PMC5406797_01
The extraoral (a) and intraoral (b) picture showing mild swelling on the left maxillary anterior region. The orthopantomogram revealing a fusion of the teeth (c)
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F1
A 15-year-old female [Figure 1a] reported to the Department of Pedodontics and Preventive Dentistry, with a chief complaint of unesthetic upper front tooth with an associated swelling [Figure 1b]. The patient was advised for an intraoral periapical radiograph, orthopantomogram (OPG) [Figure 1c] and cone beam computed tomography (CBCT) imaging.
Cone beam computed tomography in three-dimensional reconstruction (a), axial view (b) and panoramic view (c), shows abnormal tooth structure in maxillary left anterior region
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F2
The CBCT in three-dimensional reconstruction [Figure 2a], axial view [Figure 2b] and the panoramic view [Figure 2c], showed an abnormal tooth structure in maxillary left anterior region confirming a provisional diagnosis of fusion of teeth.
Upon surgical exploration, the three roots depicting triplication of maxillary central incisor (a) are apparent. After curettage of the granulation tissue, a fragment of tooth was removed to maintain the bony contour (b). The cavity was packed with a hydroxyapatite bone graft and following that a plasma-rich fibrin membrane was placed (c) which acted as scaffold (d)
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F3
After the surgical exposure of the site, three roots were visible which confirmed the diagnosis of fusion of three teeth, known as triplication of teeth [Figure 3a]. After granulation tissue curettage, the area was irrigated with normal saline, and a fragment of tooth was removed to maintain the bony contour [Figure 3b]. The cavity was packed with a hydroxyapatite bone graft and following that a plasma-rich fibrin membrane was placed [Figure 3c and d] which acted as scaffold.
Photomicrograph of decalcified section and ground section of a tooth showing fusion of teeth in low power (a and c) and high power (b and d)
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F4
The extracted tooth was then sent for histopathological analysis by decalcification [Figure 4a and b] and ground sectioning [Figure 4c and d].