Fusion of the Maxillary Central & Lateral

Large root, sharing one Pulp chamber. Vey difficult. Can not shave it down....What age do you remove the tooth to replace it is the big decision.
Band

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I have a similar case and we shaved it a little bit but the result is not rewarding. There is an idea of turning the tooth 90 degrees to create the proper space for orthodontics and root canal treatment and restorative. Root canal treatment has to be done when the apex is closed. We still considering this idea and any other suggestions are very welcome!!

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From what I can make out of the PA and photo, # 7 is present..so this is a supernumery lateral and central fusion...two roots on PA?..I am unsure but is the fusion only crown level? Let's take a focus field and if the roots are separate, maybe we can do a hemisection surgery..to precise measurments of a central ( with possible RCT/ bonding) and thereafter manage space...would love to see the Pano and CT of this tooth..

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extract, orthodontic space appropriation, wait till full dentition is developed while in some type of provisinal to replace #8, say a hawley type retainer, at completion of maxillary growth evaluate for hard and soft tissue grafting and implant restoration.

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Great comments and insight on this case. Thank you. Atypical indeed. Maha, you are correct about there being a Lateral incisor present. Very Large root, sharing one pulp. Lateral pushed into canine space. Need room to allow proper canine eruption and to align midline. Has anyone ever attempted to extract the tooth, reshape both the root and crown out of the mouth and then re-implant the tooth with enamel matrix proteins (emdogain)? Would we still get ankylosis? Would the pulp survive? Just thinking outside the box.
Dr. S

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Dear Dr, thank you for sharing this challenging case. According to inter oral photos and history I think, this patient has either anterior open bite, or is in mix dentition period or both of them. As you know, alveolar bone maintenance directly dependents to the tooth, so if we extract a tooth, it will be lost. Also, socket preservation technique cannot be effective for future bone growth in the vertical, horizontal and frontal view; in addition we'll expose to soft tissue deficiency. However, I do not know about orthodontic treatment plan and its limitations.... .

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why to extract?!!
preservation of permanent tooth is better than anything else
to solve the esthetic problem, re-contouring (drawing the 2 teeth) then pink composite for the part that is supposed to be the interdental papilla, and maybe normal composite as direct veeneer

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Alireza and Rami; Good points and that is why I have posted the case. The tooth removed was a FUSED tooth sharing one large Pulp chamber. The width was 14.5mm! Typically the central incisor is 8.5mm in width. With mild crowding and canines yet to erupt there was a lack of space for the natural permanent teeth, enameloplasty was not possible due to the shared root and the ability to create space for the erupting canines was at risk. I agree that maintaining teeth is always best when possible for many reasons. Just did not see that as a possibility here. Yes, the patient was in mixed dentition and had slight open bite due to tongue thrust and was receiving speech therapy. At 6 months the space is now ideal and matches the adjacent central incisor and we continue to expand and create space for the Canines. Once through ortho correction a resin bonded bridge will be inserted until he is of adult age to pursue implant replacement.
Dr. Salama

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