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Case Report

Bilateral fusion of mandibular primary teeth

with partial anodontia of permanent teeth:
A report of a rare case
V. Rajashekar Reddy, Nagalakshmi Chowdhary1, Kumar GS2, Zeenath Ambareen
Departments of Pedodontics and Preventive Dentistry, 2Orthodontics and Dentofacial Orthopedics, Sharavathi Dental College and
Hospital, Shivamogga, 1Department of Pedodontics and Preventive Dentistry, Sri Siddhartha Dental College and Hospital, Tumkur,
Karnataka, India

Address for correspondence:

Dr. V. Rajashekar Reddy, Fusion is a developmental anomaly of shape of the tooth seen in developing primary or permanent
ABSTRACT

Department of Pedodontics and Preventive
Dentistry, Sharavathi Dental College and
Hospital, Shivamogga, Karnataka, India.
E‑mail: drvrajashekarreddy@gmail.com
teeth. Etiology is not exactly known, but the physical pressure or force generated during growth
causes contact and fusion between adjacent tooth buds. The genetic foundation for the anomaly is
possibly autosomal dominant with reduced penetrance. The bilateral type of fusion in the primary
dentition is very rare and is usually 0.02%. Till now, only 18 cases have been previously reported in
dental literature since 1940, and in the Indian population, only few cases have been reported. In
bilateral fusion of primary lateral incisor and canine, 75% chance of lacking the succedaneous lateral
incisors have been reported. The anomalies of the permanent dentition are strongly associated
with anomalies in the primary dentition. The potential clinical problems associated with fusion
require orthodontic, prosthetic, cosmetic, and periodontal intervention also. Thus, to establish a
right treatment to this anomaly, the early proper examination and knowledge to recognize the
anomalies associated between primary teeth and permanent teeth is a prerequisite.

Key words: Bilateral, congenital missing, fusion, primary teeth

INTRODUCTION pregnancy for viral infections. The genetic foundation for

Fusion or synodontia is a developmental anomaly of shape
of the tooth formed by the union of two independently
developing primary or permanent teeth. The union of two
separate tooth buds may be either complete or incomplete.
Fused teeth have separate or shared pulp chambers and
canals depending on the time of fusion. This malformation
can be distinguished from gemination because it is an attempt
by the tooth germ to divide.[1]
The etiology of fusion is not exactly known. Most of the
researchers believe that physical pressure or force generated
during growth causes contact between adjacent tooth buds.
Some writers contend that fusion results when two tooth
buds develop close together that, as they grow, they come
into contact and fuse before calcification. Another possibility
for this anomaly may be the use of thalidomide drug during
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the anomaly is possibly autosomal dominant with reduced
penetrance.[2,3]
The prevalence of tooth fusion is estimated at 0.5%–2.5% in
the primary dentition and less in permanent dentition.[4] The
bilateral type of fusion in the primary dentition is very rare
and is only 0.02%.[5] Till now, 18 cases have been previously
reported in the dental literature between 1940–2017, and
in Indian population, only few cases have been reported.[1,5‑9]
The most common problem related to the fused primary
teeth is the hypodontia of permanent teeth. Therefore,
case with bilateral fused primary teeth necessitates careful
examination and knowledge of the anomalies in primary
dentition and its association with succeeding permanent
dentition anomalies is a prerequisite for proper treatment
planning. Hence, this article aimed at reporting a case of this
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DOI: How to cite this article: Reddy VR, Chowdhary N, Kumar GS, Ambareen Z.
10.4103/sjhs.sjhs_43_17 Bilateral fusion of mandibular primary teeth with partial anodontia of permanent
teeth: A report of a rare case. Saudi J Health Sci 2017;6:182-4.

182 © 2018 Saudi Journal for Health Sciences | Published by Wolters Kluwer - Medknow
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Reddy, et al.: Fusion of mandibular primary teeth with partial anadontia
rare condition and evaluating the anomalies of succeeding
permanent teeth.
CASE REPORT
A 7‑year‑old boy reported to the department of pedodontics
and preventive dentistry with the complaint of large
irregular teeth in the lower jaw. The patient has no systemic
disorders, and there were no abnormalities in his medical
and family history. The patient had undergone dental
treatment previously due pain in the lower left back teeth
region. On intraoral examination, the patient was in early
mixed dentition, there was bilaterally fused mandibular
primary lateral incisor and canine, which was confirmed by
counting the number of teeth present [Figure 1] and 74 had
stainless steel crown. On radiographic examination, there
was incomplete type of fusion bilaterally between mandibular
primary lateral incisor and canine and congenital missing of
mandibular permanent lateral incisor tooth buds bilaterally
and pulpotomy in 74 [Figure 2].
The case was diagnosed as bilaterally fused mandibular
primary lateral incisor and canine of incomplete type with
congenital missing of mandibular permanent lateral incisors.
DISCUSSION
A rare case of bilateral fusion between the primary mandibular
lateral incisor and canine is presented here. Fusion can be
classified into complete type and incomplete type. In the
complete type, fusion begins before calcification, and the
crown includes features of both participating teeth regarding
their enamel, dentin, cementum, and pulp. In the incomplete
type, fusion occurs at a later stage, the tooth might exhibit
separate crowns and fusion may be limited to the roots alone
with pulp canals fused or separate. The differential diagnosis
for fused teeth includes gemination and macrodontia. Several
clinical and radiographic benchmarks are used to distinguish
fusion from gemination. Fusion is the incomplete attempt
of two tooth buds to fuse into one; however, gemination
is the incomplete attempt of one tooth bud to divide into
two.[3] These two anomalies can be differentiated clinically
by counting the number of teeth present.
Figure 1: Bilateral fusion of <72–73> and <82–83>
Saudi Journal for Health Sciences - Volume 6, Issue 3, September-December 2017 183
Cho reported that double teeth involving primary canines
and lateral incisors is found only in the mandible.[7] White
and Pharoah reported that, when a primary canine and
lateral incisor fuse, the corresponding permanent lateral
incisor may be absent[8] and Hegman also reported that,
such patients have a 75% chance of lacking the succedaneous
lateral incisors.[10]
When fusion of primary teeth occurs, the clinician must have
knowledge on anomalies associated with permanent teeth
and for treatment planning, clinician must be aware of five
major dental concerns. First, fused teeth are clearly wider
than the surrounding teeth; esthetics may be a concern.
Second, when normal teeth fuse, excess dental space can
result. This occurs because two fused teeth require less space
in the dental arch than two normal teeth. This can result in
diastema formation.[11]
The third concern relates to both esthetics and occlusion
because of missing permanent teeth. When fusion occurs
in the primary dentition, some of the permanent incisors
often not present. This problem requires both cosmetic
and orthodontic consideration. Fourth concern is careful
monitoring of delayed erupting permanent tooth. The
final concerns involve their surface contour.[6‑8,10‑12] Fused
teeth commonly exhibit labial and lingual grooves running
vertically on the crown surface. These grooves may be very
pronounced, particularly in cases of incomplete fusion. Since
these grooves may be difficult to clean, caries may result.
The placement of fissure sealants or composite restorations
in these grooves will decrease the caries risk.[13] In addition,
if these grooves continue to the root surface, periodontal
problems may result, although grooves were also present on
the tooth surface, no caries or periodontal problems were
found. Pit and fissure sealants were applied to both the fused
teeth as a preventive measure [Figure 3].
The management of a case of fusion depends on which teeth
are included, the level of fusion, and the morphologic result.
Figure 2: Congenital missing of 32 and 42
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Reddy, et al.: Fusion of mandibular primary teeth with partial anadontia
Figure 3: Pit and fissure sealant application for <72–73> and
<82–83>
If the affected teeth are primary, they may be retained as
they are. If the clinician intends extraction, it is important
to first determine whether the corresponding teeth are
present. Treatment of a fused tooth will depend on the
clinical situation. If the fused tooth is free from caries, it
may require no particular treatment. Universal preventive
advice should be given to the parent and the child, and if
caries already exists, a restoration should be performed to
retain function and esthetics. If there is pulpal involvement,
endodontic treatment should be conducted as it would for
a multi‑rooted tooth.
The most common problem related to double teeth is
hypodontia of the permanent dentition. The anomalies of the
permanent dentition are strongly associated with anomalies
in the primary dentition.[9] Consequently, early diagnosis
of this anomaly is important and should be followed by
careful clinical and radiographic observations that will allow
surgical intervention at an appropriate time. The present
cases continue to be followed by our department with a
multidisciplinary view [Figure 4].
CONCLUSION
Dental fusion is asymptomatic, but the squeal will result
in number of difficulties such as, tooth reduction in the
permanent successors, increased susceptibility to subgingival
bacterial plaque, aplasia or malformation of the permanent
successors and impaction. The potential clinical problems
associated with fusion require orthodontic, prosthetic,
cosmetic, and periodontal intervention also. Thus, to
establish a right treatment to this anomaly, the early proper
examination and knowledge to recognize the anomalies
associated between primary dentition and permanent
dentition is a prerequisite.
184 Saudi Journal for Health Sciences - Volume 6, Issue 3, September-December 2017
Figure 4: Follow-up after 3 years
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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