Conservative Management Of A Fused Supernumerary-Geminated Maxillary Canine

This report presents the interdisciplinary management of a rare dental anomaly in a 39-year-old female with a geminated maxillary canine (#23) fused to a supernumerary tooth, presenting with recurrent palatal swelling. The complex root canal anatomy necessitated computer-assisted technological intervention combined with periodontal therapy. A patient presented with a two-year history of palatal swelling. Clinical examination revealed a geminated left maxillary canine with divergent crown morphology, labial cortical expansion, and a palatal sinus tract. CBCT imaging confirmed bifid crown anatomy with complete pulpal confluence and interconnected root canals systems between the geminated tooth and the labial supernumerary tooth .Treatment involved: (1) dynamic navigation-guided endodontic access to prevent iatrogenic perforation, (2) microscope-assisted root canal therapy with iroot BP apical barrier placement, and (3) periodontal defect filling.At 8-month follow-up, the patient remained asymptomatic with reduced periapical pathology. This case highlights three critical aspects: First, dynamic navigation technology enhances safety in treating anomalous anatomies by providing real-time guidance. Second, the integration of endodontic and periodontal approaches addresses both pulpal and periradicular pathology simultaneously. Third, such complex cases demand coordinated care between endodontists, periodontists, and radiologists for optimal outcomes. The successful management of this rare dental fusion demonstrates that precise preoperative planning, advanced navigation technology, and multidisciplinary collaboration can achieve excellent results while preserving natural dentition. This approach serves as a valuable paradigm for similar challenging cases.