Vijaylaxmi B.M, et al.

J Dent Med Res, 2018;1(2):5-7

World Inventia Publishers

Journal of Dental and Medical Research

http://www.worldinventiapublishers.com/JDMR/
Vol. 1, Issue 2, 2018

Case Report

BILATERAL FUSION OF MANDIBULAR THIRD MOLAR AND SUPERNUMERARY TOOTH - A RARE CASE REPORT

Dr. Saishreya Pasumathi 1, Dr. Vijaylaxmi B. Madalli 2 *, Dr. Priyanka Mahale 3, Dr. Sharmila Tapeshetti 4, Dr. Atul Sattur 5
1 Intern, Department of Multispecialty, SDM College of Dental Sciences, Dharwad, Karnataka - 580009, INDIA.

* 2 Reader, Department of Oral Medicine and Radiology & Department of Multispecialty, SDM College of Dental Sciences, Dharwad,
Karnataka - 580009, INDIA.
3 Lecturer, Department of Multispecialty, SDM College of Dental Sciences, Dharwad, Karnataka - 580009, INDIA.
4 Assistant Professor, Department of Multispecialty, SDM College of Dental Sciences, Dharwad, Karnataka - 580009, INDIA.
5 Professor and Head Department of Multispecialty, SDM College of Dental Sciences, Dharwad, Karnataka - 580009, INDIA.

Received on: 10-07-2018; Revised and Accepted on: 17-08-2018

ABSTRACT

Fusion is a developmental disturbance that occurs in the shape of teeth during tooth development. Fusion arises through union of two
normally separated tooth germs. Fusion is said to occur either due to a physical force or pressure generated during development or it may be genetically
transmitted as autosomal dominant trait. They usually occur unilaterally in both primary and permanent dentition. The purpose of this article is to
report a rare case of bilateral fusion of mandibular third molar with supernumerary tooth.

KEYWORDS: Fusion, Gemination, Supernumerary Tooth, Double Tooth.

CASE REPORT two separate tooth germs during development [1]. The aetiology is
unknown. However crowding of tooth germs during development can
be a factor [2]. It is thought to be either hereditary or due to the pressure
A 41 year old female patient reported to the department generated during development [1].
with a chief complaint of decayed teeth in the upper right back tooth
region since one year. History revealed that the patient was apparently
It is most commonly seen in the deciduous dentition than in
alright one year back after which she noticed discoloration of the tooth
the permanent dentition. The occurrence of fusion in the permanent
in the upper right back tooth region. There was no history of pain or
posterior teeth is rare. It may either between two normal teeth or like
swelling, or fever. Her medical history was noncontributory. On clinical
in this case between a normal tooth and a supernumerary tooth like a
examination, there was deep proximal decay with 14; there was pain on
distomolar or a mesiodens [3]. Radiological examinations play a crucial
vertical percussion. Mobility was within the normal limits.
role in the diagnosis of this condition. The tooth may have fused or
Supernumerary tooth seen fused with both left [Fig. 1] and right third
separate root canals.
molars [Fig. 2]. Instrument probing didn’t cause any pain. Since the
extent and nature of the union of teeth are better recognized radio
The most common differential diagnosis for fusion is
graphically, radiographs were obtained for further examinations and
gemination. The number of teeth is usually reduced in fusion, but is will
final diagnosis. Radiographic evaluation revealed fusion of third molar
be normal if the anomaly occurs between a normal tooth and a
and supernumerary tooth resulting in large pulp chamber [Fig. 3 & 4].
supernumerary tooth. In contrast gemination results in the increase in
As the chief complaint of the patient was the decayed tooth in the upper
the number of teeth as it is caused by the division of a single tooth germ
right tooth region, Root canal treatment was advised with respect to
to form two separate teeth [4]. The portion of the fused tooth that is
right upper first premolar. Since third molars were asymptomatic and
formed by the supernumerary tooth is conical in appearance whereas in
caries free, patient was encouraged to practice strict oral hygiene and
gemination both the halves are mirror images of each other.5
maintain periodic follow ups.
Differentiation of fusion from gemination is usually very difficult. Fused
and geminated teeth are usually asymptomatic but require treatment
DISCUSSION when decayed.

Dental fusion is a developmental anomaly, characterized Intra oral radiographs may be considered in the
most commonly by the appearance of clinically a wide tooth, almost differentiation as the geminated teeth have a single large root canal
twice the size of the normal crown. It usually occurs due to the fusion of whereas fused teeth usually have separate or fused root canals.
The clinical problems that may arise due to fusion are many.
The teeth affected are morphologically abnormal that will be
unanaesthetic, it favours plaque accumulation leading to periodontal
conditions, complex tooth and pulp anatomy leading to difficulties in
*Corresponding author: endodontic procedures which may lead to surgical extraction [5].
Dr. Vijaylaxmi B. Madalli
Reader, Department of Oral Medicine and Radiology & Department of
Multispecialty, SDM College of Dental Sciences, Dharwad,
Karnataka-580009, INDIA.
* E-Mail: [email protected]

DOI: https://doi.org/10.5281/zenodo.1403671

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Vijaylaxmi B.M, et al. J Dent Med Res, 2018;1(2):5-7

Fig. 1: Picture showing fusion of left mandibular molar with Fig. 2: Picture showing fusion of right mandibular molar with
Supernumerary tooth Supernumerary tooth

Fig. 3: Radiographic picture showing fusion of left mandibular molar with Supernumerary tooth

Fig. 4: Radiographic picture showing fusion of right mandibular molar with Supernumerary tooth

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Vijaylaxmi B.M, et al. J Dent Med Res, 2018;1(2):5-7
CONCLUSION 2. Tsesis I, Steinbock N, Rosenberg E, Kaufman AY. Endodontic
treatment of developmental anomalies in posterior teeth:
Treatment of geminated/fused teeth–report of two cases. Int
In conclusion, fusion is a rare developmental anomaly which Endod J 2003;36:372‑9.
requires careful clinical examination and others radiological tests for
3. Marechaux SC. The treatment of fusion of a maxillary central
the proper diagnosis and treatment. The abnormal morphology of such incisor and a supernumerary: Report of a case. ASDC J Dent
teeth requires regular prophylaxis and early interceptive treatment in
Child 1984;51:196‑9.
order to avoid complex periodontal and pulpal treatments.
4. O’Reilly PMR. Structural and radiographic evaluation of four
cases of tooth fusion. Aus Dent J 1990;35:226-229.
REFERENCES: 5. Nunes E, de Moraes IG, de Novaes PM, de Sousa SM.
Bilateralfusion of mandibular second molars with
1. Muthukumar RS, Arunkumar S, Sadasiva K. Bilateral fusion of supernumerary teeth:Case report. Braz Dent J 2002;13:137‑41.
mandibular second premolar and supernumerary tooth: A rare
case report. J Oral Maxillofac Pathol 2012;16:128-30.

How to cite this article:

Vijaylaxmi B.M, et al. BILATERAL FUSION OF MANDIBULAR THIRD MOLAR AND SUPERNUMERARY TOOTH - A RARE CASE
REPORT. J Dent Med Res 2018;1(2):5-7. DOI: https://doi.org/10.5281/zenodo.1403671

Conflict of interest: The authors have declared that no conflict of interest exists.
Source of support: Nil

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