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The term double tooth has often replaced the clinical diagnosis of gemination or fusion. If teeth have been extracted or exfoliated, the use of the neutral term ‘double tooth’ avoids the need to arbitrarily decide if it was gemination or fusion in origin. This case reports on a 16-year-old male who presented with an UL2 ‘double tooth’ and his combined restorative, surgical and orthodontic intervention to achieve his ideal result. CPD/Clinical Relevance: A multidisciplinary approach should be adopted when treating patients with a double tooth and an appropriate protocol as cited can be used.

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.

The presence of a double-tooth requires specific complex management due to the need for differential diagnosis and following treatment choices. The aim of this report was to present a rare case of a geminated mandibular lateral incisor, treated with an orthodontic approach. A Caucasian 10.9-year-old girl presented a lower right double-tooth incisor, with a class 1 molar and a class 2 cuspid tendency on both sides. The upper arch was constricted as shown by bilaterally tendencies to cross-bite, a slightly lower midline deviation was reported and a lack of space for all four permanent cuspids was confirmed also by the panoramic X-ray. In the lower arch, there was a severe crowding of about 14 mm and a buccally ectopic left canine. Overbite was normal and Overjet minimally increased. The double-tooth was identified like a geminated tooth, for the presence of one root and one pulp canal of increased size, as shown by the radiographic examinations. The anomalous tooth was managed with an orthodontic approach associated with a progressive stripping to reshape the crown. A two-phase treatment plan was performed, based on first maxillary expansion and lip bumper and then fixed appliances, in order to achieve a proper occlusion and a better aesthetic.

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.

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 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.

A supernumerary tooth is an entity in addition to the normal series of teeth that, although rare, can be fused to a tooth, whether deciduous or permanent. Diagnosis and management in cases involving supernumerary teeth in the anterior region of the maxilla are often challenging. The clinical examination associated with the radiographic examination is decisive for the diagnosis and planning of cases. This article describes a case of unilateral fusion of a supernumerary tooth to a permanent upper lateral incisor, in which clinical and radiographic diagnosis was essential for a conservative approach. Descriptors: Diagnosis; Fused Teeth; Tooth, Supernumerary. References Rajab LD and Hamdan MA. Supernumerary teeth: review of the literature and a survey of 152 cases. Int J Paediatr Dent. 2002;12:244–54. Yang G. Supernumerary teeth and gemination. Br J Oral Maxillofac Surg. 2012;50:15–8. Zhu M, Liu C, Ren S, Lin Z, Miao L, Sun W. Fusion of a supernumerary tooth to right mandibular second molar: a case report and literature review. Int J Clin Exp Med. 2015;8(8):11890-95. Rudagi K, Rudagi BM, Metgud S, Wagle R. Endodontic management of mandibular second molar fused to a supernumerary tooth, using spiral computed tomography as a diagnostic aid: a case report. Case Rep Dent. 2012;2012:614129. Nandini DB, Deepak BS, Selvamani M, Puneeth HK. Diagnostic dilemma of a double tooth: a rare case report and review. Journal of Clinical and Diagnostic Research. 2014;8(1):271-72. Duncan WK, Helpin ML. Bilateral fusion and gemination: a literature analysis and case report. Oral Surg Oral Med Oral Pathol.1987;64(1):82-7. Gupta S, Singla S, Marwah N, Dutta S, Goel M. Synodontia between permanent maxillary lateral incisor and a supernumerary tooth: treatment J Oral Health Comm Dent. 2007;1:52-5. Mader CL (1979) Fusion of teeth. J Am Dent Assoc 98:62-4. Kumar V, Pandey V, Rohini G, Jyoti B. Fusion Between Maxillary Premolar and A Supernumerary Tooth: A Rare Case Presentation. J Clin Diagn Res. 2015;9(11): ZJ03-4. Maréchaux SC. The treatment of fusion of a maxillary central incisor and a supernumerary: report of a case. ASDC J Dent Child. 1984;51:196-99. De Siqueira VC, Braga TL, Martins MA, Raitz R, Martins MD. Dental fusion and dens evaginatus in the permanent dentition: literature review and clinical case report with conservative treatment. J Dent Child (Chic) 2004;71:69-72. Karacay S, Guven G, Koymen R. Management of a fused central incisor in association with a macrodont lateral incisor: a case report. Pediatr Dent. 2006;28:336-40. Cetinbas T, Halil S, Akcam MO, Sari S, Cetiner S. Hemisection of a fused tooth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:e120-24. Nunes E, deMoraes IG, de Novaes PM, de Sousa SM. Bilateral fusion of mandibular second molars with supernumerary teeth: case report. Brazilian Dent J. 2002;13:137-41.

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.

A new gear tooth modification model of planetary gear system was established by considering the characteristics of tooth longitudinal crowning modification and tooth profile modification. Using this model, the influences of modification parameters on the time-varying mesh stiffness, transmission error, contact spots and dynamic response of the planetary gear system were analyzed through numerical analysis. The results show that tooth profile modification can effectively restrain the mesh stiffness sudden variation in the single and double tooth alternation of both the internal and external mesh pairs, and significantly decrease the transmission error fluctuation. However, longitudinal crowning modification has no marked influence on mesh stiffness sudden variation or transmission error fluctuation. The tooth profile modification can significantly reduce the sudden variation of tooth surface load during gear mesh course. Longitudinal crowning modification can make the tooth surface load evenly distributed in tooth width direction. When the external meshing pairs are modified at the tooth profile individually, the magnitude values of main response resonance peaks of internal meshing pairs have a great reduction, but those values of external meshing pairs change slightly. In the case of tooth profile modification of the internal meshing pairs, the phenomenon is reversed. By contrast with tooth profile modification, longitudinal crowning modification has little influence on the resonance peaks of internal and external meshing pairs.

Introduction: A double tooth can be a consequence of fusion or gemination and is characterized by a size increasing of the tooth and a morphological modification. This anomaly concerns the anterior teeth and occurs in temporary and permanent dentition. Double teeth causes various problems (aesthetic, occlusal, endodontic, orthodontic, periodontal…). The management of clinical situations involving such abnormalities is often complex. Our aim is to present a reasoned analysis based on a systematic review of therapeutic attitudes used in different clinical situations when the abnormal tooth is located at the anterior maxillary region. Material and Methods: We carried out electronic research via Pubmed and Sciencedirect to collect case reports published during the 20 recent years (1999-2020). We included 46 articles corresponding to 57 relevant case report that we classified based on Aguilo and coll. Classification (1999). Results: Partial crown and root section is indicated for type I. Stipping is indicated for type II. The management of type III is compromised by the canal morphology. Extraoral and entraoral hemisection are only indicated for type IV. Coronoplasty is usually unavoidable. Endodontic, orthodontic, or periodontal treatment can be indicated depending on the situation. The extraction is considered as a last resort, the space is restored by autotransplantation of a supernumerary tooth, a prosthetic restoration, or an implant by the end of the craniofacial growth. Conclusion: The management of double teeth is a therapeutic challenge, every case is different, a multidisciplinary approach is recommended.

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.

Gear tooth spalling is one of the most common defects in gear transmission. The loss of surface materials due to tooth spall reduces the Time-Varying Mesh Stiffness (TVMS) of the gear pair, and thus modifies the vibration response of the gear transmission. The evaluation of the TVMS of the gear tooth pair under gear tooth spalling conditions plays an important role in gear dynamic simulation and the corresponding fault feature analysis. Common approaches assume that the tooth spall has a flat bottom with a constant tooth spall depth. This assumption implies an abrupt change in dent depth and cliff-like material loss. However, in practice, the flake of the surface material usually results in a gradually changing dent depth with a curve-shaped bottom. Thus, the modelling of tooth spalls with a flat bottom may result in mesh stiffness differences. To address this shortcoming, this paper proposes a curved-bottom shaped tooth spall to model the tooth spalling geometric features as observed in practice. The proposed method is constructed based on an ellipsoid geometry which is capable of varying radii in three dimensions to best fit the shape of the tooth spall. The foundation stiffness within the double tooth contact area in the proposed method is corrected and the non-linearity of Hertzian contact stiffness is considered. The effectiveness of the proposed method on modelling single and multiple tooth spalls with different shapes and severity conditions is then validated.

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.

Gear meshing surfaces are readily exposed to wear due to inadequate lubrication and long-time operation. Accumulative wear causes variations of gear tooth profile, resulting in variations of gear tooth's mesh stiffness and gear system's dynamic characteristics. This study presents an evaluation of influences of tooth surface wear (TSW) on stiffness of the gear mesh considering wear evolution process. Specifically, a wear prediction model for external spur gear (ESG) was established according to the Archard's wear equation. Considering the worn tooth profile, a modified analytical time-varying mesh stiffness (TVMS) model was derived by the potential energy method. The modified TVMS model was then applied for an ESG pair and the numerical results demonstrate that TSW may lead to significant reductions of mesh stiffness during the double tooth contact period. Furthermore, effects of TSW on TVMS were quantified and the results indicate that the mean decrease of mesh stiffness is almost proportional to the maximum tooth wear in the initial wear evolution process.

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.

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.

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.

Double teeth present challenges for their clinical management. Recent advances in imaging, particularly cone-beam computed tomography (CBCT), have aided clinicians in accurate diagnosis and management. Data from CBCT imaging can be used for three-dimensional reconstruction to further aid pre-surgical planning. A 14-year-old Caucasian male presented with an aesthetically unacceptable double tooth in the 22 region. Clinical and radiographic examination and assessment included CBCT imaging and three-dimensional reconstruction. Based on this information, together with a comprehensive assessment of the patient’s motivation, a treatment plan consisting of extra-alveolar sectioning, re-implantation, endodontic therapy and composite resin restoration was carried out. The patient failed to return for follow-up at 6 months post-treatment. However, he did return at 12 months, where clinical and radiographic examination was undertaken. At this point the tooth was clinically sound and bony infill was seen radiographically. The information gained from the pre-surgical imaging with CBCT was useful in planning treatment in this case. However, this had to be combined with a careful assessment of the patient’s motivation to ensure that the course of treatment embarked upon was likely to be successful whilst addressing the patient’s concerns.

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.

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.

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.

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.

Variation in size, form and morphology of the teeth result in anomalies such as macrodontia, microdontia,hyperdontia, hypodontia, double tooth, taurodontism and dens in dente. While traits that may occur more commonly in certain ethnic groups may be considered to be specific to that population. The characteristics of these anomalies and traits are presented along with the prevalence figures for their occurrence in primary dentition of southern Chinese.

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.

A great number of abnormalities in form and number of teeth is congenital. These abnormalities are manifested in a decreased or increased number of teeth or just in changes of tooth form. The term of double teeth is a dental anomaly which a single-tooth germ tries to produces two teeth. A 16-year-old boy presented to our clinic to solve a dental anomaly of his teeth. His medical history was non-contributory. In the clinical and radiographic evaluation, it was determined that the double tooth had twinned crown and one single root. Fixed orthodontic treatment was planned for the patient. Regular dental controls might improve our ability to detect these anomalies and plan for the treatment at the appropriate time.

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).

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

– 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.

The term double tooth is used to describe fused teeth, gemination, twinning and concrescence. Fused teeth can be the cause of a local malocclusion manifesting as crowding or spacing. The aetiology of dental fusion is unclear, with both genetic and environmental factors suggested. Treatment options for fused teeth include: accept and align, reduction in size, extraction and surgical hemi-section. Successful management of these cases may involve a multidisciplinary approach. The following is a description of a clinical case in which a fusion of the LL1 and LL2 presented in association with a complex malocclusion. The aetiology and management of fused teeth is discussed.

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.

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.

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]

The transmission characteristics of gears are the functional requirement when the gears are used for precision motion applications such as robotics, actuators of satellite launchers, etc. In the present study, a test rig has been developed to simulate steel-polymer gear mesh and measured static transmission errors at various roll angles for different loading conditions. Multi tooth gear pair was considered and finite element method was adopted to evaluate static transmission error and gear mesh stiffness at different loads. From the evaluated path of contact, premature and extended contacts were observed due to less stiffness of polymer gear tooth. The results obtained through numerical simulations were compared with experimental results and found to be in good agreement. The difference between polymer and steel gear tooth stiffness, contributes to the non-uniform gear mesh stiffness/static transmission error both at single and double tooth contact regions. The roll angle and static transmission error of gear pair were found to increase with load.

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.