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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2008  |  Volume : 26  |  Issue : 5  |  Page : 32-33

Bilateral fusion of permanent mandibular incisors: A case report

Department of Pedodontics with Preventive Dentistry, Faculty of Dental Sciences, Chhatrapati Shahuji Maharaj Medical University, Lucknow, UP, India

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A Saxena
1/30, Sector-I, Jankipuram, Lucknow - 226 021, UP
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Source of Support: None, Conflict of Interest: None

PMID: 18974544

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This case report showing a classical presentation of bilateral fusion of permanent mandibular incisors in a child patient for dental attention. Fusion defined as the merger of two adjacent tooth germs producing one tooth. These teeth may be fused by enamel, dentin, or both. The fused crown is broader than non fused adjacent teeth and thus resembles gemination. However, tooth counting reveals decreased numbers. Fused teeth are rare in the permanent dentition. The incisors are reported to be fused in primary and permanent dentition, but bilateral fusion is a rare occurrence. Hence the case report of bilateral fusion in an 11-year-old boy is presented.

Keywords: Bilateral fusion, dental sprouts, germination

How to cite this article:
Saxena A, Pandey R K, Kamboj M. Bilateral fusion of permanent mandibular incisors: A case report. J Indian Soc Pedod Prev Dent 2008;26, Suppl S1:32-3

How to cite this URL:
Saxena A, Pandey R K, Kamboj M. Bilateral fusion of permanent mandibular incisors: A case report. J Indian Soc Pedod Prev Dent [serial online] 2008 [cited 2023 Feb 3];26, Suppl S1:32-3. Available from: http://www.jisppd.com/text.asp?2008/26/5/32/41753

   Introduction Top

Fusion is commonly observed as the union of two distinct dental sprouts which occurs in any stage of the development. Joined by the dentine; pulp chambers and canals may be linked or separated depending on the developmental stage when the union occurs. The prevalence of fusion in permanent dentition is approximately 0.2% [1] where cases of bilateral fusion are less frequent than unilateral fusion reported to be 0.05%. [2]

In the anterior region, this anomaly also causes an unpleasant aesthetic tooth shape due to the irregular morphology. These teeth also tend to be greatly predisposed to caries and periodontal disease and, in some cases, endodontic treatment is very complicated. Unfortunately, most of these fusions require surgical removal because of their abnormal morphology and excessive mesiodistal width, which cause problems with spacing, alignment and function. Commonly fusion can occur between teeth of the same dentition, mixed dentitions, or between normal and supernumerary teeth.

   Case Report Top

An 11-year-old male child was referred to Department of Pedodontics, Chhatrapati Shahuji Maharaj Medical University, Lucknow with the chief complaint of malaligned upper teeth. During oral examination, it was noticed that number of teeth present in mandibular arch were less than normal and two teeth (31 and 41) were found larger [Figure 1] with missing 32 and 42 Periapical radiographic examination revealed the complete fusion of central and lateral incisors with one root and one pulp canal, [Figure 2],[Figure 3] on both side of mandible, which is an unusual dental anomaly. There was no history of pain or discomfort and incisors were caries free. Family history was not found contributory.

   Discussion Top

In spite of considerable number of cases reported in the literature, the differential diagnosis between fusion and gemination is difficult some authors use the terms as synonyms [3],[4] while some differentiated by counting the teeth or by shape of the root. Proper case history, clinical and radiographic examinations can update the information required for the diagnosis of such abnormalities.

It has been thought that some forces or pressure produces impact of the developing tooth germs and subsequent union of enamel organ and the dental papilla resulting in fusion of teeth [5] or genetic inheritance can be a possible etiology. [6] If this contact occurs early, at least before calcification begins, the two teeth may be completely united to form a single large tooth. Fused teeth are usually asymptomatic.

According to reviewed literature for bilateral fusion for permanent dentition, only one case of complete fusion of incisors was reported [7] and one was of an incomplete fusion [8] Teeth with this abnormality are unaesthetic due to their irregular morphology. They also present a high predisposition to caries, periodontal disease, and spacing problems as fused teeth occupies less space than two separate teeth which may cause diastema. The main periodontal complication in fusion cases occurs due to the presence of fissures or grooves in the union between the teeth involved if it is extended subgingivally and causing accumulation of plaque. The efforts must be directed to understand the root canal anatomy to avoid treatment complications.

   References Top

1.Grover PS, Carpenter WM, Allen GW. Panographic survey of US army recruits: Analysis of dental health status. Military Med 1982;147:1059-61.  Back to cited text no. 1    
2.Neves AA, Neves ML, Farinhas JA. Bilateral connation of permanent mandibular incisors: A case report. Intl J Paediatr Dentist 2002;12:61-5.  Back to cited text no. 2    
3.Munro D. Gemination in the deciduous dentition: Report of 31 cases. Br Dent J 1958;104:238-40.  Back to cited text no. 3    
4.O'Reilly PM. Structural and radiographic evaluation of four cases of tooth fusion. Aust Dent J 1990;35:226-9.  Back to cited text no. 4  [PUBMED]  
5.Lowell RJ, Solomon AL, Fused teeth. J Am Dent Assoc 1964;68:762.  Back to cited text no. 5    
6.Hitchin AD, Morris I. Geminated odontome: Connation of the incisors in the dog, its etiology and ontogeny. J Dent Res 1966;45:575-83.  Back to cited text no. 6    
7.Shafer WG, Hine MK, Levy BM. Distúrbios do desenvolvimento das estruturas bucais e parabucais. In: Tratado de Patologia Bucal. Rio de Janeiro: Guanabara Koogan; 1987. p. 2-79.  Back to cited text no. 7    
8.Parks CR. Fusion and gemination. Oral Surg Oral Med Oral Pathol 1970;29:394.  Back to cited text no. 8  [PUBMED]  


  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Fusion of teeth - A rare developmental anomaly
Sunny, J. and Kedilaya, V. and Pai, R. and Rai, D.S. and Rao, M.
Brunei International Medical Journal. 2013; 9(1): 52-55
2 Bilateral fusion of permanent maxillary incisors
Hans, M.K. and Shetty, S. and Chopra, H.
Indian Journal of Dental Research. 2011; 22(4): 603-605


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