The Multidisciplinary Management of A Fusion Involving a Permanent Maxillary Central Incisor and a Partially Erupted...

A 12-year-old female patient was initially referred to and examined in the oral surgery department at the School of Dentistry, Belfast following referral from her high street orthodontist. Reason for referral was extraction of two supernumeraries associated with the palatal aspect of the maxillary central incisors along with removal of two retained maxillary primary canines, to facilitate orthodontic treatment with fixed appliances. Although not clinically evident, dental cone beam computed tomography (CBCT) revealed fusion between the right maxillary central incisor and adjacent palatal supernumerary tooth at the enamel level. This discovery prompted a multidisciplinary approach with comprehensive treatment planning, to separate the fusion and remove the supernumerary tooth. Pre-surgical input from the orthodontic department focused on fixed appliance placement to support the splinting of the maxillary central incisor, providing stability intra-operatively and during the post-operative healing period. Consultation with the restorative department centered on contingency planning, should the central incisor be lost during surgery, including fabrication of a removable prosthesis and discussion of definitive replacement options. This culminated in successful surgical separation of the fusion and removal of the supernumerary teeth. This case highlights the value of CBCT in confirming the presence of dental anomalies and demonstrates the importance of multidisciplinary planning in optimizing treatment outcomes whilst minimizing the risk of permanent tooth loss.