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| Year : 2013 | Volume
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| Issue : 2 | Page : 277 |
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| Bilateral fusion in primary mandibular teeth |
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Rachana V Prabhu1, Laxmikanth Chatra1, Prashant Shenai1, Vishnudas Prabhu2
1 Department of Oral Medicine and Radiology, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India
2 Department of Oral Medicine Oral and Maxillofacial Pathology, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India
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| Date of Submission | 11-Feb-2012 |
| Date of Decision | 22-Aug-2011 |
| Date of Acceptance | 02-Dec-2011 |
| Date of Web Publication | 20-Aug-2013 |
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 Abstract | | |
Fusion has been described as a developmental anomaly characterized by the union of two adjacent teeth. Few cases of this rare anomaly in primary dentition have been reported in Indian population. A rare case of bilateral fusion between primary mandibular lateral incisors and canines is presented in this report. Keywords: Developmental anomaly, double teeth, fusion, primary dentition
How to cite this article:
Prabhu RV, Chatra L, Shenai P, Prabhu V. Bilateral fusion in primary mandibular teeth. Indian J Dent Res 2013;24:277 |
Fusion can be defined as a union of two separate tooth buds at some stage in their development. They are joined by the dentin; pulp chambers and canals may be linked or separated dependingon the developmental stage when the union occurs. Thus, it involves epithelial and mesenchymal germ layers resulting in irregular tooth morphology. [1] It is seen as a single enlarged tooth or a joined tooth in which the tooth count reveals a missing tooth when the anomalous tooth is counted as one. The phenomenon of fusion has often been confused with gemination, especially if it involves a supernumerary tooth. [2]
Terms such as double teeth and twinning are commonly used to describe both fusion and gemination because of the difficulty in clinical differentiation. [3]
It is seen in primary as well as permanent dentition with a higher frequency in the anterior and maxillary regions. [4] Prevalence for double teeth ranges from 0.1% to 1.5% in the primary dentition for unilateral presentation. [2] Cases of bilateral fusion are less frequent than that of unilateral fusion, with a prevalence of 0.02% in both dentition. [4] The data for bilateral fusion in Indian population are not available; the previous survey for unilateral fusion of primary teeth revealed 0.14%, as confirmed by Reddy and Munshi. [5] To the best of our knowledge, only three cases of bilateral fusion of mandibular primary lateral incisor and canines in an Indian population have been reported so far in the English literature. [6],[7]
A rare case of bilateral fusion of mandibular lateral incisor and canine in an Indian child is reported.
| Case Report | |  |
A 4-year-old male patient presented with bilateral anomalous primary mandibular lateral incisor and canine [Figure 1]. Medical history appeared noncontributory. There was no family history of dental anomalies and no consanguinity was reported in the parents. Intraoral examination revealed that < 72-73 > and < 82-83 > were fused together with a deep groove on the labial and lingual aspect. An incisal ditch was also seen in both < 72-73 > and < 82-83 >. | Figure 1: Bilateral fusion of primary mandibular lateral incisor and canine
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The periapical radiographs exhibited that the crowns and the roots of < 72-73 > and < 82-83 > were fused with complete union of their pulp chambers and root canals. Missing tooth buds of 32 and 42 were also noticed [Figure 2]. | Figure 2: Intraoral periapical radiograph showing complete fusion of 72-73 and 82-83
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A preventive approach was planned which consisted of topical fluoride application, dietary changes, and periodic follow-ups. Parents were informed about the missing permanent mandibular lateral incisors.
| Discussion | | |
Fusion has been described as a developmental anomaly characterized by the union of two adjacent teeth. This union of two separate tooth germs may be either complete or incomplete. Fused teeth have separate or shared pulp chambers and canals. [8] There will be one less tooth in the arch than normal if the affected tooth is counted as one. [9] Gemination is recognized as an attempt by a single tooth bud to divide, with a resultant formation of either a large tooth with a bifid crown or two completely divided teeth throughout the crown and root. [4] Normal number of teeth is observed if the affected tooth is counted as one. [2] Differential diagnosis between fusion and gemination is difficult when a normal tooth and a supernumerary tooth are involved. [4],[9] The etiology of double teeth may be attributed to evolution, trauma, heredity and environmental factors. Fusion can be classified as complete and incomplete depending upon the stage at which it begins and accordingly the features are seen in the fused tooth. [6] In this case, there was complete fusion of the 72-73 and 82-83 which shared the pulp chamber and canal.
Clinical problems that are caused due to fusion are esthetic problem, malocclusion, diastema formation, and susceptibility to caries due to the presence of deep fissures. Delayed resorption of the root has been reported due to greater root massand increased area of root surface relative to the sizeof the permanent successor crown. [2] When fusion occurs in the primary dentition, some of the permanent incisors are often not present. [10] Hagman reported that such patients have a 75% chance of lacking the succedaneous teeth. [11] These problems require both cosmetic and orthodontic consideration. In this case also, the permanent lateral incisors were found to be missing. Parents were informed regarding the importance of long-term follow-up of the patient.
The management of a case of fusion depends on which teeth are included, the level of fusion, and the morphologic result. If the affected teeth are primary, they may be retained as they are. If the clinician intends to extract, it is important to first of all determine whether the corresponding teeth are present. [2] If the fused tooth is free from caries, it may require no particular treatment. Universal preventive advice should be given to the parent and the child, and in case of presence of caries, a restoration should be placed for the retention of the function and esthetics.
In this case, the fused teeth were free of caries but the presence of a deep groove was noticed; hence, a preventive approach was planned that consisted of topical fluoride application, dietary changes, and periodic follow-ups.
The presence of pulpal involvement requires endodontic treatment in the same way as for a multirooted tooth. [12] Orthodontic and prosthodontic management should be considered to ensure functionalocclusion and improvement of the esthetics.
The minimal intervention technique and preventive approach for the management of the fused teeth have been advocated, if the pulp exposure can be ruled out. Management of fusion warrants regular and long-term follow-ups.
| References | | |
| 1. | Eidelman E. Fusion of maxillary primary central and lateral incisors bilaterally. Pediatr Dent 1981;3:346-7. 
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| 2. | Ahmet ES, Yildiray S, Yasin Y, Halil S, Abdullah E. Prevalence of fusion and gemination in permanent teeth in Coppadocia region in Turkey. Pak Oral Dent J 2011;31:17-22.
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| 3. | Tomizawa M, Shimizu A, Hayashi S, Noda T. Bilateral maxillary fused primary incisors accompanied by succedaneous supernumerary teeth: Report of a case. Int J Paediatr Dent 2002;12:223-7.
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| 4. | Neville BW, Damm DD, Allen CM, Bouquot JE, editors. Abnormalities of teeth. In: Oral and Maxillofacial Pathology. 2 nd ed. New Delhi: Elsevier; 2005. p. 49-106.
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| 5. | Reddy NN, Munshi AK. Fusion of primary incisors: A report of six cases. J Indian Soc Pedod Prev Dent 1999;17:55-60.
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| 6. | Chalakkal P, Thomas AM. Bilateral fusion of mandibular primary teeth. J Indian Soc Pedod Prev Dent 2009;27:108-10.
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| 7. | Tewari N, Pandey RK. Bilateral fusion in primary mandibular teeth: A report of two cases. J Indian Soc Pedod Prev Dent 2011;29:50-2.
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| 8. | Velasco LF, de Araujo FB, Ferreira ES, Velasco LE. Esthetic and functional treatment of a fused permanent tooth: A case report. Quintessence Int 1997;28:677-80.
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| 9. | Duncan WK, Helpin ML. Bilateral fusion and gemination: A literature analysis and case report. Oral Surg Oral Med Oral Pathol 1987;64:82-7.
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| 10. | Yuen SW, Chan JC, Wei SH. Double primary teeth and their relationship with the permanent successors: A radiographic study of 376 cases. Pediatr Dent 1987;9:42-8.
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| 11. | Hagman FT. Anomalies of form and number, fused primary teeth, a correlation of the dentitions. ASDC J Dent Child 1988;55:359-61.
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| 12. | Santos LM, Forte FD, Rocha MJ. Pulp therapy in a maxillary fused primary central incisor: Report of a case. Int J Paediatr Dent 2003;13:274-8.
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Correspondence Address:
Rachana V Prabhu
Department of Oral Medicine and Radiology, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.116680
[Figure 1], [Figure 2] |
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| This article has been cited by | | 1 |
Fusion of Primary Mandibular Anterior Teeth Associated with Partial Anodontia of Primary and Permanent Dentition: A Case Report |
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| Vivek Mehta | | Journal of Dental Health, Oral Disorders & Therapy. 2015; 3(3) | | [Pubmed] | [DOI] | | | 2 |
Fusion of Primary Mandibular Anterior Teeth Associated with Partial Anodontia of Primary and Permanent Dentition: A Case Report |
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| Vivek Mehta | | Journal of Dental Health, Oral Disorders & Therapy. 2015; 3(3) | | [Pubmed] | [DOI] | |
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