10.

5005/jp-journals-10011-1200
Sandhya
Shrivastava et al
CASE REPORT

Fusion/Double Teeth
1
1

Sandhya Shrivastava, 2Manisha Tijare, 3Shweta Singh

Professor, Department of Oral Pathology and Microbiology, Saraswati Medical and Dental College, Lucknow, Uttar Pradesh, India
2

Professor and Head, Department of Oral Pathology and Microbiology, Peoples College of Dental Science and Research Centre
Bhopal, Madhya Pradesh, India
3

Lecturer, Department of Oral Medicine and Radiology, Horizon Dental College, Bilaspur, Chhattisgarh, India

Correspondence: Sandhya Shrivastava, Professor, Department of Oral Pathology and Microbiology, Shop No 4, 5 and 6, Maitri
Nagar Shopping Complex, Risali, Bhilai Nagar, Durg, Chhattisgarh, India, e-mail: sandhyas1212@rediffmail.com

ABSTRACT
Odontogenic anomalies of teeth can be encountered frequently in dental practice. Fusion and gemination are developmental anomalies
leading to eruption of joined elements as double teeth. These anomalies pose a challenge even to the most experienced clinician in treating
these teeth. This article highlights the importance of clinical and radiographic correlation in arriving a definitive diagnosis.1
Keywords: Anomalies, Fusion, Gemination, Double teeth.

INTRODUCTION
Developmental dental disorders may be due to abnormalities
in the differentiation of the dental lamina and tooth germ or
abnormalities in the formation of dental hard tissue.
Odontogenic anomalies of number and forms may occur in
primary and permanent dentition. These include gemination,
fusion and concrescence.
The term double teeth, joined teeth, fused teeth, connoted
teeth are often used to describe these anomalies.1-4
In 1963, Tannenbaun and Alling defined gemination as the
formation of the equivalent of two teeth from the same follicle,
with evidence of an attempt for teeth to be completely separate,
this indicated clinically by a groove or depression which could
delineate two teeth. Radiographically, there appears to be only
one pulp chamber. They stated that in gemination, the bifid
tooth is counted as one entity; the total number of teeth in dental
arch is otherwise normal.2-5
Pindborg defined fusion as the union between dentin and
enamel of two or more separate developing teeth. Fusion might
occur between normal teeth or normal tooth and supernumerary
tooth.6 In latter case, it is difficult to differentiate from
gemination and for which the dentist must carry out a highly
judicious radiographic and clinical examination.
This anatomic irregularity occurs more often in deciduous
than in permanent dentition. In the primary dentition, the
frequency of gemination or fusion is about 2.5%. Prevalence is
higher in anterior region. Cases of bilateral fusion are less
frequent than unilateral fusion ranging from 0.01 to 0.04% in
primary and 0.05% in permanent dentition.7-9 These anomalies
may cause an unpleasant esthetic tooth shape due to the irregular
morphology. These teeth also tend to be greatly predisposed to
caries and periodontal disease and in some cases endodontic
treatment is complicated.
S468

Presence of the anomaly in primary dentition could be

followed by dental anomaly in permanent dentition. The etiology
of fusion is still unknown but the influence of pressure or
physical forces producing close contact between two developing
teeth have been reported as one possible cause. Genetic
predisposition and racial difference have also been reported as
contributing factor.3-9 Several treatment methods have been
described in literature with respect to the different types and
morphological variation of fused teeth, including endodontic,
restorative, surgical, periodontal and/or orthodontic treatment.
The purpose of this article is to highlight the rarity of the
condition and to evaluate the presence associate consequences.
CASE REPORT
A 14-year-old boy visited to dental clinic for large teeth in
mandibular anterior region. His medical and dental histories
were unremarkable. Intraoral examination revealed the presence
of irregular morphology of mandibular permanent incisors. The
number of teeth present in lower arch was missing counting
that large tooth as one. The fused incisor was vital, noncarious
and almost of the same shade as the adjacent and contralateral
teeth. Increased mesiodistal width with a groove on incisal edge
(Fig. 1). The remaining maxillary and mandibular teeth were
normal in shape.
Radiographic examination showed the union of 31 and 32
with a groove on the incisal edge separating coronal pulp
chamber and single completely developed root (Fig. 2). This
describes a case of fusion between 31 and 32.
DISCUSSION
The terminology dental fusion and gemination are used to define
two different morphological dental anomalies characterized by
the formation of a clinically wide tooth.10-12 Despite the
considerable number of cases reported in the literature; the
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Fusion/Double Teeth

Fig. 1: Intraoral photograph of fused 31 and 32

differential diagnosis between these abnormalities is difficult.

Case history, clinical and radiological examination can provide
the information required for the diagnosis of such
abnormalities.13-15
The use of Levitas classification to distinguish between
cases of fusion and gemination is very practical.13 This is
based on the number of teeth in the dental arch, is not,
however, always possible. This is because nothing impairs
the fusion between normal and supernumerary element while
the contiguous normal tooth is congenitally absent
resembling a clinical case of gemination. Fused teeth arise
through union of two normally separated tooth germ and
depending upon the stage of tooth development of teeth and
at the time of union it may be either complete or
incomplete.10,13,14
Tannebaum and Alling 2 described a phenomenon of
gemination and twinning. A suggested scheme of classification
is as follows:
Cleavage of single tooth: Partial cleavage (true gemination)
and complete cleavage (twinning).

Fusion: Two separate tooth germ fused during formative

stage, union by enamel and dentin (true fusion) and union by
dentin and/or cementum (late fusion). A late fusion by cementum
is called a concrescence.2
If fusion begins before calcification stage, the teeth unite
completely and their crown incorporates feature of both
participating teeth with regards to their enamel, dentin,
cementum or pulp. Incomplete fusion occurs at a later stage
and resultant tooth may exhibit separate crowns and fusion
may be limited to root alone and pulp canals fused or
separate. In fusion, tooth count reveals a missing tooth when
anomalous tooth is counted as one. It may be unilateral or
bilateral. It is more common in anterior mandibular
segment.9-16 Our both cases were unilateral and involving
anterior segment.
Although the term double teeth as suggested by Miles in
1954 is widely accepted and may be more appropriate.9
The anomaly may cause unpleasant esthetic appearance
due irregular morphology. When deep grooves are present, these
teeth may be susceptible to caries and periodontal disease and
may require endodontic intervention in some cases which may
be complicated. In these cases, groove was present. Gemination
of primary teeth presents several problems to the clinician.
Since, exfoliation times are different for each tooth involved in
the gemination, consideration should be given to the variations
in root resorption. Double teeth may also contribute to esthetic
concerns, space problems and occlusal disturbances.17 The
minimal intervention technique and preventive approach for
these double teeth have been advocated.
CONCLUSION
Double teeth are not usual condition but they are important
dental anomalies. Both fusion and gemination are prevalent in
primary dentition with incisors being more affected. Early
diagnosis of an anomaly has a considerable importance and it
should be followed by careful clinical and radiographic
observation that allows the dentist to plan the treatment at proper
time.
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Fig. 2: Periapical radiograph of fused teeth

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