Bilateral maxillary fused second and third molars:a rare occurrence

This case report describes the diagnosis and endodontic therapy of maxillary fused second and third molars, using cone-beam computed tomography （CBCT）. A 31-year-old Chinese male, with no contributory medical or family/social history, presented with throbbing pain in the maxillary right molar area following an unsuccessful attempted tooth extraction. Clinical examination revealed what appeared initially to be a damaged large extra cusp on the buccal aspect of the distobuccal cusp of the second molar. However, CBCT revealed that a third molar was fused to the second molar. Unexpectedly, the maxillary left third molar also was fused to the second molar, and the crown of an unerupted supernumerary fourth molar was possibly also fused to the apical root region of the second molar. Operative procedures should not be attempted without adequate radiographic investigation. CBCT allowed the precise location of the root canals of the right maxillary fused molar teeth to permit successful endodontic therapy, confirmed after 6 months.

Endodontic management of a fused left maxillary second molar and two paramolars using cone beam computed tomography: A case report

BACKGROUND Fused teeth usually involve several complications,such as the development of caries in the groove between fused crowns,tooth impaction,diastemas,aesthetic and periodontal problems,and pulpal pathosis,due to the complex anatomical structure of fused teeth.A thorough diagnosis is paramount to forming an accurate treatment plan and obtaining a favourable prognosis.With the advent of cone-beam computed tomography(CBCT),accurate 3-dimensional images of teeth and their surrounding dentoalveolar structures can now be readily obtained,and the technology can accurately provide a minimally invasive approach to acquire detailed diagnostic information.Therefore,we utilize CBCT data herein to generate a digital model for the infected region in a patient,and this model enables us to better plan the management of his case.CASE SUMMARY This report details the diagnosis and endodontic treatment of a rare case involving a fused maxillary second molar and two paramolars with apical periodontitis.The patient experienced pain upon biting and cold sensitivity in the area of the maxillary left molar.No caries or other defects were identified in these teeth,and a normal response to a pulp electric viability test was observed.With the aid of CBCT and digital model technology,we initially suspected that the infection originated from the isthmus between the maxillary second molar and two paramolars.Therefore,we only treated the isthmus by an endodontic approach and did not destroy the original tooth structure;furthermore,the vital pulp was retained,and good treatment outcomes were observed at the 24-month follow-up.CONCLUSION This finding may provide new insights and perspectives on the diagnosis and treatment of fused teeth.