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Dental anomalies such as fusion, germination, double teeth are frequently encountered during routine dental examination often leading to crowding or abnormal spacing in dental arches or increased susceptibility to dental caries and aesthetic problems in pediatric dental patients. Tooth fusion is illustrated when there is the union between dentin and / or enamel of two or more separate developing teeth. Since the fused tooth may pose a wide spectrum of dental problems hence managing such cases requires thorough knowledge and technical skills of dental practitioners. Most of the clinicians advocate minimal intervention technique and preventive approach along with a regular and a long term follow up for the management of fused teeth Keywords: Fusion, Gemination, Double tooth, Dental anomaly, Mandibular incisors, Dentition.

In the process of odontogenesis, a disturbance in the formation of the epithelium and mesenchyme can be observed and this can be manifested by atypical forms of dental development. Such biological phenomena with altered morphology are as follows: dens invaginatus (DI), dens evaginatus (DE), talon cusps, and double teeth (DT) or connate teeth (fusion and gemination). Patients with orthodontic anomalies who also exhibit teeth with morphogenetic disorders are presented in this article. Dens evaginatus and talon cusps pose orthodontic challenges in the treatment finishing phase. These reduce the possibility of achieving maximum intercuspidation between the lower and upper front teeth as well as poor incisor guidance. Other orthodontic challenges are as follows: the risk of occlusal trauma and periodontal loading of the antagonists and the possibility of accessory cusps to play the role of the inclined plane and lead to deviations in the closure of the lower jaw. The fused teeth can cause aesthetic and occlusal disturbances in the anterior segment. Furthermore, double teeth can lead to ectopic eruption or noneruption of adjacent teeth due to their increased crown size as is the case with one of the presented patients. This is because a double tooth occupies more space in the dental arch. If not diagnosed early, impaction of the adjacent tooth, violation of the occlusal ratios (Bolton/anterior), and exacerbation of the orthodontic deformity can be observed. The modern CBCT imaging is the best diagnostic method for identifying problems related to tooth positions or tooth germs.

Fusion can be described as the complete or partial union between the dentin and enamel of two or more developing teeth. This union could be seen in the primary or permanent dentition or between a permanent tooth and a supernumerary tooth. Various theories have been put forward to explain the aetiology of fusion including that of increased force generated during growth, use of thalidomide or viral infection during pregnancy and a genetic aetiology. Fusion may cause aesthetic problems, occlusal disturbances, increased tendency for dental caries and periodontal disease. Developmental anomalies such as fusion are not observed frequently in clinical practice. Morphologic alterations of teeth can be observed as an incidental finding during thorough clinical examination. This case report discusses 2 such cases of fusion along with review of literature. Keywords: Fusion, Developmental disturbance, Double tooth.

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.

Developmental anomalies in the hard tissue are seen frequently in dental practice. Gemination and fusion are the most commonly encountered anomalies, and distinction between the two is always challenging. Gemination, also called double tooth, is an anomaly exhibiting two joined crowns and usually a single root. It represents an incomplete attempt of a single tooth germ to split. It is considered multifactorial in etiology, with genetic and environmental causes. This paper discusses a rare example of bilateral gemination (prevalence 0.04%) of maxillary central incisors with completely separated roots. Multidisciplinary care ensured a successful esthetic and functional outcome.

Double tooth is a dental anomaly consequent to fusion of two or more teeth or gemination of a single tooth. This report describes a unique case of double tooth in relation to a mandibular lateral incisor exhibiting the presence of four root canals. The role of conventional radiography and advanced three-dimensional imaging techniques in the better assessment of complex root canal systems and their aid in endodontic management has also been highlighted.

Dental anomalies of number and forms may occur in the primary and permanent dentition. Various terms have been used to describe dental twinning anomalies: Germination, fusion, concrescence, double teeth, conjoined teeth, twinned teeth, geminifusion, and vicinifusion. Fused tooth is a developmental anomaly that is seen more frequently in the primary than the permanent dentition. Double tooth involving deciduous anterior teeth is found mostly in the mandible.Very few cases of nonsyndromic double primary molar have been reported in the literature. The succeeding permanent tooth is often found missing congenitally in the same region. This article reports a very rare unilateral occurrence of an anomalous, primary mandibular first macromolar formed by fusion with a dysmorphic premolar like supernumerary tooth in deciduous dentition period. Instead of agenesis of succedaneous tooth, the double tooth has been succeeded by normally developing mandibular first premolar in the same region.

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.

Supplemental teeth refer to extra teeth that resemble the normal tooth series. Bilateral supplemental central incisors in a healthy individual are rare and bilateral supplemental incisors with double-tooth like appearance are exceptionally rare and has not been previously reported in the dental literature. This clinical report describes an 8-year old healthy Indian boy referred for the management of delayed eruption of his permanent maxillary incisor teeth. Following clinical and radiographic examination the two supplemental incisors closer to the midline were extracted under local analgesia and both of them exhibited double-tooth like appearance. The present case refutes the conventional wisdom that “supplemental teeth are usually smaller than the normal tooth type they resemble and occur distal to the normal tooth series”, illustrates that the unusual can occur and that the clinician should be aware of such variations.

To assess management of non-syndromic double tooth affecting permanent maxillary central incisors, we performed a systematic review and also present 2 case reports. We searched MEDLINE via PubMed and the reference lists of included reports. Eligible studies were any type of clinical studies describing the management of non-syndromic double tooth affecting the crown of a permanent maxillary central incisor. We included 68 studies corresponding to 72 relevant case reports. Therapeutic options in descending order of priority were restorative dentistry (35%), hemisection (33%), abstention (17%) or extraction (15%). Orthodontic management resulted in 57% of cases. We report an 11-year-old boy with bilateral fusion of the two maxillary central incisors and a 9-year-old boy with a double left central incisor and a supernumerary lateral right incisor. A multidisciplinary approach is key to management of permanent maxillary central incisors affected by coronary anomalies.

International Journal of Paediatric Dentistry 2012; 22: 419–426 Background. Abnormally, large teeth are often referred to as ‘double teeth’. These can pose numerous challenges for the clinician. There is no published protocol on the management of double teeth. Aim. To review the published literature and also patients managed at the Eastman Dental Hospital (EDH) and to develop a clinical protocol for the management of double teeth in children and adolescents. Design. Literature was searched (Medline and Embase) and data collated. Patient notes of cases managed at the EDH were reviewed. Results. Eighty-one teeth from 53 papers and 22 patients were included in the review. Success criteria were only reported in 32 papers and were variable. Twenty-three papers had no follow-up period. The main factor in determining the management of a double tooth was root and root canal system morphology. The treatment of choice in teeth with separate roots was hemisection and in those with a single root was crown modification or extraction. Conclusion. It was not possible to determine the best management strategies because of the variable reporting in the literature. The authors have proposed a protocol for management and a data collection sheet for essential information needed when reporting on double teeth cases.

BACKGROUND: The diagnosis and management strategies of double teeth have largely relied on clinical examination and conventional radiographic findings. Cone-Beam Computed Tomography (Cone-beam CT) was developed in the late 1990’s and, therefore, is a relatively recent addition to the imaging armamentarium for use in Maxillofacial Radiology. There have been no publications in the dental literature demonstrating the use of Cone-beam CT or 3D stereolithography in the diagnosis and surgical planning of the management of double teeth. CASE REPORT: An 11 year old girl presented with a double left lateral maxillary incisor. Conventional plain film radiography failed to provide the requisite information for pre-operative planning. Cone-beam Computed Tomography (Cone-beam CT) allowed determination of location of fusion, three-dimensional (3D) visualisation of pulpal anatomy and the construction of a 3D stereolithographic model for surgical planning. The double tooth was surgically divided in situ under local analgesia. The redundant distal unit was extracted and the residual mesial unit built up in composite resin following physiological mesial drift of displaced maxillary left canine. No endodontic therapy was required. FOLLOW-UP: At a 10-month follow-up visit, clinical and radiographic vitality and success was noted. CONCLUSION: The great amount of radiological information which Cone-beam CT can offer not only improves pre-operative and surgical planning, but the 3D models provided can be used to further educate and inform patients and guardians in the management of double teeth.

Talon cusp is a rare developmental anomaly in deciduous and permanent dentition. This paper reports a case of talon cusp affecting the deciduous maxillary left incisor from a Portuguese child who died more than 680 years ago. Metric analysis suggests that the affected tooth is a double tooth. The possible co-existence of these two anomalies in the deciduous dentition, although clinically rare, represents the second archaeological case reported.

Morphological and anatomical aberrations present a great challenge to the endodontic treatment. In such cases, knowledge of anatomical variations and developmental disturbances of teeth is essential for successful root canal treatment. The purpose of this article is to differentiate the diagnostic dilemma between gemination and fusion and to step by step outline the endodontic management of such types of anatomical aberrations. A 21-year-old female was referred to a practicing endodontist for the root canal treatment of maxillary left premolar. The patient’s chief complaint was a throbbing pain with sensitivity to cold and hot associated with the offending tooth since 1 month. Clinical examination revealed three intact crowns with tooth coloured restorations on each of them performed by a general dentist [Table/Fig-1]. [Table/Fig-1]: Clinical examination revealed three intact crowns with tooth colored restorations on each of them All the crowns were termed as mesial, distal and palatal. Her systemic health was good and medical history was non-contributory. Distal and palatal crowns demonstrated atypical morphology, palatal the most atypical whereas the mesial crown was characteristically & anatomically similar to the maxillary first premolar. Radiographically, it appeared to be a single root at the cemento-enamel junction [Table/Fig-2]. No periapical pathology was evident which led to the diagnosis of irreversible pulpitis with acute apical periodontitis. [Table/Fig-2]: Preoperative radiograph shows the presence of separate roots at cement-enamel junction After an informed consent access openings were made into each crown using Endo access bur (Dentsply Tulsa, UK) to allow access into the pulp chamber and preparation of the chamber walls, in one operation. Working length was established [Table/Fig-3] using an apex locator (Root ZX mini, J. Morita, USA) which was confirmed using a radiovisiography (Kodak RVG 5100, Care stream dentals LLC, North America). [Table/Fig-3]: Working length was established All the canals were prepared with Hyflex CM rotary files (Coltene Whaledent, Switzerland) in a crown down manner. Sodium hypochlorite was used as an irrigant. Obturation was performed with warm vertical condensation using System B and Obtura II (Sybron Endo, CA, USA) for backfilling. A radiograph was taken immediately to verify the obturation [Table/Fig-4]. After a week the patient reported with complete resolution of the symptoms. Gemination is a developmental anomaly of tooth shape that develops when a single tooth bud attempts to form two teeth. It leads to the formation of two or more identical crowns with a single root and root canal radio graphically [1,2]. Fusion is often correlated and confused with gemination. In our case we distinguished between the two on the basis of the following features: [Table/Fig-4]: Postobturation radiograph Morphology- Gemination results in mirror images of coronal portion of the tooth whereas fusion gives a crooked appearance to the oral cavity. Anatomy- Radio graphically fused teeth has a separate pulp chamber and root canal while gemination has a single pulp chamber. Count of teeth- Mader in 1979 emphasized on the count of teeth in the arch as a differentiating feature between gemination and fusion. He stated that fusion is counted as one tooth in the arch and in gemination the number is increased. This was called as two-tooth rule. He explained that if the resulting dental anomaly is counted as two teeth with the normal count present in the arch, it is fusion. Whereas the resulting dental anomaly is counted as two with the extra count present in the arch, it is termed as gemination or a fusion between normal and supernumerary teeth [3]. Morphological and anatomical variations are not uncommon finding; however, their simultaneous presentation is. This case presents the occurrence of fusion in a supernumerary tooth, which is a very rare finding. Yang et al., reported a geminated supernumerary tooth with two crowns and one root in the maxillary premolar region [3,4]. Fusion between supernumerary teeth and permanent teeth occurs less frequently than fusion between other types of teeth. Yuzuwa et al., reported incidence of 0.1% fusion with a supernumerary tooth [5]. Diagnostic tools such as radiographic examinations and an operating microscope played an important role in the diagnosis of this case. Endodontic treatment is usually difficult owing to complex anatomy, tooth position in the arch and difficulty in isolation. Strict adherence to biomechanical principles of root canal preparation provided successful treatment. Multidisciplinary treatment modalities have been suggested for fused teeth. The endodontic treatment depends on the thorough knowledge of the morphological variations of root canal anatomy [5]. Diagnostic tools such as cone-beam computed tomography and better visualization by using an operating microscope are all important aids in detecting communication. The occurrence of fusion between normal and supernumerary tooth is very rare but the clinician should be conscious of specific treatment needs, canal variations and importance of radiographic diagnosis. Clinicians should also consider the status of pulp of the supernumerary tooth and the tooth to which it is fused. Proper diagnosis and treatment planning of the fused teeth can ensure predictable and successful results.

This report describes a 37-year-old man with 3 erupted supernumerary teeth in the maxilla and 6 impacted supernumerary teeth in the mandible, 2 of which were fused (a double tooth and a triple tooth).

– The term ‘double tooth’ is used to describe two developmental dental anomalies of shape: gemination and fusion. Traumatic episodes involving a fused or geminated primary tooth are rare. This report describes an unusual case of crown root fracture in a primary double tooth.

Purpose: Synodontia or fusion is a developmental anomaly of shape of tooth formed by union of two independently developing primary or secondary teeth. Prevalence of tooth fusion is estimated at 0.5-2.5% in the primary dentition and less in permanent dentition. The bilateral type of fusion in the primary dentition is rare and is about 0.02%. This paper describes a rare case of bilateral fusion of primary mandibular lateral and canine teeth. Case description: An 8 year old girl had a complaint of unusually large sized teeth in her mandible. After physical examination and use of periapical radiographs and study models bilateral fused teeth in the mandibular lateral incisor and canine region was diagnosed. Conclusion: The bilateral fusion of primary mandibular lateral and canine teeth is a rare condition and should be carefully evaluated to diagnose any associated pathology.

Dental anomalies of number and forms may occur in the primary and permanent dentition. Various terms have been used to describe dental twinning anomalies: gemination, fusion, concrescence, double teeth, cojoined teeth, twinned teeth, geminifusion and vicinifusion. Double tooth is a term used to describe connate tooth and includes both dental fusion and gemination. The phenomenon of gemination occurs when two teeth develop from one single bud leading to a larger tooth. Fusion is a condition in which the crowns of two separate teeth have been joined toge- ther during the crown development. Fusion occurs infrequently but could cause esthetic, spacing and periodontal problems. The present article highlights the presence of a primary double tooth in an 11 year old boy involving primary mandibular left lateral incisor and canine. Clinical examination and radiographic examination confirmed the absence of the permanent left mandibular lateral incisor. Cases with primary double tooth necessitate careful examination as they may be associated with anomalies in the succeeding permanent dentition and require proper treatment planning

Double tooth is a developmental anomaly that is seen more frequently in the primary than the permanent dentition. Double tooth involving primary canines and lateral incisors is found only in the mandible. The succeeding permanent lateral incisor is often found missing congenitally in the same region. This article reports a rare case of a double tooth involving a mandibular primary canine and lateral incisor. Instead of agenesis, the double tooth has been succeeded by a permanent supernumerary tooth in the same region.

Objectives: The purpose of the present study was to evaluate mandibular talon cusps distribution from the compre - hensive literature search and proposal of new classification Material and Methods: The study was a review of articles published in the English language from January 1960 to December 2013. The PubMed/MEDLINE/Google Scholor databases were searched electronically using "talon cusp", "dens evaginatus", "anterior teeth", mandible, "primary dentition" and "permanent dentition" as search terms in various combinations. The citation lists from the included references were subsequently examined, and a hand search was also performed in an attempt to identify additional reports. The distribution, characteristics, common tooth type, associated dental anomaly and proposal of new classification have been included in final data analysis. Descriptive statistics were carried out using Chi square test (SPSS, version 17). Results: Overall 37 citations were retrieved from the literature where one was prevalence studies and rest were case reports among those two were duplication. Total 35 articles with 43 patients were reported on mandibular talon cusps. Males were predominantly affected than females ( p

Gemination or Schizodontism is a developmental anomaly affecting the tooth shape which is often confused with fusion. It affects primary dentition more often than permanent. It is a rare occurrence in the posterior teeth. Its etiology, pathogenesis, prevalence, differential diagnosis and management are discussed and a rare case of gemination of maxillary premolar is reported here.

Background: The prevalence of dental anomalies in children with cleft lip and palate (CLP) has been said to be higher than in the normal children; however, such findings have not been expressed for different racial groups. Aim: To determine the prevalence of anomalies in children with CLP and to ascertain if there were any differences between the prevalence figures for CLP and non-CLP children. Design: This is a retrospective study looking at previously collected clinical records. The sample consisted of 231 pairs of age and gender matched CLP and non-CLP southern Chinese aged between 12 and 16 years. The dental records of the subjects were examined to gather data on anomalies of tooth number, size and shape. Results: It was found that 57.6% of the CLP children had hypodontia, 10.0% hyperdontia, 8.7% taurodontism, 0.8% a double tooth, 1.30% dens evaginatus, and 42.4% had microdontia in the permanent dentition. The CLP subjects had a statistically higher prevalence of hypodontia (p

CASE REPORT Developmental anomalies in permanent molars frequently require surgical intervention. A case of a mandibular third molar fused with a fourth molar which was successfully treated with conservative endodontic therapy is reported.

Aim To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. Summary 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.

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. Summary 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.

In this article we report a case of a mandibular lateral incisor in which 3 separate root canals were located. Clinical and radiographic examinations suggested that fusion had occurred between the mandibular incisor and a supernumerary tooth. The endodontic management of the tooth is described, and repair of an apical periodontitis had occurred after 9 months.

Double tooth is a term used to describe connate tooth and includes both dental fusion and gemination. Fusion refers to the union of two tooth germs resulting in a single large tooth. Owing to its irregular morphology, this anomaly can cause unpleasant aesthetic appearance. The diagnosis is based on the clinical findings and radiographic examination. We hereby discuss a case of fusion in a 30-year-old woman.

Gemination and talon's cusps are rare developmental dental anomalies affecting both primary and permanent dentitions. Talon's cusps normally occur on the palatal surface of permanent maxillary incisors, whereas gemination is more common in the primary dentition. The purpose of this article is to report an uncommon case of talon's cusp on a geminated primary maxillary lateral incisor, including details of the clinical and radiographic findings and treatment in an 8-year-old girl.

The prevalence of double teeth in the primary dentition, for the British schoolchild, is 1.6%. Although primary double teeth in the anterior region of the mouth are not uncommon, double teeth in the primary molar region are rare. This case report describes the intra-oral findings, and in particular a case of a primary molar double tooth, in a young child who has Russel-Silver syndrome.

[Extract] Sir, we would like to share with your readers an unusual case of a patient with a double mandibular molar. A 26-year-old male patient presented to our department complaining of a missing tooth in the lower left posterior region. He gave a history of extraction of the tooth two years previously due to caries. Clinical examination revealed missing teeth 36 and 38 but tooth 37 demonstrated the anomalous morphology of a double tooth (Fig. 1), which radiographically (Fig. 2) revealed a large tooth with multiple roots, none of which were anomalous.