PMC5514813_01
(a) Preoperative intraoral periapical radiograph of fused teeth (tooth 32 and supernumerary tooth) showing a large apical radiolucent area. (b) Gutta-percha cone fistulous path showing the relationship between the radiolucent area and the fused tooth. (c) Cone-beam computed tomography scan showing the presence of a radiolucent area in the anterior region, between teeth 32 and 33. (d) Cone-beam computed tomography scan in longitudinal direction showing an open apex in the fused tooth and (e) a radiolucent area in the apical region of tooth 32. Cone-beam computed tomography scan of tooth 32 in axial direction: (f) cervical, (g) middle, and (h) apical thirds
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F1
Radiographic examination revealed the presence of a dental anomaly characterized by fusion of tooth 32 with a possible supernumerary tooth [Figure 1a]. Intraoral examination revealed the presence of a fistula in the buccal region corresponding to the root apices of teeth 32 and 33 [Figure 1b]. CBCT scans [Figure 1c] confirmed the anomaly and provided details about the root canal system of the fused teeth, especially incomplete apex formation in the supernumerary tooth [Figure 1d-1h].
Postoperative intraoral periapical radiograph (a). Cone-beam computed tomography scan in axial direction at 2 years of follow-up: (b) cervical, (c) middle, and (d) apical thirds. Two-year follow-up intraoral periapical radiograph (e)
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F2
Root canals were filled using #60 McSpadden compactors (Dentsply Maillefer, Ballaigues, Switzerland) with Sealapex  (SybronEndo, Portland, USA) and gutta-percha cones (Dentsply Maillefer, Ballaigues, Switzerland) [Figure 2a]. In addition, tissue color was normal, and tissue repair was observed both on CBCT [Figure 2b-d] and on the intraoral periapical radiograph [Figure 2e].