Endodontic Management of a Fused Mandibular Third Molar with Supernumerary Tooth Using Cone-Beam Computed Tomography: A Case Report

Patient: Male, 26-year-old Final Diagnosis: Symptomatic irreversible pulpitis with symptomatic apical periodontitis Symptoms: Sever spontaneous pain related to the lower right mandibular area Medication:— Clinical Procedure: — Specialty: Dentistry OBJECTIVE: Congenital defects/diseases BACKGROUND: Dental fusion is a developmental dental anomaly that clinicians must be aware of and able to identify. It results from the union of 2 adjacent tooth germs affecting the normal dentition and leads to a decrease in the number of permanent teeth. Clinically, the fused teeth show excessive width and irregular anatomy and can complicate any endodontic intervention. CASE REPORT: A 26-year-old male patient presented to the clinic with severe pain related to the lower right mandibular area. The dental examination revealed a large tilted and irregular fused third molar with the fourth molar. The endodontic findings suggested a diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis. An intraoral periapical radiograph revealed fused molars with an irregular morphology and a wide mesio-distal width. Cone beam computed tomography (CBCT) was performed after obtaining consent from the patient. The morphology of the involved tooth was obtained in sagittal, coronal, and axial CBCT slices of 0.13 mm. The pulp chamber was continuous, and the number of canals was 5 in the 3-dimensional view before initiating endodontic treatment. After we discussed the options with the patient, he decided to proceed with nonsurgical root canal treatment for the fused molar. A successful management of a fused third molar with a supernumerary tooth was performed, and a 6-month follow-up radiograph showed normal apical tissue with absence of tenderness on percussion or palpation. No clinical swelling or sinus tract swelling was observed. CONCLUSIONS: This case report indicates that a proper treatment plan ensures predictable outcomes by the use of all available diagnostic tools.