Endodontic Management of Fused Teeth: A Case Presentation

Case Report

J Dent App. 2014;1(5): 78-80.

Endodontic Management of Fused Teeth: A Case Presentation

Buyukbayram I1, Helvacioglu-Yigit D2 and Ozel E3*

1Acibadem Hospital, Turkey

2Department of Endodontics, University of Kocaeli, Turkey

3Department of Restorative Dentistry, University of Kocaeli, Turkey

*Corresponding author: Ozel E, Department of Restorative Dentistry, University of Kocaeli, Yuvacik, Basiskele, Kocaeli, Turkey

Received: July 26, 2014; Accepted: September 20, 2014; Published: September 22, 2014


Fusion is a rare developmental anomaly that is described as a union of two independently developing primary or secondary teeth. It can be either partial or complete, depending on the developmental stage of the teeth when the union occurs, and is infrequently seen in the permanent posterior dentition. Endodontic therapy of these teeth requires special care and careful management because of their abnormal anatomy. This paper reports a case of fusion between a maxillary lateral incisor and a supernumerary tooth and describes the endodontic and restorative management applied.

Keywords: Endodontic therapy; Fusion; Maxillary lateral incisor; Supernumerary tooth


Fusion is defined as a union of two separate tooth buds at some stage in their development. The pulp chamber and root canal may be joined or separated, depending on the stage of development at the time of union [1].

Fusion may occur between teeth of the same dentition or between supernumerary teeth. Clinically, a broad crown with a vertical groove extending toward the gingival sulcus is seen. The pulp chamber and the root canals can be joined or separated [2].

The etiology of tooth fusion is still unknown. Genetic predisposition, racial differences, the influence of pressure or physical forces that produce close contact between the developing tooth germs, and trauma have all been attributed as causative factors of tooth fusion [3,4]. Although the etiology is not clear, trauma, disease, or genetics have been suggested as possible causes [5,6].

Most reported cases of fusion are in the incisors and only rarely in the posterior dentition [4,7-10]. Problems with crowding, alignment, and occlusal functions can occur as a result of abnormal morphology and excessive mesiodistal width of a fused molar and a supernumerary tooth [11]. These teeth also tend to be greatly predisposed to caries and periodontal disease [12].

They are joined by the dentine; pulp chambers and root canals may be linked or separated depending on the stage of development at the time of union [13-15].

This paper reports a rare case of a fused maxillary lateral incisor with a supernumerary tooth and treatment with endodontic and restorative treatments.

Case Presentation

A 15-year-old female patient with an esthetic complaint regarding caries was referred to our clinic. Her medical history had no significant data.

The clinical examination revealed that the left maxillary lateral incisor appeared to have an unusual clinical crown and presented as two previously separated crowns joined in the enamel from the incisal of the crown through the cingulum area (Figure 1). A supernumerary tooth was present in the region of the left lateral incisor and seemed to be fused to it. Caries was present along the fissure on the labial surface of the fused teeth. Radiographic examination showed that the lateral incisor and the supernumerary tooth were fused with a separated pulp chamber and two root canals (Figure 2). Mild tenderness on percussion was observed, while there was no tenderness on palpation. The fused teeth were unresponsive to heat, cold, or electrical pulp testing. From the combined clinical and radiographic examinations, a diagnosis of chronic periapical periodontitis was established, and treatment consisted of endodontic therapy and the reconstruction of hard dental tissues with restorative treatment.