Abstract

Gemination is a rare morphoanatomical alteration that may lead to aesthetic, functional, and orthodontic issues. This study presents a clinical case of multidisciplinary treatment of a geminated maxillary central incisor. A 12-year-old patient presented with aesthetic concerns due to gemination in the left maxillary central incisor, dental agenesis, and malocclusion. Root canal treatment was performed using an operating dental microscope, an apex locator, and motor-driven instruments, which were essential for facilitating the planned aesthetic and orthodontic procedures. Clinical and radiographic follow-ups conducted six years and three months after treatment revealed no clinical or radiographic signs or symptoms, indicating success in all endodontic, orthodontic, and aesthetic outcomes. Restoring the aesthetics had a positive impact on patient ́s psychosocial well-being, self-esteem, confidence, and social interactions. Accurate diagnosis and the role of each area in the multidisciplinary approach are crucial for achieving long-term success in treating dental gemination.

Clinical Relevance: Accurate diagnosis and multidisciplinary planning are crucial for achieving long-term success in treating dental gemination.

Al Shaikhly B, Harrel SK, Umorin M, Augsburger RA, Jalali P. Comparison of a dental operating microscope and high-resolution videoscope for endodontic procedures. J Endod. 2020;46(5):688–93.

Al-Dewani N, Hayes SJ, Dummer PM. Comparison of laterally condensed and low-temperature thermoplasticized gutta-percha root fillings. J Endod. 2000;26(12):733–8.

Altug-Atac AT, Erdem D. Prevalence and distribution of dental anomalies in orthodontic patients. Am J Orthod Dentofacial Orthop. 2007;131(4):510–4.

Amaral RR, Oliveira AGG, Braga T, et al. Quantitative Assessment of the Efficacy of Two Different Single-file Systems in Reducing the Bacterial load in Oval-Shaped Canals: A Clinical Study. J Endod 2020;46:1228–34

Barbizam JVB, Fariniuk LF, Marchesan MA, Pecora JD, Sousa-Neto MD. Effectiveness of manual and rotary instrumentation techniques for cleaning flattened root canals. J Endod. 2002;28(5):365–6.

Braun A, Appel T, Frentzen M. Endodontic and surgical treatment of a geminated maxillary incisor. Int Endod J. 2003;38(6):380–6.

Chang SW, Lee YK, Zhu Q, Shon WJ, Lee WC, Kum KY, et al. Comparison of the rheological properties of four root canal sealers. Int J Oral Sci. 2015;7(1):56–61.

Cheung GS, Liu CS. A retrospective study of endodontic treatment outcome between nickel-titanium rotary and stainless steel hand filing techniques. J Endod. 2009;35(7):938–43.

Davis LG, Ashworth PD, Spriggs LS. Psychological effects of aesthetic dental treatment. J Dent. 1998;26(7):547–54.

Del Bello TPDL, Wang N, Roane JB. Crown-down tip design and shaping. J Endod. 2003;29(8):513–8.

Figini L, Lodi G, Gorni F, Gagliani M. Single versus multiple visits for endodontic treatment of permanent teeth: a Cochrane systematic review. J Endod. 2008;34(9):1041–7.

Friedman S, Mor C. The success of endodontic therapy—healing and functionality. J Calif Dent Assoc. 2004;32(6):493–503.

Gerosa R, Menegazzi G, Borin M, Cavalleri G. Cytotoxicity evaluation of six root canal sealers. J Endod. 1995;21(9):446–8.

Goerig AC, Michelich RJ, Schultz HH. Instrumentation of root canals in molar using the step-down technique. J Endod. 1982;8(12):550–4.

Gonçalves LS, Rodrigues RCV, Junior CVA, Soares RG, Vettore MV. The effect of sodium hypochlorite and chlorhexidine as irrigant solutions for root canal disinfection: a systematic review of clinical trials. J Endod. 2016;42(4):527–32.

Heling I, Chandler NP. The antimicrobial effect within dentinal tubules of four root canal sealers. J Endod. 1996;22(5):257–9.

Martins JN, Marques D, Mata A, Caramês J. Clinical efficacy of electronic apex locators: systematic review. J Endod. 2014;40(6):759–77.

Patel S, Brown J, Pimentel T, Kelly RD, Abella F, Durack C. Cone beam computed tomography in Endodontics—a review of the literature. Int Endod J. 2019;52(8):1138–52.

Ricucci D, Russo J, Rutberg M, Burleson JA, Spångberg LS. A prospective cohort study of endodontic treatments of 1,369 root canals: results after 5 years. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(6):825–42.

Riitano F. Anatomic Endodontic Technology (AET)—a crown-down root canal preparation technique: basic concepts, operative procedure and instruments. Int Endod J. 2005;38(8):575–87.

Ruddle CJ. The ProTaper endodontic system. Endod Pract. 2002;5(3):34–44.

Ruksakiet K, et al. Antimicrobial efficacy of chlorhexidine and sodium hypochlorite in root canal disinfection: a systematic review and meta-analysis of randomized controlled trials. J Endod. 2020;46(8):1032–41.

Schilder H. Filling root canals in three dimensions. Dent Clin North Am. 1967;11(3):723–44.

Shaw WC, Addy M, Ray C. Dental and social effects of malocclusion and effectiveness of orthodontic treatment: a review. Community Dent Oral Epidemiol. 1980;8(1):36–45.

Silveira LFM, Martos J, Pintado LS, Teixeira RA, Neto JBC. Early flaring and crown-down shaping influences the first file bind to the canal apical third. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(1):99–101.

Siqueira JF Jr, Alves FR, Versiani MA, et al. Correlative bacteriologic and micro-computed tomographic analysis of mandibular molar mesial canals prepared by self-adjusting file, reciproc, and twisted file systems. J Endod 2013;39:1044–50.

Siqueira JF Jr, Rôças IN, Marceliano-Alves MF, et al. Unprepared root canal surface areas: causes, clinical implications, and therapeutic strategies. Braz Oral Res 2018;32:1–19.

Sjögren U, Figdor D, Persson S, Sundqvist G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. Int Endod J. 1997;30(5):297–306.

Sjögren U, Hägglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990;16(10):498–504.

Song CK, Chang HS, Min KS. Endodontic management of supernumerary tooth fused with maxillary first molar by using cone-beam computed tomography. J Endod. 2010;36(11):1901–4.

Spatafore CM. Endodontic treatment of fused teeth. J Endod. 1992;18(12):628–31.

Steinbock N, Wigler R, Kaufman AY, Lin S, Abu-El Naaj I, Aizenbud D. Fusion of central incisors with supernumerary teeth: a 10-year follow-up of multidisciplinary treatment. J Endod. 2014;40(7):1020–4.

Thilander B, Ödman J, Gröteborg K, Friberg B. Osseointegrated implants in adolescents: an alternative in replacing missing teeth?. Eur J Orthod. 1994;16(2):84–95.

Trope M, Delano EO, Orstavik D. Endodontic treatment of teeth with apical periodontitis: single vs. multivisit treatment. J Endod. 1999;25(5):345–50.

Tsesis I, Steinbock N, Rosenberg E, Kaufman AY. Endodontic treatment of developmental anomalies in posterior teeth: treatment of geminated/fused teeth—report of two cases. Int Endod J. 2003;36(5):372–9.

Vieira AR, Siqueira JF Jr, Ricucci D, Lopes WS. Dentinal tubule infection as the cause of recurrent disease and late endodontic treatment failure: a case report. J Endod. 2012;38(2):250–4.

Wong M. Treatment considerations in a geminated maxillary lateral incisor. J Endod. 1991;17(4):179–81.

Xu H, et al. Effects of concentration of sodium hypochlorite as an endodontic irrigant on the mechanical and structural properties of root dentine: a laboratory study. Int Endod J. 2022;55(10):1091–102.