Our case study presents a 22-year-old male that came in for a dental checkup.

The oral
examination revealed two abnormally large and misshapened maxillary central incisors. The patient
recently went to a dentist for restorative dental treatment and the dentist commented on the unusually
large incisors but did not suggest a diagnosis or recommended treatment. The patient demonstrated
good health at the visit with no major problems and no medications. During the extraoral exam no
abnormal findings were identified. The patients dentition is in a good state other than the two large
misshapened maxillary central incisors. No other unusual findings were found during the intraoral exam.
The patient presents with 28 teeth with no wisdom teeth. Several diagnoses can be considered based
on the information given including fusion, concrescence, dilacerations, taurodontism, and gemination.
Fusion occurs when the dentin of two adjacent tooth buds fuse together to become a single
mass. Fusion can be differentiated from gemination by counting the number of teeth present. In fusion,
less than the normal number of crowns/teeth appear to be present. Gemination demonstrates more
than the normal number of crowns/teeth. Due to the patient having both maxillary central and lateral
incisors, the possibility of fusion can be ruled out because the patient would be lacking an anterior
tooth.
Concrescence occurs during cementum formation and deposition. It is a condition in which two
adjacent teeth are united by cementum only. Due to this only fusing at the cementum clinically it would
not be visible. The only way to determine concrescence would be radiographically. Not to mention it is
mainly present in maxillary molars. Therefore it is not concrescence due to the visible notching and
oversized crown that can be seen clinically.
Dilaceration is an abnormal curve or angle in the root or, less frequently, the crown of the tooth.
This usually happens due to trauma of the tooth germ during development. Dilaceration is usually
discovered radiographically. Because there is no curvature of the root visible on his x-ray it cannot be
dilacerations.
Taurodontism is an increase in the size of the pulp chamber with small roots. The molar teeth
are usually affected and only identified radiographically. Based on the patients x-rays the pulp does not
appear elongated. Also, taurodontism does not affect the crowns of the teeth.
Based on the information presented the most likely clinical diagnosis is gemination. Gemination
is a developmental anomaly that occurs when a single tooth germ attempts to divide and results in the
incomplete formation of two teeth. Most often this deformity occurs in the permanent maxillary
incisors. Clinically it appears as two crowns joined by a notched incisal area. Radiographically, usually
one single root and one common pulp canal exists. A geminated tooth poses an aesthetic problem
especially when found in the maxillary anterior region. Based on the picture and radiograph presented
the patient has large maxillary central incisors with notching and a single pulp chamber. Therefore, his
condition matches the effects of gemination making that his diagnosis.

References

Myers, Sandra L., and Alice E. Curran. General and Oral Pathology. F.A. Days Company, 2015.
Ibsen, Olga A.C., and Joan Anderson Phelan. Oral Pathology for the Dental Hygienist. Saunders
Elsevier, 2009.