Management of a supernumerary tooth fused to a permanent maxillary central incisor

A supernumerary tooth fused to a normal tooth often causes malocclusion and esthetic problems because of malformation and large crown. This requires treatment such as sectioning and extraction of the supernumerary tooth, modification of crown shape by contouring and restoration, or extraction. Moreover, endodontic treatment is often required as part of the procedure since pulp exposure occurs frequently during sectioning and modification of crown shape. The purpose of this paper was to report the case of a supernumerary tooth fused to the permanent maxillary left central incisor in a 9-year-old boy with unilateral (left side) cleft lip and palate and describe its management. After a thorough examination employing X-ray Computed Tomography (CT), the supernumerary tooth was separated from the central incisor at the fusion site and extracted under local anesthesia. No endodontic treatment was performed on the conserved central incisor. The central incisor's rotation was corrected by orthodontic treatment, followed by modification of the crown shape with composite resin. More than 4 years have passed since the first operative treatment, and the central incisor still remains vital. This case shows that a precise diagnosis is important in sectioning a fused tooth, and that CT-based data are very useful in planning treatment.