Steinbock Nelly, Wigler Ronald, Kaufman Arieh Y, Lin Shaul, Abu-El Naaj Imad, Aizenbud Dror
Departments of Endodontics and Dental Traumatology, School of Graduate Dentistry, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel.
Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel.
J Endod. 2014 Jul;40(7):1020-4. doi: 10.1016/j.joen.2013.12.004. Epub 2014 Jan 10.
Macrodontia of anterior teeth may occur as an isolated condition or as a result of fusion or gemination and may cause clinical problems such as tooth crowding and esthetic problems. Preliminary planning and careful management are often required by a dental team comprising an orthodontist, an endodontist, a prosthodontist, and an oral surgeon. A multidisciplinary treatment approach in a case with fused teeth is presented.
A 9-year-old girl presented with macrodontia of a left maxillary central incisor. The patient was referred to the orthodontic department because of a large central incisor as a result of fusion with an unspecific supernumerary tooth. The surgical procedure included sectioning off the mesial segment as far as possible, both apically and subgingivally, and extracting 1 of the fused supernumerary teeth. During the sectioning procedure, the pulp of the remaining tooth was exposed at the middle third of the root. Direct pulp capping was performed by an endodontist using mineral trioxide aggregate. Twelve weeks later, orthodontic treatment was commenced, and finally after a 26-month orthodontic treatment period, the central incisors' crown was restored using composite material.
A 10-year clinical and radiographic follow-up revealed that the remaining resected central incisor kept its vitality, and the patient was pleased with the esthetic result.
Proper interdisciplinary treatment planning of complicated cases such as anomalous teeth, which involve fusion to a supernumerary tooth, may lead to minimal invasive conservative procedures that maintain tooth vitality and result in a pleasing esthetic result.
前牙巨齿症可能作为一种孤立的情况出现，也可能是融合或双生的结果，并且可能导致诸如牙齿拥挤和美观问题等临床问题。一个由正畸医生、牙髓病医生、修复医生和口腔外科医生组成的牙科团队通常需要进行初步规划和仔细管理。本文介绍了一例融合牙病例的多学科治疗方法。
一名9岁女孩因左上颌中切牙巨齿症前来就诊。由于与一颗不明额外牙融合导致中切牙较大，患者被转诊至正畸科。手术过程包括尽可能在根尖和龈下切断近中部分，并拔除一颗融合的额外牙。在切断过程中，剩余牙齿的牙髓在牙根中三分之一处暴露。牙髓病医生使用三氧化矿物凝聚体进行了直接盖髓术。12周后开始正畸治疗，最终在26个月的正畸治疗期后，使用复合材料修复了中切牙的牙冠。
10年的临床和影像学随访显示，剩余的切除中切牙保持了活力，患者对美观效果满意。
对于诸如与额外牙融合等复杂牙齿异常病例，进行适当的跨学科治疗规划可能会导致微创保守治疗，保持牙齿活力并获得令人满意的美观效果。
