Fusion or Gemination? Diagnosis and Management in Primary Teeth: A Report of Two Cases

Abstract

Primary double teeth (PDT), referring to either gemination or fusion, are one of the most important and frequent developmental dental anomalies that can affect children’s oral health. Many clinical complications are correlated with these anomalies, such as dental caries, malocclusions, periodontal problems, and dental anomalies in permanent dentition. The aim of this report was to describe, through two cases, a case of gemination and another of fusion, the clinical management, the consequent effects, and the possible repercussions of these two developmental abnormalities on permanent successors. The first case involved gemination of the primary maxillary left central incisor (#61) in a 6-year-old boy. The patient presented with dental caries in the geminated tooth and its contiguous primary left lateral incisor (#62). The radiological examination revealed a slight developmental delay in the permanent left lateral incisor (#22). The treatment plan involved performing a pulpotomy and restoring the dental crowns of the affected teeth. The second clinical case describes a 6-year-old girl with unilateral fusion between a primary mandibular lateral incisor (#72) and a supernumerary tooth (#72’). The treatment included restoration of the deep grooves of the fused teeth using flowable composite and coronal restoration of the contiguous left primary canine (#73). Clinical and radiological follow-ups were performed every 3 months to monitor the development of teeth. No clinical and radiological symptoms were noted during the follow-up visits. PDT may require a multidisciplinary treatment. They should be diagnosed early to avoid and treat any possible complications in both the primary teeth and their permanent successors.

Conservative management of double teeth in molar teeth with periapical periodontitis: A report of five cases and literature review

“…The teeth that are fused may all be normal, for example, fusion between lateral incisor and canine teeth; it can also be a fusion that occurs between a normal tooth and a supernumerary tooth, such as a fusion of a lateral incisor and a supernumerary tooth. It is sometimes difficult to distinguish between a fused tooth and a geminated tooth, especially if fusion includes a supernumerary tooth [9]. Some scholars have proposed counting an abnormal tooth as one tooth.…”

“…If the total number of teeth in the dental arch is the same as that in the normal arch, the abnormal tooth is diagnosed as a "geminated tooth". Otherwise, the abnormal tooth is diagnosed as "fused teeth" [9]. However, this approach to diagnosis fails in some cases because fusion possibly occurs between natural and supernumerary teeth.…”

Classification and treatment of double teeth in primary dentition according to clinical involvement. Series of clinical cases.

“…La geminación dental es un intento fallido del folículo dental en dividirse en dos, dependiendo del grado de geminación, el diente afectado puede tener dos coronas o una corona grande parcialmente separada. Por otro lado, la fusión es la unión completa o parcial entre la dentina y/o esmalte de dos o más dientes separados durante el desarrollo (1)(2)(3)(4)(5).…”

“…Estas alteraciones dentarias plantean desafíos para el clínico a hora de realizar el diagnóstico y el plan de tratamiento. Un diagnóstico temprano permite instaurar un tratamiento preventivo y reducir la necesidad de tratamientos futuros (4,5). El profesional puede guiar la cronología de erupción, el desarrollo oclusal y diagnosticar en una fase precoz posibles alteraciones en la dentición permanente.…”

Gemination of an Erupted Mandibular Third Molar: A Short Presentation of an Exceptionally Rare Clinical Occurrence

“… 1 2 Occasionally, there is some confusion regarding the correct use of these terms, and an exact diagnosis is not always possible clinically. 3 4 5 6 …”