Extraction of teeth 11 and 21 due to gemination and space closure with skeletal anchorage in a patient with class III tendency: a case report

TL;DR

This case report describes the extraction of two geminated teeth and space closure using skeletal anchorage in a patient with a Class III growth tendency.

Contribution

The paper presents a clinical approach to managing geminated teeth with skeletal anchorage in a Class III patient.

Findings

Extraction of geminated teeth 11 and 21 followed by orthodontic space closure was successfully performed.

Skeletal anchorage was used to manage the Class III tendency and close the space effectively.

The treatment approach prioritized aesthetics, function, and periodontal health.

Abstract

Tooth gemination is a dental phenomenon in which a single tooth bud attempts to divide into two, resulting in the formation of a structure that appears as two teeth but originates from the same follicle. This partial separation is often indicated clinically by a groove or depression that suggests the presence of two distinct teeth (Rajeswari M, Ananthalakshmi R. 2011. Gemination-case report and review. Indian Journal of Multidisciplinary Dentistry). The distinction between gemination and fusion plays an important role in treatment planning. If the number of teeth is one less, the tooth is fused and not geminated. In addition, it is assumed in the literature that geminated teeth have a single root canal and fused teeth have two separate root canals (Mahendra et al. in Case Rep Dent. 2014:425343, 2014;Duncan and Helpin in Oral Surg Oral Med Oral Pathol 64:82–87, 1987). The gemination of teeth is relatively rare and occurs mainly in the frontal region of the upper jaw. The prevalence of unilateral tooth gemination in the primary dentition is between 0.01 and 0.04% and in the permanent dentition: 0.05% (Duncan and Helpin in Oral Surg Oral Med Oral Pathol 64:82–87, 1987). Gemination management often requires a multidisciplinary approach and involves several steps ( Rajeswari M, Ananthalakshmi R. 2011. Gemination-case report and review. Indian Journal of Multidisciplinary Dentistry). The orthodontist will then take a thorough medical, dental and family history and perform clinical and radiographic examinations to confirm the diagnosis. Treatment options would include reshaping and restoring teeth with appropriate materials, performing root canal treatment followed by reduction of the mesiodistal width and crown restoration, extraction if the tooth is not suitable for root canal treatment followed by orthodontic space closure or fixed or removable prosthesis if required, transplantation of supernumerary teeth to replace the missing tooth. This case report presents a patient with gemination of teeth 11, 21 and progressive Class III growth tendency. In this case, the malformed anterior teeth were extracted and the gap was closed using skeletal anchorage. Patients with missing central incisors often require a complex interdisciplinary treatment, whether a prosthetic tooth-supported restoration of the missing anterior tooth, single implant, or orthodontic space closure are chosen. Ideally, each alternative should fulfill individual aesthetic concerns, functional requirements, and periodontal tissue health, not only at the end of treatment but also in the long term (Marco in Sem Orthodont 26:1, 2020; Rosa M, Zachrisson BU. Integrating space closure and esthetic dentistry in patients with missing maxillary lateral incisors. J Clin Orthod. 2007; 41(9); Czochrowska ,E.M.,Skaare,A.B.,Stevnik A, Zachrisson, B.U. Outcome of orthodontic space closure with a missing maxillary central incisor;) If gap closure is chosen, it is important to select the correct orthodontic appliance and anchorage especially in Class III patients with sagittal maxillary deficiency.

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