Case Report: Endodontic management of a fused maxillary lateral incisor and canine with split

Abstract

Background Dental fusion, characterized by the joining of two neighboring tooth germs during odontogenesis, is an uncommon condition affecting approximately 0.1% of the permanent dentition. The unusual anatomy of the pulp chamber and the unpredictable root canal system pose significant challenges during endodontic treatment. Case report A 47-year-old female patient presented with a 6-month history of spontaneous nocturnal pain in the upper left anterior region. Clinical examination revealed a solitary tooth occupying the positions of teeth 22 and 23; the tooth had a buccal groove and severe distoproximal decay, with no tooth 23. Two pulp chambers joining into one canal in the middle third of the root and a distal periapical radiolucency were found on periapical radiography and cone beam computed tomography imaging. Management Root canal treatment was performed using nickel–titanium rotary instrumentation with activated irrigation and warm vertical obturation, followed by a split porcelain-fused-metal crown. Conclusion At the 6-month follow-up, the tooth was asymptomatic tooth with improving periapical condition, thus proving that the interdisciplinary approach guided by imaging provides predictable results in the treatment of permanently fused teeth.