Our case study presents a 22-year-old male that came in for a dental

checkup. Oral examination revealed two abnormally large and misshapened

maxillary central incisors. The patient recently went to a dentist for restorative
dental treatment and the dentist commented on the unusually large incisors but did
not suggest diagnosis or recommended treatment. The patient demonstrated good
health at the visit with no major problems and no medications. During the extraoral
exam no abnormal findings were identified. The patients dentition is a good state
other than the two large misshapened maxillary central incisors. No other unusual
findings were found during the intraoral exam. The patient presents 28 teeth with
no wisdom teeth. Several diagnosis can be considered based on the information
given including fusion, concrescence, dilacerations, taurodontism, and gemination.
Fusion occurs when the dentin of two adjacent tooth buds fuses
together to become a single mass. Fusion can be differentiated from gemination by
counting the number of teeth present. In fusion, less than the normal number of
crowns/teeth appear to be present. Gemination presents more than the normal
number of crowns/teeth. Due to the patient having both maxillary central and
lateral incisors, the possibility of fusion can be ruled out because the patient would
be lacking an anterior tooth.
Concrescence occurs during cementum formation and deposition. It is a
condition in which two adjacent teeth are united by cementum only. Due to this only
fusing at the cementum clinically it would not be visible. The only way to determine
concrescence would be radiographically. Not to mention it is mainly present in
maxillary molars. Therefore it is not concrescence due to the visible notching and
oversized crown that can be seen clinically.
Dilaceration is an abnormal curve or angle in the root or, less frequently, the
crown of the tooth. This usually happens due to trauma of the tooth germ during
development. Dilaceration is usually discovered radiographically. Because there is
no curvature of the root visible on his x-ray it cannot be dilacerations.
Taurodontism is an increase in the size of the pulp chamber with small roots.
The molar teeth are usually affected and only identified radiographically. Based on
the patients x-rays the pulp does not appear elongated. Also, taurodontism does not
affect the crown of the teeth.
Based on the information presented the most likely clinical diagnosis is
gemination. Gemination is a developmental anomaly that occurs when a single
tooth germ attempts to divide and results in the incomplete formation of two teeth.
Most often this deformity occurs in the permanent maxillary incisors. Clinically it
appears as two crowns joined by a notched incisal area. Radiographically usually
one single root and one common pulp canal exists. A geminated tooth poses an
aesthetic problem especially when found in the maxillary anterior region. Based on

the picture and radiograph presented the patient has large maxillary central incisors
with notching and a single pulp chamber.