Multidisciplinary Management of a Permanent Maxillary Lateral Incisor Fused to a Palatally-Positioned Supernumerary...

Fusion between a permanent tooth and a supernumerary tooth is a rare developmental anomaly, particularly when the teeth share pulp anatomy, making diagnosis and treatment challenging. This case involved a 10-year-old boy with an esthetic concern caused by a supernumerary tooth fused to the palatal aspect of the permanent maxillary left lateral incisor. CBCT imaging revealed a rare configuration consisting of a shared coronal pulp chamber with separate apical constrictions. A multidisciplinary, phased treatment approach was implemented, including endodontic therapy with placement of an MTA apical barrier, surgical recontouring while preserving periodontal tissues, and orthodontic space redistribution. At the 12-month follow-up, clinical and radiographic evaluation showed favorable healing, stable periodontal and periapical health, satisfactory esthetics, and high patient and parent satisfaction, as assessed by informal verbal feedback and clinical interview at follow-up visits. This case highlights that careful multidisciplinary planning and staged endodontic, surgical, and orthodontic management can successfully treat complex fusion anomalies, preserving function, esthetics, and periodontal health.