Guided tissue regeneration in managing an incisor with a labially fused supernumerary: case report.

S upernumerary teeth occur most commonly in the maxillary anterior region. When in the midline area, such a tooth is commonly referred to as a mesiodens with most remaining unerupted. 1, 2 The prevalence of supernumerary teeth is reported to be from I to 3%. 3‘4 Supernumerary teeth may cause or be related to over-retention of primary teeth, impaction, or ectopic eruption of nearby permanent teeth, and abnormal development or root resorption of adjacent teeth2 Most commonly, a mesiodens is located between or palatal to the central incisors. Very few are located labially. ~ Uncommonly, supernumerary teeth may be fused to normal teeth in the arch, most frequently by lateral fusion, s-7 Problems associated with this type of fusion include poor esthetics, crowding, abnormal eruption, residual periodontal defects, and difficulty managing the tooth to which the supernumerary is fused. When a supernumerary tooth is fused to a normal tooth in the lateral position, spacing may be a problem in the arch and has usually indicated the removal of the supernumerary. The fusion may involve the root cementum only or also the root and crown dentin and/ or enamel, with separate or communicating root canals. When the fusion occurs palatally or labially, there also may be problems with the occlusion, repair of a bony defect, and/or the attached gingiva. Removing a fused tooth presents several difficulties. Healing may result in the formation of a pocket or a long junctional epithelium. In teeth with fused crowns and roots, this has sometimes been avoided by the sequential removal of the fused root and later the crown. 8