Multidisciplinary Management of a Double Immature Permanent Tooth: A Case Report

Fused or geminated teeth require complex and multi-faceted treatment to maintain their health, functionality, and appearance. The current paper describes the multidisciplinary/minimally invasive treatment of fused immature permanent teeth. A 9-year-old-girl with an abnormally large left permanent maxillary lateral incisor was referred to the Paediatric Outpatient Clinic. The treatment plan of the referring orthodontist included the extraction of left maxillary lateral incisor, which was fused to a supernumerary tooth, followed by subsequent orthodontic and prosthetic treatments. In the paraclinic evaluation, cone-beam computed tomography (CBCT) showed two separate roots and two root canals, with communication between the pulp chambers of the double teeth. The modified treatment plan was to section the geminated tooth, remove the supernumerary and save the lateral incisor. During the sectioning procedure, the pulp of the remaining tooth was inevitably exposed. Direct pulp capping with Biodentine™ was performed. Next, glass-ionomer cement was applied as a temporary restoration and the supernumerary tooth was removed. The distal surface of the tooth was restored two weeks later so as to re-establish the original shape of the lateral incisor. Clinical and radiographic control examinations revealed that the tooth was symptom-free. Follow-up appointments after 3, 6, 12 and 18 months included standard clinical examinations and sensivity tests including electric pulp testing, which showed a fully functional, healthy tooth with apical maturation. Careful clinical and radiographic evaluations/examinations are essential for determining the correct treatment of a double tooth. The proposed multidisciplinary and minimally invasive treatment of the double tooth using a bioactive cement may facilitate the maturation of immature teeth and result in a desirable aesthetics and function.