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Macrodontia of Maxillary Central Incisors: Case Reports Esther Gazit* / Myroti A

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Macrodontia of Maxillary Central Incisors: Case Reports Esther Gazit* / Myroti A Ciinicai Communication Macrodontia of maxillary central incisors: case reports Esther Gazit* / Myroti A. Liebertnati* * Two cases of maxillary anterior macrodontia, resulting from fusion and gemination, were treated orthodontically. Problems of esthetics and overjet were solved in the first patient by sectioning and extraction of a fused mesiodem, and in the second patient by treating toward an Angle Class 111 buccal occlusion. {Quintessence Int ¡991,22:883-887.) Introduction Macrodontia of anterior teeth, whether caused by fusion or gemination, creates problems of crowding, Macrodontia of anterior teeth may result from ftjsion esthetics, and piaque accumulation because of surface or gemination and can occur in the primary or perma- notching.' For the orthodontist, additional problems nent dentition or both. Fusion is believed to be a of tooth interdigitation and overjet reduction require union between dentin and/or enamel of two separately special treatment planning. Two case reports involving developing teeth, leading to a rednced total nnmber of fusion and gemination are presented. teeth. Fnsion may bc total or partial and may also occur between a normal and a supernumerary tooth. Prevalence varies between 0.5% and 2.5% and ap- Case 1 pears to be a dominant trait in some families.'"^ Gemi- nation is an aborted attempt by a tooth bud to divide. An Il-year-old boy presented with a mild Class II, As with fusion, gemination occurs mainly in the incisor division I, malocclusion and a severe bilateral space area, but, unlike fusion, the root and root canal shortage for maxillary canines. Contributing to this remain undivided. A notch or groove on the coronal space shortage was an oversized maxillary right central surface gives evidence of the attempted division, and incisor (12 mm mesiodistal) and an even larger maxil- the total number of teeth remains normal.'-^ Concres- lary left centra] incisor (15 mm) (Fig 1). The remaining cence is the union of two root surfaces by cementum primary and permanent teeth were of normal size and only." shape. The overbite was 3 mm and overjet 5.5 mm. The maxillary left central incisor had a deep, vertical Fusion or gemination may be associated with other groove on the labial and lingual surfaces, that divided dental anomalies, such as dens en dente, macrodontia. the crown into a one-third mesial segment and a two- hypodontia. and supemumerary teeth, and nondental thirds distal segment. The maxillary right central anomalies, such as syndactyly and nail disorders.' An incisor had an incisai notch in the central part of the association between fused teeth in the primary detiti- incisai edge (Figs 1 and 2). Radiographs revealed two tion and subsequent fusing and macrodontia in the distinct roots of the left incisor that were probably permanent dentition has been described." united by cementum (Figs 3 and 4). The diagnosis was late fusion of the left central incisor with a mesiodens and an early gemination of the right centrai incisor. Family and medical history were noncontributory. frofessor and Chairman, Department of Occlusion. Tel Aviv University, The Maurice and Gabriela Goldschleger School of Surgical exposure of the left fused incisor confirmed Dental Medicine, Ramat Aviv, ö9978Tel Aviv, Israel, the clinical diagnosis, and the smaller mesial segment Professor and Chairman, Department of Orthodontics, Tel Aviv University. was sectioned and extracted (Fig 5). The root surface Quintessence International Volume 22, Number 11/1991 883 Clinical Communication Figs 1 and 2 Oversized maxillary right and left central incisors and their grooves. Figs 3 and 4 Radiographs reveai one large root and root canai in the right centrai and a divided rDot and root canal in the left central. Fig 5 Postsurgicai view of the extracted mesial segment of the left central incisor. 884 Quintessence International Volume 22, Number 11/iggi Clinical Communication Figs 6 to 9 Posttreatment views. Fig 7 Fig 8 Fig 9 and enamel of the remaining segment were polished, tation with a basic Class i maloeclusion. characterized and healing was uneventful. Orthodontic treatment by a lingually blockcd-out maxillary left lateral incisor, was instituted and completed on a nonextraction basis excessive overjet (5 mm), and an overbite of 3 mm. because the patient diligently wore his cervical The mandibular arch, aside from a slipped contact headgear. Final facial photographs demonstrate es- between the right central and lateral incisors, was nor- thetically pleasing dental and facial results (Figs 6 to mal and required no orthodontic intervention. The 9). Dental esthetics will be further enhanced by repair maxillary space shortage and excessive overjet were of the fractured incisai edge of the maxillary right hoth due to the oversized central incisors, which meas- centra] incisor with composite resin. ured 14 mm each (mesiodistally). Longitudinal grooves weie present along the labial and lingual sur- faces (Figs 10 and 11). Radiographie examination Case 2 revealed one large root and one large root canal for each tooth, indicating gemination (Figs 12 to 14), The A 12-year-old boy presented for orthodontic consul- Ouintessence international Volume 22, Number 11/1991 885 Clinieal Communioation Figs 10 and 11 Grooved and oversized maxillary central incisors result in space shortage for the left lateral incisor. Figs 12 to 14 Radiographs show one large root and root canal for each maxillary incisor. Fig 14 Quintessence Intemationai Volume 22, Number 11/1991 Clinical Communication Figs 15 to 17 Completed orthodontic treatment resulting in a slight Class III buccal occlusion. retnaining teetb were normal in size, shape, and number. Family and medical history were noncon- tributory, Tbe overjet was reduced and tbe space needed for the maxiliary left lateral ineisor was gained by distal repositioning of ibe maxillary bueeal segments and finishing with a sligbt Class ffl molar and eanine re- lationship, Tbis was aceomplisbed by bead gear therapy and maxillary arcb treatment only. The results are shown in Figs f5 to 17, Fig 17 Discussion The presence of an abnormally sized anterior tootb presents a challenge to eonventional orthodontic treat- ment planning, Tbe orthodontist cannot tbink in con- ventional terms of fitting tbe cusps and inclined planes of posterior teetb in "ideal occlusion" so that normal References anterior relationships can follow. Undersized maxillary 1, Pindborg JJ: Paihology of the Dental Hard Tissues. Philadel- anterior teetb may dictate a bticcal occlusion toward phia, WB Saunders Co, 197Ü. pp 47-54, Angle Class II (gnathologic occlusion, in prostbetic 2, Shafer WG, Hine MK, Levy BM: A Ti^xibook of OmI Patho- terminology), wbile oversized maxillary anterior teetb logy. Philadelphia, WB Saunders Co, 1974, pp 35-37, may dictate a slight Angle Class III buccal occlusion. 3, Brook GB, Winter GB: Double teeth: a retrospective study of geminated and fused teeth in children. Br Dent J Matching maxillary and mandibular midlines may not 1970;129:12.-i-]3n, be possible, and "ideal" overbite and overjet measure- 4, Yuen SWH, Chan CY. Wei SHY: Dowie primary teeth and ments may be compromised, their relationship with the permanent successors: a radio- graphic study of 376 cases Pediatr Dent 1^87:9:42-49. Tbese two patients witb oversized maxillary anterior 5, Gellin ME: The distribution of anomalies of primary anterior teetb were treated by different means. In case f. sec- teeth and their effect on the permanent suecessors. Dent Clin tioning and removal of tbe fused mesiodens allowed a NorlhAm 19 89; 28:69-80, normal Class I occlusion and better esthetics. In case 6, O'Reilly PMK: Structural and radiographie evaluation of four 2, establishing an occlusion toward an Angle Class fll cases of tooth fusion. Aiisi Dent J 1990;35:226-229, 7, Plank BS, Randall-Ogg R, Levy AR: A fused eentral incisor: relationsbip allowed a reduction in overjet that would periodontal considerations in comprehensive treatment. J not otherwise have been possible. Periodontoi I985;56:21-24. D Quintessence International Volume 22, Number 11/1991 887.
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