Mei XH, Liu J, Wang W, Zhang QX, Hong T, Bai SZ, Cheng XG, Tian Y, Jiang WK. Endodontic management of a fused left maxillary second molar and two paramolars using cone beam computed tomography: A case report. World J Clin Cases 2022; 10(23): 8367-8374 [PMID: 36159529 DOI: 10.12998/wjcc.v10.i23.8367]
Corresponding Author of This Article
Wen-Kai Jiang, PhD, Associate Chief Physician, Associate Professor, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, No. 145 Western Changle Road, Xi’an 710032, Shaanxi Province, China. Jiangw6@cardiff.ac.uk
Research Domain of This Article
Dentistry, Oral Surgery & Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 16, 2022; 10(23): 8367-8374 Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8367
Endodontic management of a fused left maxillary second molar and two paramolars using cone beam computed tomography: A case report
Xiao-Han Mei, Jin Liu, Wei Wang, Qian-Xia Zhang, Tao Hong, Shi-Zhu Bai, Xiao-Gang Cheng, Yu Tian, Wen-Kai Jiang
Xiao-Han Mei, Wei Wang, Qian-Xia Zhang, Xiao-Gang Cheng, Yu Tian, Wen-Kai Jiang, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
Jin Liu, Department of Stomatology, Huangshan City People's Hospital, Huangshan 245000, Anhui Province, China
Tao Hong, Shi-Zhu Bai, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China
Author contributions: Mei XH and Jiang WK performed the dental treatment; Liu J, Wang W and Qianxia Zhang QX reviewed the literature, and contributed to the drafting of the manuscript; Hong T and Bai SZ contributed to the design of the treatment plan; Cheng XG, Tian Y and Jiang WK were responsible for the revision of the manuscript for important intellectual content; and All authors issued final approval for the version to be submitted.
Supported bythe Innovative Talents Promotion Program-Youth Science and Technology Star Project, No. 2019KJXX-086; Shaanxi Provincial Natural Science Basic Research Foundation of China, No. 2019JM-376; and National Nature Science Foundation of China, No. 81970929.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest regarding the publication of this paper.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Kai Jiang, PhD, Associate Chief Physician, Associate Professor, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, No. 145 Western Changle Road, Xi’an 710032, Shaanxi Province, China. Jiangw6@cardiff.ac.uk
Received: March 17, 2022 Peer-review started: March 17, 2022 First decision: May 12, 2022 Revised: May 20, 2022 Accepted: July 11, 2022 Article in press: July 11, 2022 Published online: August 16, 2022 Processing time: 137 Days and 0.6 Hours
Abstract
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.
Core Tip: Fused teeth usually involve several complications due to their complex anatomical structure. A thorough diagnosis is of vital importance. With the aid of cone-beam computed tomography (CBCT) and digital model technology, accurate 3-dimensional images of teeth can be obtained; thus, CBCT provides a minimally invasive approach to acquiring detailed diagnostic information. In this report, we utilized CBCT data to generate a digital model of a fused tooth and only treated the infected isthmus by an endodontic approach. Good treatment outcomes were observed at the 24-month follow-up. This finding provides new perspectives on the diagnosis and treatment of fused teeth.
