Department of Endodontic, College of Dentistry, Qassim University, Buraydah, Saudi Arabia.
Am J Case Rep. 2022 Jul 29;23:e937224. doi: 10.12659/AJCR.937224.
BACKGROUND Dental fusion is a developmental dental anomaly that clinicians must be aware of and able to identify. It results from the union of 2 adjacent tooth germs affecting the normal dentition and leads to a decrease in the number of permanent teeth. Clinically, the fused teeth show excessive width and irregular anatomy and can complicate any endodontic intervention. CASE REPORT A 26-year-old male patient presented to the clinic with severe pain related to the lower right mandibular area. The dental examination revealed a large tilted and irregular fused third molar with the fourth molar. The endodontic findings suggested a diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis. An intraoral periapical radiograph revealed fused molars with an irregular morphology and a wide mesiodistal width. Cone beam computed tomography (CBCT) was performed after obtaining consent from the patient. The morphology of the involved tooth was obtained in sagittal, coronal, and axial CBCT slices of 0.13 mm. The pulp chamber was continuous, and the number of canals was 5 in the 3-dimensional view before initiating endodontic treatment. After we discussed the options with the patient, he decided to proceed with nonsurgical root canal treatment for the fused molar. A successful management of a fused third molar with a supernumerary tooth was performed, and a 6-month follow-up radiograph showed normal apical tissue with absence of tenderness on percussion or palpation. No clinical swelling or sinus tract swelling was observed. CONCLUSIONS This case report indicates that a proper treatment plan ensures predictable outcomes by the use of all available diagnostic tools.
牙融合是一种临床医生必须意识到并能够识别的发育性牙齿异常。它是由两个相邻的牙胚融合引起的，影响正常的牙齿排列，并导致恒牙数量减少。临床上，融合牙表现出过度的宽度和不规则的解剖结构，并可能使任何根管治疗复杂化。
一名 26 岁男性患者因右下颌区域严重疼痛就诊于诊所。口腔检查显示，一个大的倾斜和不规则的融合第三磨牙与第四磨牙。根管检查提示症状性不可复性牙髓炎伴症状性根尖周炎。口腔根尖片显示融合磨牙形态不规则，近远中宽度较宽。在获得患者同意后，进行了锥形束 CT（CBCT）检查。在矢状、冠状和轴位 CBCT 切片中以 0.13mm 的层厚获得受累牙的形态。在开始根管治疗之前，三维视图中牙髓腔连续，有 5 个根管。在与患者讨论了各种选择后，他决定对融合磨牙进行非手术根管治疗。成功地对融合的第三磨牙进行了治疗，6 个月的随访根尖片显示正常的根尖组织，叩诊和触诊无压痛。未观察到临床肿胀或窦道肿胀。
本病例报告表明，通过使用所有可用的诊断工具，制定适当的治疗计划可确保可预测的结果。
