365 - Bilateral Fusion of Primary Maxillary Incisors: A Case Report

Background:
Fusion of primary teeth is a rare dental anomaly that poses diagnostic and management challenges. This report describes a pediatric patient with bilateral fusion of primary maxillary incisors, interproximal caries, and congenitally missing permanent maxillary lateral incisors.

Case Description:
A 5-year-5-month-old patient presented to the UNLV Pediatric Dentistry Clinic for a comprehensive examination. The patient’s medical history was non-contributory. Clinical and radiographic evaluation revealed bilateral fusion of primary teeth D and E, as well as F and G, with congenital absence of permanent maxillary lateral incisors. Interproximal caries were noted between D/E and F/G, extending toward the pulp chambers but appearing arrested and hard upon clinical examination.

Management:
Three treatment options were presented:

1. No Treatment: Poor prognosis due to proximity of decay to the pulp chambers.


2. Minimal Intervention: Removal of decay and glass ionomer restorations, with a guarded prognosis due to the risk of pulp exposure and possible need for pulpectomy or extraction.


3. Extraction: Removal of the fused teeth with a fair prognosis, reducing future complications.

Future management of the missing lateral incisors included orthodontic consultation for canine substitution, space maintenance for prosthetics (e.g., flipper, bridge), or dental implants after maturity.

Conclusion:
This case highlights the importance of a multidisciplinary approach in managing fused primary teeth and addressing long-term issues associated with missing permanent successors.


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