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Title Inspection Of Pulp Chambers Of Double Teeth (Fused Or Geminated)Is Key To Diagnosis And Appropriate Endodontic Treatment
Clinical Question When treating double teeth (fused or geminated) with endodontic treatment, is considering the fused teeth as a single entity better than considering them as two different entities?
Clinical Bottom Line Endodontic treatment of double teeth must involve careful inspection of the pulp chambers of both teeth before proceeding to endodontic procedures such as chemo-mechanical debridement and obturation.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16617200Ghoddusi/200621 year old male with a fusion of a supernumerary tooth with a mandibular second molar requiring endodontic therapyCase Study
Key resultsPulpal involvement was only observed for the supernumerary tooth and hence endododntic treatment was initiated and completed only for the supernumerary tooth sparing the second molar from any enododontic treatment.
#2) 9550030Rotstein/199725 year old male with a fused mandibular second and third molar requiriing endodontic therapyCase Study
Key resultsPulp chambers for the double teeth was found to communicate with each other, and the fused teeth were considered as a single entity for endodontic treatment.
#3) 12752652Tsesis/200311-year-old girl with an anomalous 'double' first mandibular molar and premolar and 16-year-old boy with 'double' second and supernumerary mandibular molars requiring endodontic therapyCase Study
Key resultsBoth case reports demonstrated pulp chamber communication between the fused teeth and hence endodontic therapy was completed considering both fused teeth as a single entity.
Evidence Search "fused teeth" AND "endodontic therapy"
Comments on
The Evidence
A case report published by Tsesis I. et al. in 2002 presented two cases of double teeth in young patients aged 11 and 16 years. Clinical and radiographic diagnosis revealed that both cases required endodontic treatment. However, the authors were unable to discern which tooth between the double teeth was the cause of the odontogenic infection. Hence, in both cases, the double teeth were accessed separately. However, during the procedure, communication between the pulp chambers of the double teeth was evident and the teeth were then treated as a single entity. Another case report by Rotstein I., et. al., in 1997 also demonstrated a similar strategy in a 25 year old patient when treating a fused mandibular second molar. Several other reports point towards observing a communication between the pulp chambers in double teeth. On the other hand, a singular case report by Ghodussi J. et al., 2005 demonstrated a fusion of a supernumerary tooth with a mandibular second molar. Occlusal caries was observed on the occlusal of the double teeth. Upon caries excavation and access, no pulpal exposure was seen with the second molar; however, pulpal exposure was seen with the supernumerary tooth. Further caries debridement revealed no communication between the pulp chambers of the supernumerary tooth and the second molar. Endodontic treatment was completed for the supernumerary tooth using standard chemo-mechanical procedures and a amalgam restoration for the second molar. The patient was symptom free with no periapical pathology and vital second molar at the 9 months follow period.
Applicability The evidence presented in these case reports is applicable to a small number of patients since the reported incidence of double teeth is very rare in posterior teeth with a relatively higher incidence in incisors. Many cases involve extraction of these teeth due to crowding, misalignment and occlusion disturbance. However, in cases where extraction poses uncertainty and potential adverse effects, infected double teeth require endodontic therapy. Although most case reports recommend treating these double teeth as a single entity, a rare case may be encountered where treating these teeth as a single entity might risk the longevity of the uninvolved tooth and should be avoided. Hence, pulpal communication between these teeth must be determined first before beginning chemo-mechanical debridement of the canal spaces of both teeth to definitively diagnose the source of infection and to avoid unnecessary over treatment of the uninvolved tooth if present.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords fused teeth, endodontic therapy
ID# 2146
Date of submission: 09/22/2011spacer
E-mail ruparel@uthscsa.edu
Author Nikita B. Ruparel
Co-author(s) e-mail
Faculty mentor/Co-author Kenneth M. Hargreaves, DDS, PhD
Faculty mentor/Co-author e-mail HARGREAVES@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments and Evidence-Based Updates on the CAT
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by Garrett Howze, Samantha Whitten (San Antonio, Tx) on 11/29/2017
A PubMed search conducted in November 2017 found a systematic review by Zhu M, Liu C et al. 2015 (PMID 26550101) which supports the conclusion that an individual approach is needed in the evaluation of fused teeth for endodontic therapy. The use of advanced imaging systems like CBCT to aid in the diagnosis of these cases was also advocated.

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