearance of the maxillary right and left central incisors. However, clinical
CASE
REPORT
64
examination showed a supernumerary tooth in close contact to the palatal surface of the maxillary left central incisor. It seemed that the crown of the supernumerary tooth was fused to the central incisor at the cingulurn, and a thin ligature wire which was inserted between the supernumerary tooth and the permanent incisor could not be moved further gingivally at the cingulum. Radiographic examination of the maxillary left central incisor (Fig. 1) revealed the presence of an additional tooth fused to the palatal side of the permanent incisor with one joined root canal. Treatment A local anaesthetic was infiltrated over the apex of the maxillary left central incisor. After a palatal flap had been elevated the supernumerary tooth was ground away using a diamond instrument with a water spray at ultraspeed. The small opening into the root canal of the central incisor, resulting from the removal of the additional crown, suggested that the nerve-supply to the supernumerary tooth came from the permanent incisor. This opening was sealed with calcium hydroxide and zinc-oxideeugenoi, and filled with amalgam (Fig. 2). The surgical flap was then sutured. Periodically, vitality tests of the maxillary left central incisor, have been made using an electric pulp tester. On each occasion the tooth responded within normal limits.
Journal of Dentistry, Vol. 2/No. 2
DISCUSSION A l t h o u g h the literature on s u p e r n u m e r a r y teeth is quite extensive there are only a very few case reports o f fused s u p e r n u m e r a r y teeth. Luten (1967) f o u n d no fused s u p e r n u m e r a r y teeth in the p e r m a n e n t dentition when he studied the prevalence o f s u p e r n u m e r a r y teeth in a p o p u l a t i o n o f 1558 children. However, H a r r i s (1971) reported a maxillary central incisor with two r o o t canals a n d suggested this to be a result o f fusion between a mesiodens and a n o r m a l central incisor. Similarly, the case r e p o r t e d here seemed to be a s u p e r n u m e r a r y t o o t h fused to a maxillary central incisor. F u s i o n p r o b a b l y t o o k place at the onset o f r o o t d e v e l o p m e n t o f the n o r m a l central incisor, explaining the f o r m a t i o n o f one j o i n e d root. REFERENCES
GRAHNEN, H., and LINDAHL,B. (1961), Odont. Rev.v, 12, 290.
HARRIS, W.
E. (1971), J. Am. dent. Ass. dent. Cosmos, 83, 643. HOWARD, R. D. (1967), Dent. Practnr dent. Rec., 17, 332. LUTEN, J. R. (1967), J. Dent. Child., 34, 346. MACPHEE, G. G. (1935), Br. dent. J., 58, 59. POULTON, D. R., and PRUZANSKY, S. (1958), J. Dent. Child., 25, 212.