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Introduction: The purpose of this case report was to discuss the diagnosis and management of a rare dental anomaly involving a maxillary central incisor with a bifid crown, treated through a combined endodontic and surgical approach. Dental anomalies, such as gemination and fusion, can lead to irregularities in tooth size, structure, and number, which can pose challenges in diagnosis and careful consideration for effective management. Observation: A 13-year-old patient sought consultation for aesthetic and orthodontic concerns related to the double tooth (DT). Despite the complexity of the malformation, a conservative mixed endodontic and surgical approach was chosen after multidisciplinary discussion. The patient underwent endodontic treatment followed by crown resection and gingival plastic surgery. Post-operative follow-up showed satisfactory results. Conclusion: This case report emphasizes the challenges in DT diagnostic and the importance of a multidisciplinary approach. Various treatment modalities were explored, highlighting the lack of standardized guidelines and the importance of individualized care. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Dental fusion should be included in differential diagnosis when panoramic radiograph reveals changes in tooth shape or size. The use of specialized dental photographic techniques can augment the dentists' knowledge and awareness of such conditions. Dental fusion of impacted teeth may show up as a change in tooth shape and size on the first radiographic examination. This report presents an impacted maxillary third molar fused with a peg‐like distomolar in a 20‐year‐old male. The patient presented with symptoms of localized periodontitis distal to the second molar, and radiographic examination revealed abnormal dental structure of the third molar. Surgical extraction of the impacted molar was the treatment of choice. The final diagnosis of fusion was based on data from ex vivo CBCT, photographs of the extracted tooth, and extracted tooth's sections using polarizing filters. Two‐dimensional radiographs may conceal special dental anatomies. Visualization of such cases using CBCT and dental photography serves to educate dentists and reduce postoperative complications. Knowledge and awareness of possible dental abnormalities are of utmost importance for successful treatment planning. [ABSTRACT FROM AUTHOR]

Key Clinical Message Dental fusion should be included in differential diagnosis when panoramic radiograph reveals changes in tooth shape or size. The use of specialized dental photographic techniques can augment the dentists' knowledge and awareness of such conditions. Abstract Dental fusion of impacted teeth may show up as a change in tooth shape and size on the first radiographic examination. This report presents an impacted maxillary third molar fused with a peg‐like distomolar in a 20‐year‐old male. The patient presented with symptoms of localized periodontitis distal to the second molar, and radiographic examination revealed abnormal dental structure of the third molar. Surgical extraction of the impacted molar was the treatment of choice. The final diagnosis of fusion was based on data from ex vivo CBCT, photographs of the extracted tooth, and extracted tooth's sections using polarizing filters. Two‐dimensional radiographs may conceal special dental anatomies. Visualization of such cases using CBCT and dental photography serves to educate dentists and reduce postoperative complications. Knowledge and awareness of possible dental abnormalities are of utmost importance for successful treatment planning.

Double tooth pathologies are important indicators of trauma, disease, diet, and feeding biomechanics, and are widely documented in mammals. However, diagnosis of double tooth pathologies in extinct non-mammalian vertebrates is complicated by several compounding factors including: a lack of shared terminology reflecting shared etiology, inconsistencies in definitions and key features within and outside of mammals (e.g., gemination, fusion, twinning, concrescence); differences in tooth morphology, heterodonty, regeneration, and implantation between mammals and non-mammalian vertebrates; and the unmet need for diagnostic criteria that can be applied to isolated teeth, which are common in the fossil record. Here we report on double tooth pathologies in the lamniform and carcharhiniform Cenozoic sharks Otodus megalodon (NCSM 33639) and Carcharhinus leucas (NCSM 33640, 33641). All three teeth bear a singular bifid crown with mirrored halves and abnormal internal microstructure-a single, bifurcating pulp cavity in C. leucas and a more than tripling of vessels in O. megalodon (from two to seven main ascending canals). We identify these abnormalities as likely examples of gemination due to their symmetry, which rules out fusion of tooth buds in one tooth file in different developmental stages in polyphyodont taxa; however, we note that incomplete forms of mesiodistal tooth fusion can be morphologically indistinguishable from gemination, and thus fusion cannot be rejected. We further compile and recategorize, when possible, the diversity of tooth pathologies in sharks. The identification of double tooth pathologies in O. megalodon and C. leucas has paleobiological implications. Such pathologies in sharks are largely hypothesized to stem from trauma to developing tooth buds. Carcharhinus leucas is known to feed on prey documented to cause feeding-related oral traumas (e.g., rays, sawfish, spiny fish, and sea urchins). However, O. megalodon, is considered to have largely fed on marine mammals, and perhaps turtles and/or fish, raising the possibility that the dietary diversity of this species is, as of yet, underappreciated. The genetic underpinnings of tooth morphogenesis and regeneration is highly conserved throughout vertebrate evolution, suggesting a homologous framework can be established. However, more research is needed to link developmental, paleobiological, and/or paleoenvironmental factors to gemination/fusion in polyphyodont taxa. We argue that the definitions and diagnostic criteria for dental pathologies in vertebrates require standardization in order to advance macroevolutionary studies of feeding trauma in deep time. [ABSTRACT FROM AUTHOR]

Developmentally abnormal teeth presenting a complex root canal morphology requires special endodontic management. The present case report demonstrates successful endodontic management of a mandibular first premolar with an unusual concurrent occurrence of a double tooth and dens evaginatus with a C-shaped canal configuration in a 21-year-old patient that was diagnosed with pulpal necrosis with symptomatic apical periodontitis. In this case, the use of cone-beam computed tomography and the dental operating microscope contributed remarkably to the diagnosis and treatment of the complex root canal morphology of the anomalous tooth. Therefore, the use of recent advances in endodontics is strongly recommended in such cases to ensure predictable and successful results.

Double tooth pathologies are important indicators of trauma, disease, diet, and feeding biomechanics, and are widely documented in mammals. However, diagnosis of double tooth pathologies in extinct non-mammalian vertebrates is complicated by several compounding factors including: a lack of shared terminology reflecting shared etiology, inconsistencies in definitions and key features within and outside of mammals (e.g., gemination, fusion, twinning, concrescence); differences in tooth morphology, heterodonty, regeneration, and implantation between mammals and non-mammalian vertebrates; and the unmet need for diagnostic criteria that can be applied to isolated teeth, which are common in the fossil record. Here we report on double tooth pathologies in the lamniform and carcharhiniform Cenozoic sharks Otodus megalodon (NCSM 33639) and Carcharhinus leucas (NCSM 33640, 33641). All three teeth bear a singular bifid crown with mirrored halves and abnormal internal microstructure—a single, bifurcating pulp cavity in C. leucas and a more than tripling of vessels in O. megalodon (from two to seven main ascending canals). We identify these abnormalities as likely examples of gemination due to their symmetry, which rules out fusion of tooth buds in one tooth file in different developmental stages in polyphyodont taxa; however, we note that incomplete forms of mesiodistal tooth fusion can be morphologically indistinguishable from gemination, and thus fusion cannot be rejected. We further compile and recategorize, when possible, the diversity of tooth pathologies in sharks. The identification of double tooth pathologies in O. megalodon and C. leucas has paleobiological implications. Such pathologies in sharks are largely hypothesized to stem from trauma to developing tooth buds. Carcharhinus leucas is known to feed on prey documented to cause feeding-related oral traumas (e.g., rays, sawfish, spiny fish, and sea urchins). However, O. megalodon, is considered to have largely fed on marine mammals, and perhaps turtles and/or fish, raising the possibility that the dietary diversity of this species is, as of yet, underappreciated. The genetic underpinnings of tooth morphogenesis and regeneration is highly conserved throughout vertebrate evolution, suggesting a homologous framework can be established. However, more research is needed to link developmental, paleobiological, and/or paleoenvironmental factors to gemination/fusion in polyphyodont taxa. We argue that the definitions and diagnostic criteria for dental pathologies in vertebrates require standardization in order to advance macroevolutionary studies of feeding trauma in deep time.

Füzyon ve geminasyon, özellikle süpernumere diş veya hipodontiyle birlikte görüldüğü durumlarda klinik olarak ayırıcı tanı koymak zor olmaktadır. Bu nedenle çoğu araştırmacı bu dişler için “çift diş” terimini kullanmayı tercih etmektedir. Eğer bu dişler komşu iki diş germinin birleşmesi sonucu oluşuyorsa füzyon; tek diş germinin bölünme girişimi sonucu oluşuyorsa geminasyon olarak tanımlanmaktadır. Bu olgu sunumunda daimi üst sol santral dişi etkileyen çift diş olgusunun tedavisi anlatılmaktadır. Yapılan klinik ve radyografik muayeneler sonucunda, bu dişin üst sol santral kesici ile süpernumere dişin füzyonundan oluştuğu belirlenmiştir. Çift diş, komşu santral dişin kron boyutunda olacak şekilde ikiye ayrılarak süpernumere diş, ilgili kökle birlikte çekilmiştir. Bir yıllık takip sonunda sol santral kesici dişin vitalitesinin devam ettiği belirlenmiştir. Bu olgu, çift dişin ayrılmasında doğru teşhisin önemli olduğunu ve konik ışınlı bilgisayarlı tomografi (KIBT) tabanlı verilerin komplike olan tedavi planlanmasında oldukça yararlı olduğunu göstermektedir.

Fusion and gemination are not entirely uncommon dental anomalies that may also be named 'double teeth'. This is due to their unusual presentation in a twin-like fashion. Teeth with these irregularities may appear clinically similar, presenting as large and bulbous in shape with unusual anatomy and fissure patterns. The exact aetiology of these anomalies is uncertain, but many potential local or systemic disturbances during the morphodifferentiation stage of odontogenesis have been considered. Gemination occurs rarely in the permanent dentition and even less frequently in the posterior region of the oral cavity. This report presents a case of a geminated mandibular second molar and discusses the importance of early recognition and diagnosis of such teeth so that adequate preventative care and treatment can be provided. [ABSTRACT FROM AUTHOR]

Twinning is referred to the development of two separate teeth that arose from the complete separation of one tooth bud. The present paper discusses twinning in detail and attempts to differentiate twinning from gemination, fusion and concrescence. [ABSTRACT FROM AUTHOR]

Fusion is known as a developmental anomaly described by the union of two neighbouring teeth. The worldwide prevalence of bilaterally fused teeth in the primary dentition is about 0.02% which is considered very rare. Only few cases of bilateral fusion have been reported in Indian population. This paper presents a rare case of three-year-old boy with bilateral fusion of primary mandibular lateral incisors and canine teeth. Treatment consisted of pit and fissure sealants and topical fluoride application. To conclude, fused primary teeth are considered as harmless asymptomatic abnormality.

Fused or gemmated teeth require complex and multi-faceted treatment to maintain their health, functionality, and appearance. The current paper describes the multidisdpHnaiy/minimally invasive treatment of fused immature permanent teeth. A 9-year-old-girl with an abnormally large left permanent maxillary lateral incisor was referred to the Paediatric Outpatient Clinic. The treatment plan of the referring orthodontist included the extraction of left maxillary lateral incisor, which was fused to a supernumerary tooth, followed by subsequent orthodontic and prosthetic treatments. In the paraclinic evaluation, cone-beam computed tomography (CBCT) showed two separate roots and two root canals, with communication between the pulp chambers of the double teeth. The modified treatment plan was to section the geminated tooth, remove the supernumerary and save the lateral incisor. During the sectioning procedure, the pulp of the remaining tooth was inevitably exposed. Direct pulp capping with Biodentine™ was performed. Next, glass-ionomer cement was applied as a temporary restoration and the supernumerary tooth was removed. The distal surface of the tooth was restored two weeks later so as to re¬establish the original shape of the lateral incisor. Clinical and radiographic control examinations revealed that the tooth was symptom-free. Follow-up appointments after 3,6,12 and 18 months included standard clinical examinations and sensivity tests including electric pulp testing, which showed a fully functional, healthy tooth with apical maturation. Careful clinical and radiographic evaluations/examinations are essential for determining the correct treatment of a double tooth. The proposed multidisciplinary and minimally invasive treatment of the double tooth using a bioactive cement may facilitate the maturation of immature teeth and result in a desirable aesthetics and function. [ABSTRACT FROM AUTHOR]

Objective: Dental anomalies occurring in deciduous teeth can affect the eruption of the permanent dentition and the occlusion stability. The occurrence of dental anomalies such as double teeth during the primary dentition in the daily practice might be frequent. The study aimed to qualitatively summarize the therapeutic management of double teeth in primary incisors.Material and Methods: A systematic review regarding the therapy of primary fused incisors in the mandible was performed and the obtained data were assessed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following electronic databases were screened from 1st January, 1996 until 30th July, 2019: PubMed, Scopus, EBSCO and the archives of paediatric dental journals. The search terms were grouped in anatomic entity: (tooth OR teeth OR incisor), pathological condition: (fused OR fusion OR geminated OR double), intervention: (treatment OR intervention OR therapy OR prevention OR control OR management OR restoration), observed parameters: (primary dentition OR primary tooth OR primary teeth).Results: Ten articles met all inclusion criteria. The data disclosed the occurrence of double teeth in mandibular incisors. The main management of this clinical condition is either preventive or surgical involving the extraction of fused teeth, based on the deciduous nature of the teeth, the degree of caries and malocclusion development risk.Conclusion: An early diagnosis of dental anomalies is fundamental for the application of proper preventive strategies to avoid a potential malocclusion in permanent dentition and to maintain these teeth sound and caries-free until the eruption of the permanent dentition. [ABSTRACT FROM AUTHOR]

Teeth with aberrant root morphology present the endodontist with diagnostic and treatment challenges. This review of the literature is focused on the classification, aetiology, prevalence and diagnosis of different types of double teeth, namely fused or geminated teeth. Cases are included to illustrate the various treatment considerations when managing these variations of dental anatomy. [ABSTRACT FROM AUTHOR]

Fusion and gemination are not entirely uncommon dental anomalies that may also be named ‘double teeth’. This is due to their unusual presentation in a twin-like fashion. Teeth with these irregularities may appear clinically similar, presenting as large and bulbous in shape with unusual anatomy and fissure patterns. The exact aetiology of these anomalies is uncertain, but many potential local or systemic disturbances during the morphodifferentiation stage of odontogenesis have been considered. Gemination occurs rarely in the permanent dentition and even less frequently in the posterior region of the oral cavity. This report presents a case of a geminated mandibular second molar and discusses the importance of early recognition and diagnosis of such teeth so that adequate preventative care and treatment can be provided.

Fused teeth and talon cusp are developmental anomalies with inherently bizarre anatomy. These anomalies may develop during tooth bud morphodifferentiation as a result of a developmental aberration of both the ectoderm and mesoderm. Concurrent occurrence of different developmental anomalies is rarely seen and reported in the literature. This article describes one such encounter of bilateral fusion of permanent mandibular central and lateral incisors, along with the presence of talon's cusp on the fused teeth, and reviews the associated clinical problems and available treatments options.

Objective: The objective of this study was to estimate the prevalence of dental anomalies in primary dentition of Indian population. Materials and Methods: This cross-sectional study was conducted on 4180 children in the age of 2–6 years. Anomalies were classified based on Kreiborg criteria. The term “double tooth” was used to avoid misinterpretation between gemination. and fusion. Patients having radiographs were also examined for associated dental anomalies in permanent dentition. The occurrence and gender prevalence were evaluated using descriptive statistics. Results: About 95. (2.27%) children exhibited at least one dental anomaly. Thirty.seven children showed 51 missing teeth. (0.88%), mostly in lower right incisors with a statistically significant difference between arches. (P = 0.0056) Nine children. (0.21%) had supernumerary teeth commonly in the right maxilla. Two cases of oligodontia. (0.04%) and talon cusps. (0.04%) and one case of triple tooth. (0.02%) were observed. Forty children. (0.95%) had 43 double teeth mostly in the right mandible with a statistically significant difference between the arches. (P = 0.0105). No significant difference was observed based on gender and arch, but they were statistically significant between the right and left sides. (P = 0.018). Among the children with radiographs available, 45% showed anomalies in the succedaneous dentition. Conclusions: The prevalence rates of children with double tooth, hypodontia, and hyperdontia in our study are 0.95%, 0.88%, and 0.21%, respectively. The overall prevalence rate of anomalies among boys was higher than girls.

Wnts determine cell polarity, cell proliferation, and cell differentiation during embryogenesis and play an essential role during tooth development initiation and morphogenesis. Wnt/β-catenin signaling has a time-dependent role in development because various signaling molecules that mutually interact are involved in the pathway, and tight regulation of the pathway is essential for normal development. Studies investigating how the Wnt/β-catenin signaling pathway controls the different stages of tooth development are rare. Specifically, the effects of Wnt/β-catenin signaling loss of function on different stages of tooth development are currently unknown. Here, we report the stage-dependent role of Wnt/β-catenin signaling in tooth development. In vivo loss and gain of function of Wnt/β-catenin signaling were implemented through the genetic overexpression of DKK1 with heat shock-inducible transgenic models and the pharmacologic inhibition of β-catenin destruction complex formation in zebrafish, respectively. We demonstrated that transient inhibition of Wnt/β-catenin signaling interrupted tooth development in a stage-dependent manner and conditional activation of Wnt/β-catenin signaling during 4V morphogenesis inhibited the development of 3V. These findings suggest that Wnt/β-catenin signaling plays an important role in the morphogenesis of teeth and the initiation of sequential tooth development in a stage-dependent manner. [ABSTRACT FROM AUTHOR]

Developmental anomalies of teeth are of clinical interest because of the problems associated with them. This report describes a unique case of unilateral fusion of primary mandibular lateral incisor and canine and discusses the possible future treatment options anticipated for management of fused deciduous teeth. Clinically, this case provides an insight into management options for fused deciduous teeth for general dental practitioners.

Fusion is known as a developmental anomaly described by the union of two neighbouring teeth. The worldwide prevalence of bilaterally fused teeth in the primary dentition is about 0.02% which is considered very rare. Only few cases of bilateral fusion have been reported in Indian population. This paper presents a rare case of three-year-old boy with bilateral fusion of primary mandibular lateral incisors and canine teeth. Treatment consisted of pit and fissure sealants and topical fluoride application. To conclude, fused primary teeth are considered as harmless asymptomatic abnormality. [ABSTRACT FROM AUTHOR]

The presence of dens invaginatus (DI) and dens evaginatus (DE) on same tooth is a rare phenomenon. However, when these dental anomalies occur on a double tooth, it becomes an extremely rare phenomenon. The authors report a rare case of DI and DE on fused permanent maxillary central incisor with supernumerary tooth in a 40-year-old male. The present article also focuses on the differentiating fusion from gemination and also reviews preventive and management strategies for tooth with complex dental anatomy.

Gemination is a developmental anomaly where a single tooth bud attempts to split into two. It is also sometimes called as double tooth or twinning. Dens invaginatus is another developmental anomaly caused due to invagination of a portion of crown. These anomalies occur as separate entities. Co-occurrence of these two anomalies have been only reported four times in the literature. Here we present an extremely rare case of simultaneous occurrence of gemination and dens invaginatus in the same tooth. [Cukurova Med J 2016; 41(1.000): 175-177]

Twinning is referred to the development of two separate teeth that arose from the complete separation of one tooth bud. To the best of our knowledge very few cases of twinning in primary or permanent dentition have been previously reported. Here, we report an additional case of twinning involving primary maxillary left lateral incisor and a literature review of clinical and radiographic findings of previous reported cases of gemination and twinning is also discussed. A six-year-old male patient reported to the dental clinic with the complaint of decay in the left front teeth region of the upper jaw. On clinical examination, dentinal caries was observed on the labial surface of primary maxillary left lateral incisor. The tooth showed a deep groove present in relation to the labial surface and incisal edge and continued cervically as a shallow groove. The patient had normal compliment of teeth for his age. The intra-oral periapical radiograph of the maxillary anterior region revealed large crown and a radiolucent notch was observed in relation to the incisal edge of the maxillary left primary lateral incisor. Relatively one pulp chamber and two root canals were observed in relation to the primary maxillary left lateral incisor, which was suggestive of a case of twinning involving primary maxillary left lateral incisor. This present case is the first case report of twining seen in primary dentition.

Talon cusps in mandibular anterior teeth are very rare. Talon cusps in mandibular anterior teeth associated with other anomalies are even rarer and that a bilateral case in the mandible has not been reported before. In this report, eight such rare cases of talon cusps in permanent mandibular incisors are presented. It includes a bilateral case that in the author′s knowledge is the first case reported in the English literatures.

Gemination aka twinning and fusion, are rare occurrences in posterior mandibular teeth, often requiring endodontic and surgical treatment for functional, orthodontic or cosmetic reasons. The diagnosis and design of a precise treatment plan in cases involving double teeth are in most cases challenging. The purpose of this case report is to describe a successful multidisciplinary treatment protocol for a double tooth. Upon completion of the endodontic, restorative and orthodontic treatments, the clinical and radiographic three-year follow-up revealed that the rest of the transected premolar showed evidence of healing of the supporting tissues and satisfactory cosmetic result. [ABSTRACT FROM AUTHOR]

Fusion is an anomaly manifested in both deciduous and permanent dentitions. Triple tooth refers to the union of three separate tooth entities. It can involve the normal dentition or supernumerary teeth. Triplication is rarely encountered in deciduous and permanent dentition with an incidence of 0.02%. The case presented herein describes a rare case of triplication in permanent maxillary incisors and supernumerary teeth in a 15-year-old female. Keywords: Concrescent triplet, double tooth, fused teeth, odontoplasia, supernumerary tooth, tooth abnormalities [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to estimate the prevalence of dental anomalies in primary dentition of Indian population.Materials and Methods: This cross-sectional study was conducted on 4180 children in the age of 2-6 years. Anomalies were classified based on Kreiborg criteria. The term "double tooth" was used to avoid misinterpretation between gemination. and fusion. Patients having radiographs were also examined for associated dental anomalies in permanent dentition. The occurrence and gender prevalence were evaluated using descriptive statistics.Results: About 95. (2.27%) children exhibited at least one dental anomaly. Thirty.seven children showed 51 missing teeth. (0.88%), mostly in lower right incisors with a statistically significant difference between arches. (P = 0.0056) Nine children. (0.21%) had supernumerary teeth commonly in the right maxilla. Two cases of oligodontia. (0.04%) and talon cusps. (0.04%) and one case of triple tooth. (0.02%) were observed. Forty children. (0.95%) had 43 double teeth mostly in the right mandible with a statistically significant difference between the arches. (P = 0.0105). No significant difference was observed based on gender and arch, but they were statistically significant between the right and left sides. (P = 0.018). Among the children with radiographs available, 45% showed anomalies in the succedaneous dentition.Conclusions: The prevalence rates of children with double tooth, hypodontia, and hyperdontia in our study are 0.95%, 0.88%, and 0.21%, respectively. The overall prevalence rate of anomalies among boys was higher than girls. [ABSTRACT FROM AUTHOR]

Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation.

Double tooth is the general term that is used to describe fusion and gemination in which one tooth is conjoined with another. Fusion is defined as two separately forming teeth joined together while gemination refers to partial development of two teeth from a single tooth bud. In clinical practice fusion and gemination are often confused with one another. This report describes two unique clinical cases of double tooth in maxillary anterior region, and the intent of this report is to facilitate young clinician to differentiate fusion from gemination so that successful diagnosis of double tooth can be reached with certainty. [ABSTRACT FROM AUTHOR]

Developmental anomalies of teeth are of clinical interest because of the problems associated with them. This report describes a unique case of unilateral fusion of primary mandibular lateral incisor and canine and discusses the possible future treatment options anticipated for management of fused deciduous teeth. Clinically, this case provides an insight into management options for fused deciduous teeth for general dental practitioners. [ABSTRACT FROM AUTHOR]

Solitary median maxillary central incisor (SMMCI) is a unique developmental anomaly in primary dentition. It involves central incisor tooth germs and may or may not be associated with other anomalies. Its presence, concomitant with fusion of right mandibular incisors has not previously been reported. A 5-year-old girl was presented with a single symmetrical primary maxillary incisor at the midline, with the absence of labial frenulum, an indistinct philtrum and a prominent midpalatal ridge. There was an associated fused tooth in the right incisor region and radiographic examination confirmed only one maxillary central incisor in both the dentitions. Family history revealed that the father of the girl also had a similar anomaly providing probable evidence of etiological role for heredity in SMMCI.

The presence of dens invaginatus (DI) and dens evaginatus (DE) on same tooth is a rare phenomenon. However, when these dental anomalies occur on a double tooth, it becomes an extremely rare phenomenon. The authors report a rare case of DI and DE on fused permanent maxillary central incisor with supernumerary tooth in a 40-year-old male. The present article also focuses on the differentiating fusion from gemination and also reviews preventive and management strategies for tooth with complex dental anatomy. [ABSTRACT FROM AUTHOR]

Dental anomalies are clinically evident abnormalities which can cause vari¬ous dental problems, which may complicate orthodontic treatment planning. Clinical & radiological inspection play crucial role in identification of various anomalies. This study was carried over the period of 2 years to determine the pattern and distribution of various morphological dental anomalies among orthodontic patients. Demographic details along with detailed medical, dental and family histories were obtained from every patient. In addition to the intraoral examination, study casts and dental panoramic radiograph were also evaluated for dental anomalies causing disturbance in number, size, form, and location of teeth. Patients with syndromes were not included in the study. Out of 520 patients, dental anomalies were present in 83 (16%) patients. Hypodontia was the most prevalent dental anomaly occurring in 37 (7.1%) patients & maxillary lateral incisor was found to be the most commonly missing tooth. Microdontia was second most prevalent dental anomaly observed in 21 (4%) patients with the maxillary lateral incisor being the most commonly affected tooth. Double tooth was rare finding present only in 1 (0.19%) patient. All dental anomalies showed higher prevalence in female patients except for double tooth and transposition which were more prevalent in male patients. . Dental anomalies can lead to disturbance in occlusion. Orthodontists have the responsibility to observe each patient carefully for various dental anomalies and have full knowledge of them as it can help them in planning treatment for these patients and executing them without any complications. [ABSTRACT FROM AUTHOR]

Background: Double facial talon's cusp is a rare developmental anomaly affecting the deciduous or/and permanent dentition. The major complications associated with facial talons of maxillary incisors include poor esthetic appearance with increased susceptibility to caries and, sometimes, even soft tissue irritation, thereby needing early detection and precise management. Case Report: We report a case of a 10 year-old female patient with a large double talon's cusp on the permanent left maxillary central incisor who presented with issues of soft tissue irritation and esthetic concern. One of the highlighting feature of this documented case was the difference in the extent of both talon's cusps on the facial surface of 21 teeth. As per Mayes' classification system, the talon towards the midline belonged to stage 2 and the talon away from the midline belonged to stage 3. Highlights: Based on the previous literature search on classification systems, we intended to propose a new classification system for double facial talons depending on their size (equal/unequal) and presence of developmental grooves (separate or fused). The aim of this new classification system is to enlighten a new area of research that can be conducted on the treatment aspect by studying the difference in the structure of enamel rods, dentin, especially in case of double talons of unequal size (as the direction of enamel rods/dentinal tubules of the talons with that of the direction of enamel rods/dentinal tubules of the underlying tooth will vary) and their compatibility with choice of dental materials, to be used for proper adaptation and develop new treatment protocols of tooth preparation and restoration for such cases. [ABSTRACT FROM AUTHOR]

Twinning is referred to the development of two separate teeth that arose from the complete separation of one tooth bud. To the best of our knowledge very few cases of twinning in primary or permanent dentition have been previously reported. Here, we report an additional case of twinning involving primary maxillary left lateral incisor and a literature review of clinical and radiographic findings of previous reported cases of gemination and twinning is also discussed. A six-year-old male patient reported to the dental clinic with the complaint of decay in the left front teeth region of the upper jaw. On clinical examination, dentinal caries was observed on the labial surface of primary maxillary left lateral incisor. The tooth showed a deep groove present in relation to the labial surface and incisal edge and continued cervically as a shallow groove. The patient had normal compliment of teeth for his age. The intra-oral periapical radiograph of the maxillary anterior region revealed large crown and a radiolucent notch was observed in relation to the incisal edge of the maxillary left primary lateral incisor. Relatively one pulp chamber and two root canals were observed in relation to the primary maxillary left lateral incisor, which was suggestive of a case of twinning involving primary maxillary left lateral incisor. This present case is the first case report of twining seen in primary dentition. [ABSTRACT FROM AUTHOR]

Double tooth and talon cusp are tooth shape anomalies with rare co-occurrences in a single tooth. Double tooth is a developmental anomaly that leads to the eruption of fused teeth and may contribute to compromised esthetics, pain, caries, and tooth crowding. Talon cusp is a rare developmental extra cusp-like projection on the cingulum area that may cause functional and esthetic problems. Differential diagnosis of these anomalies may be complicated. A multidisciplinary approach for the esthetic and functional rehabilitation of double teeth is important. Various treatment methods have been described in the literature for the different types and morphological variations of double teeth. The purpose of this paper is to report the case of an unusual combination of double tooth and talon cusp on a permanent maxillary incisor and describe its esthetic and functional rehabilitation using a porcelain laminate veneer. [ABSTRACT FROM AUTHOR]

Fusion is a developmental anomaly defined as the union of two normally separated tooth buds or the partial splitting of one tooth bud into two buds. Depending on the stage of development, fusion may be either complete or incomplete. The significance of this particular case was that this fusion occurred in a posterior permanent mandibular tooth, while such a manifestation is more reported in maxillary anterior teeth; either in the primary (0.5%) or permanent (0.1%) dentition. The genetic basis for this anomaly is probably autosomal dominant with reduced penetrance. In addition, the essential findings for differential diagnosis include number of teeth, radiography and clinical features.

Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation. [ABSTRACT FROM AUTHOR]

Gemination is a developmental anomaly where a single tooth bud attempts to split into two. It is also sometimes called as double tooth or twinning. Dens invaginatus is another developmental anomaly caused due to invagination of a portion of crown. These anomalies occur as separate entities. Co-occurrence of these two anomalies have been only reported four times in the literature. Here we present an extremely rare case of simultaneous occurrence of gemination and dens invaginatus in the same tooth. [ABSTRACT FROM AUTHOR]

Aim To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. Double tooth is a dental irregularity consequent to fusion of two or more teeth or dental gemination. The teeth most commonly involved are deciduous, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, functional and periodontal problems can result. This paper reports a clinical case of a double tooth in the position of the maxillary right lateral permanent incisor. Combined orthodontic, endodontic and surgical treatment (intentional replantation) allowed the tooth to be retained without periodontal compromise and with a positive orthodontic result both immediately and 6 years following intervention. Key learning points •A conservative approach that addresses periodontal, pulpal and tooth tissues, can result in the retention of a double tooth. •Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective. [ABSTRACT FROM AUTHOR]

Aim To present a case with various morphological irregularities requiring root canal treatment and to discuss the problems and options for orthograde root canal treatment. Root canal treatment of a double tooth presenting with an acute alveolar abscess is described. The anatomical variations of this tooth included double tooth, dental invagination, incomplete apical closure, three root canal systems and an internal lacuna . The tooth was treated nonsurgically with orthograde root canal treatment resulting in nearly complete radiographic apical repair after 4 years. Key learning points •Double teeth occur infrequently and may be distinguished from fusion, gemination, concrescence and dental twinning. •Several malformations may be present in a single tooth. •Orthograde root canal treatment may be an adequate treatment option even in teeth with a complex internal anatomy. [ABSTRACT FROM AUTHOR]

Dental anomalies of number, shape and timing of eruption may occur in both the primary and permanent dentition. Various terms have been used to describe dental co-joined anomalies: twinning, fusion, germination, concrescence, double teeth, syndontia, geminifusion and vicinifusion. Co-joined tooth is a term used to describe connate tooth and includes both dental fusion and gemination. Fusion is a condition in which the crowns of two separate teeth have been joined together during the development. This phenomenon occurs infrequently but could cause esthetic, spacing and periodontal problems. Germination is when two teeth develop from one single bud leading to a larger tooth. The present article reports the presence of a co-joined primary mandibular central and lateral incisors in 5 yr. old male child as 1st case where no anodontia was revealed through radiographs . In 2nd case, primary co-joined tooth in a 10 year old female involving primary mandibular left lateral incisor and canine is reported. Radiographic examination in this case confirmed the absence of the permanent left mandibular lateral incisor. Cases with primary co-joined tooth necessitate careful examination as they may be associated with anomalies in the succeeding permanent dentition and require proper treatment planning. [ABSTRACT FROM AUTHOR]

Solitary median maxillary central incisor (SMMCI) is a unique developmental anomaly in primary dentition. It involves central incisor tooth germs and may or may not be associated with other anomalies. Its presence, concomitant with fusion of right mandibular incisors has not previously been reported. A 5-year-old girl was presented with a single symmetrical primary maxillary incisor at the midline, with the absence of labial frenulum, an indistinct philtrum and a prominent midpalatal ridge. There was an associated fused tooth in the right incisor region and radiographic examination confirmed only one maxillary central incisor in both the dentitions. Family history revealed that the father of the girl also had a similar anomaly providing probable evidence of etiological role for heredity in SMMCI. [ABSTRACT FROM AUTHOR]

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