Management Of Fused Permanent Mandibulary Central Incissors: Intentional Replantation

Abstract

Dental fusion is a rare developmental anomaly, which stems from embryogenic union of 2 teeth originating from two different germs. These teeth also tend to be greatly predisposed to caries and periodontal disease and in some cases, endodontic treatment might be complicated. A 15 year-old male patient was referred to our clinic with the chief complaint of pain in the mandibulary incissor region. Clinic and radiographic examinations revealed that two mandibulary permanent central incissors were fused. The fused tooth was devital and had a periapical lesion. Therefore root canal treatment was applied primarily. During the treatment, it was concluded that a surgical approach is required. The fused tooth was extracted and its crown and root was reshaped. After the curettage of periapical granulation tissue, tooth was replantated with otogen bone graft. After 12 month follow-up period, it was seen that tooth was in function and periapical lesion was healed.

Keywords

• Fusion, root canal teratment, intentional replantation

Füzyonlu Alt Daimi Keser Dişlerin Tedavisi: Planlanmış Replantasyon

Abstract

Dental füzyon, farklı iki diş germinden meydana gelen 2 dişin embriyojenik birleşmesinden köken alan ve nadir rastlanan gelişimsel bir anomalidir. Bu dişler çürük ve periodontal hastalık oluşumuna yatkındırlar ve bazı vakaların endodontik olarak tedavi edilmeleri güç olabilir. 15 yaşındaki erkek hasta kliniğimize alt keser bölgesinde ağrı şikayetiyle başvurdu. Klinik ve radyografik incelemeler daimi alt iki santral keserin füzyonunu ortaya çıkardı. Diş devital ve periapikal lezyonlu olduğu için ilk aşamada kök kanal tedavisi yapıldı. Tedavi sırasında cerrahi yaklaşımın gerekli olduğuna karar verildi. Diş kökü ve kronu aeratörle şekillendirildi. Periapikal granülomun küretajından sonra diş, otojen kemik greftiyle reimplante edildi. 12 aylık takip döneminden sonra dişin fonksiyonda olduğu ve periapikal lezyonun iyileştiği görüldü.

Keywords

• Füzyon, kanal tedavisi, planlanmış replantasyon

References

1. Yucel AC, Guler E. Nonsurgical endodontic retreatment of geminate teeth: a case report. J Endod 2006;32:1214-6.
2. Danesh G, Schrijnemakers T, Lippold C, Schäfer E. Fused maxillary central incisor with dens evaginatus as a talon cusp. Angle Orthod 2006; 77:176-80.
3. Alpöz AR, Munanoğlu D, Önçağ Ö. Mandibular bilateral bilateral fusion in primary dentition: Case report. J Dent Child 2003;70:74-6
4. Milano M, Seybold S, McCandless G, Cammarata R. Bilateral fusion of the mandibular primary incissors: Report of case. J Dent Child 1999; 66: 280-2
5. Lowel RJ, Soloman AL. Fused teeth. JADA 1964; 68: 762-3
6. Acs G, Cozzi E, and Pokala. Bilateral double primary molars: case report. Ped. Dent. 1992; 14: 115-6
7. Hassan FS, Al Sarraj FR. Fusion of primary teeth: a case report . Quntessence Int 1989; 20: 149
8. Kim S, Choi S, Chung Y. Management of the fused permanent upper lateral incisor: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:649-52

9. Weine FS. The case against intentional replantation. J Am Dent Assoc 1980;100:664-8. Dryden JA. Intentional replantation. Compendium. 1989;10:23-8.
10. Gutmann JL, Harrison JW. Posterior endodontic surgery: anatomical considerations and clinical techniques Int Endod J 1985;18:8-34.
11. Nosonowitz DM, Stanley HR. Intentional replantation to prevent predictable endodontic failures. Oral Surg Oral Med Oral Pathol 1984; 57:423-32.
12. S. Sivolella, E. Bressan, V. Mirabal, E. Stellini, M. Berengo. Extraoral endodontic treatment, odontotomy and intentional replantation of a double maxillary lateral permanent incisor: case report and 6-year follow-up. Int Endod J 2008; 41, 538–46
13. Braun A, Appel T, Frentzen M. Endodontic and surgical treatment of a geminated maxillary incisor. Int Endod J 2003;36:380-6
14. Michanowicz AE, Michanowicz JP, Ardila J, Posada A. Apical surgery on a two-roted maxillary central incisor. J Endod 1990;16:454-5
15. Evcil S, Özcan E, Köseoğlu M, Çolak Topçu KM. Anormal kök formasyonlu üst santral kesicinin endodontik tedavisi-Bir vaka raporu. Atatürk Üni Diş Hek Fak Derg 2009;19:203-6
16. Messkoub M. Intentional replantation: a successful alternative for hopeless teeth. Oral Surg 1991;71:743-7.
17. Peer M. Intentional replantation—a “last resort” treatment or a conventional treatment procedure? Nine case reports. Dent Traumatol 2004;20:48-55.
18. Yaprak EY, Hakkı SS, Akman S, Belli S. Aesthetical and functional management of periodontially involved hopeless anterior teeth with multidiciplinary approach: 4 years follow-up. SÜ Diş Hek Fak Derg 2010;19:176-81 Yazışma Adresi
19. Yrd. Doç. Dr. Özgür Genç Şen Yüzüncü Yıl Üniversitesi. Diş Hek. Fak. Kampüs e-mail: [e-mail]