Triplication of Deciduous Teeth: A Rare Dental Anomaly
A 10-year-old boy reported to the dental clinic with the chief complaint of large tooth in the maxillary anterior region of the jaw. No other member of the family was affected with similar dental anomaly and patient was mentally challenged. Intraoral examination revealed that the patient was in mixed dentition phase along with fusion of the maxillary right primary central incisor and primary lateral incisor with an additional (supernumerary) tooth []. Dental caries was evident on the incisal edge and proximal surface of supernumerary tooth. The child's dentition revealed Angle's class 1 molar relation on both right and left side. Maxillary right permanent central incisor was erupted, but it was in cross-bite relationship. A mid line diastema was also noted in maxilla. Clinical examination revealed missing right permanent lateral incisor and there was no history of previous extraction, of this tooth. Further investigation included intraoral periapical radiograph of maxillary anterior region []. Based on clinical and radiographical findings, the provisional diagnosis of fused triple teeth was made.\nThe treatment plan was aimed at removal of fused teeth. Under sedation, fused teeth were carefully extracted []. Macroscopically, root resorption was evident on apical portion of maxillary right primary lateral incisor. For histological examination, the extracted teeth were sectioned at three levels: The coronal, middle root and apical levels, respectively. These sections were visualized under a stereomicroscope at a magnification of ×50. Histological view of the coronal section revealed three teeth fused with each other with confluent dentin without intervening cementum and with separate pulp chambers []. The middle-third of the roots of three fused teeth also showed confluent dentin without intervening cementum []. The apical third of fused teeth showed merging of root canals of the fused teeth []. Based on these findings, a final diagnosis of incomplete fusion was confirmed.\nFurther treatment plan involved thorough oral prophylaxis and correction of anterior cross- bite. After oral prophylaxis and pit and fissure sealant application, a removable Hawley's appliance with Z-spring was fabricated for the correction of the anterior tooth cross-bite, but as patient was mentally challenged, cooperation from him was poor as the child was not ready to wear the appliance. Again Catalan's appliance was made and cemented on the lower incisors, but the attempt for the correction of cross- bite failed because of insufficient compliance of the patient as he was not occluding his teeth.