cone beam international magazine of cone beam dentistry

case report _ CBCT in endodontics I agnostic consideration, but not a set rule, is that supernumerary teeth are often slightly aberrant and haveacone-shapedclinicalappearance.Thus,fusion between a supernumerary and a normal tooth will generally involve differences in the two halves of the joined crown. However, in gemination cases, the two halves of the joined crown are commonly mirror images.9 Periodontic problems occur as a part of the pathology in these cases.5–8 A high prevalence of caries also occurs due to anatomically abnormal plaque retention. In the anterior region, an anti-aes- thetic effect occurs owing to the abnormal anatomy. In contrast, crowding and occlusal dysfunction may occur in the posterior region, especially in cases with supernumerary teeth, which often leads to tooth extraction.5,10,11 Fusedteethareusuallyasymptomatic.Thecollab- oration of practitioners with expertise in multiple areas of dentistry is important to create or achieve functional and aesthetic success in these cases. Sev- eral treatment methods have been described in the literature with respect to the different types and morphological variations of fused teeth, including endodontic, restorative, surgical, periodontal, and orthodontic treatment.3–6,10–12 In cases in which endodontic therapy is indicated, cliniciansmustbeverycarefulduringaccessbecause anatomy is not predetermined and canals may be displaced from their normal position, depending on the position of the two germs and whether the teeth involvedarepartofthenormaldentitionorsupernu- merary.Forthisreason,cliniciansshouldexaminethe elementmeticulously,bothclinicallyandradiograph- ically.Thiscasereportdemonstratestheusefulnessof a CBCT scan in addition to conventional intra-oral X-rays from different projections in diagnosing and designingappropriatetreatmentforthisrarecase.13,14 _Case presentation A45-year-oldwomanwasreferredbyanoralsur- geon who had proposed an extraction of the last mandibular molar because of pain and abnormal anatomy. The patient complained of pulsing pain in therightsideoftheoralcavity,whichextendedtothe ear region and worsened at night. After a comprehensive extra-oral and intra-oral examination,thepainwasfoundtobelocalisedtothe region of teeth 47 and 48 (Fig. 1). Both cold and hot stimuliconsistentlycausedpaininthoseteeth.Anob- viousanatomicabnormalitynotedduringtheclinical examination was confirmed with intra-oral X-rays Fig. 4_Axial images where fusion is obvious. Fig. 5_Access cavity. Non-conventional shape due to abnormal anatomy. Fig. 6_Working length X-ray. Fig. 7_Finished case. I 37cone beam1_2014 Fig. 4 Fig. 5 Fig. 6 Fig. 7 CBE0114_36-40_Krokidis 31.01.14 15:53 Seite 2