Gemination of a maxillary permanent central incisor treated by autogenous transplantation of a supernumerary incisor: case report.

This report describes the extraction of a geminated maxillary right permanent central incisor in an 8-year-old white female followed by the autogenous transplantation of a maxillary left supernumerary incisor. A 2-year clinical and radiographic followup revealed no pathologic findings and confirmed continued root development and pulp vitality in the transplanted tooth. This report documents he usefulness of autogenous transplantation as a viable treatment option in selected cases. Autogenous transplantation of teeth has been utilized successfully for many years primarily for replacing grossly carious permanent molars with unerupted permanent third molars. 1-3 The autogenous transplantation of permanent anterior teeth is less common because of a lack of appropriate donor teeth suitable for transplantation. 4 Supernumerary teeth may be ideal for replacing missing or developmentally malformed permanent incisors. 5 Gemination and fusion are 2 developmental anomalies affecting the permanent and primary dentitions. Gemination, the attempt by a single tooth bud to divide, is detected clinically by crown enlargement and incisal notching. 6 In contrast, fusion is defined as a union between the dentin and/or enamel of 2 or more developing teeth. 6 The incidence of gemination and fusion is less than 1% and is more common in the primary dentition. 7 Radiographically, a fused tooth will have 2 root canals and pulp chambers. Geminated teeth have a single pulp chamber and a single root canal. When fusion occurs, the total number of teeth in the dental arch will be reduced unless a supernumerary tooth is involved, s Gemination of teeth by definition will not reduce the number of teeth present. Clinically, the 2 anomalies may be difficult to differentiate. Orthodontic, periodontic, endodontic, surgical, prosthetic, and multidisciplinary approaches have been used in the management of fused and geminated teeth. 9-11 This report describes the autogenous transplantation of a supernumerary incisor to replace a geminated maxillary permanent central incisor.