ENDODONTIC AND SURGICAL MANAGEMENT OF FUSED MANDIBULAR INCISORS ASSOCIATED WITH AN INFECTED RADICULAR CYST: A CBCT BASED CASE REPORT

Abstract

Background: Fusion of permanent mandibular incisors is a rare developmental anomaly with a prevalence of less than 0.1% in the permanent dentition. When associated with an infected radicular cyst and cortical plate perforation, the case demands a precisely guided multidisciplinary protocol. Cone Beam Computed Tomography (CBCT) is indispensable for delineating complex root canal anatomy and characterising periapical pathology in such presentations. Case Presentation: A 36-year-old systemically healthy female presented with a six-month history of pain in the lower anterior region. CBCT confirmed an Aguiló Type III morphological fusion of the mandibular right central and lateral incisors (teeth 41 and 42) — two fused crowns with a double conical root configuration, an infected radicular cyst measuring 6.29 × 7.53 mm with labial cortical plate perforation, and concurrent chronic apical periodontitis of tooth 31. Sequential endodontic treatment was completed using bioceramic sealer obturation with warm vertical compaction, followed by periradicular surgery with cyst enucleation and platelet-rich fibrin (PRF) augmentation. Tooth 31 received single-visit root canal therapy. Prosthetic crown rehabilitation was completed at final review. Conclusion: CBCT-guided multidisciplinary management incorporating bioceramic obturation and PRF augmentation achieved excellent clinical and radiographic outcomes in this rare and complex endodontic-surgical presentation.