Tooth Hemisection In Permanent-Supernumerary Tooth Fusion

This case report described a teenager with fusion of tooth 21 with a supernumerary tooth, treated by hemisection. A vital pulpotomy was performed on tooth 21. The treatment achieved aesthetic restoration while preserving pulp vitality and periodontal integrity. The teenager was scheduled to undergo orthodontic treatment. During oral examination, a developmental malformation of tooth 21 was identified. The crown of tooth 21 exhibited an irregular morphology. A conical cusp was observed on the distopalatal aspect, fused with the crown. Radiographic examination revealed that the pulp chambers of tooth 21 and the conical cusp were continuous coronally, their roots were separate. The treatment plan included hemisection of tooth 21, vital pulpotomy, and resin restoration. Hemisection was performed to maintain the crown morphology. Following removal of the supernumerary tooth, pulp exposure was noted, and vital pulpotomy was performed to maintain pulp vitality. The tooth was finally restored with composite resin to achieve anatomical contour. Postoperative radiographs confirmed complete removal of the fused supernumerary tooth. In this case, the crown and root of the patient's supernumerary tooth were fused with tooth 21. Both roots showed complete development with entirely independent pulp chambers. To optimally preserve pulp vitality and minimize periodontal tissue damage, an in vivo hemisection technique was employed to manage the fused teeth. This treatment approach promotes periodontal tissue healing while effectively maintaining pulp vitality. Hemisection for the management of tooth fusion facilitates pulp and periodontal preservation while ensuring aesthetic outcomes.