Marina Fayek 09/3403

Introduction:
The abnormalities in hard dental tissues are of great importance during lots of clinical procedures. It is important for every dentist to be able to diagnose these abnormalities and how to deal with it during different procedures. The abnormalities resulting from the division and union of tooth germs include fusion, germination and concrescence. This research is concerned with the concrescence and its clinical importance.

Definition:
Concrescence is a type of fusion in which the roots of the adjacent teeth are joined by cementum only "dentin is not involved".

Types:
1- True concrescence: occurred during root formation. Therefore, it is developmental. 2- Acquired concrescence: occurred after the completion of teeth development.

Causes:
Actually, the etiology of the concrescence is unknown. But it is supposed to be: 1- In case of true concrescence: the cause is the close proximity of the developing roots of adjacent teeth. 2- While, in the case of acquired concrescence: the cause can be due to trauma or chronic inflammation.

Pathogenesis:
The pathogenesis of acquired concrescence due to trauma will be taken as an example: It is common in the posterior maxillary molars "6, 7". As the roots of the upper 1st molar are divergent while that of the upper 2nd molar are straight. Therefore, they are near to each other.

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When these teeth are subjected to trauma, the interdental bone and cementum will be resorbed. While as the turnover of cementum is higher than bone. Therefore, the cementum will get deposited before the bone. So, the roots of the adjacent teeth in the absence of the interdental bone will get fused together by cementum.

Clinical considerations:
Actually, the concrescence is asymptomatic and it is not annoying to the patient. While, it is only problematic during tooth extraction as lots of oral surgery complications could be manifested as: 1- Inadvertent removal of adjacent tooth. 2- Maxillary sinus exposure. 3- Tuberosity fractures. 4- Buccal plate fractures

Therefore, this condition should be diagnosed properly before extraction.

Diagnosis:
Unfortunately, it is impossible to diagnose this condition clinically. Which is worse is that it is not easy to be diagnosed radio graphically as it can be confused with overlap or the superimposition of adjacent teeth.

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Therefore, it is a must to take multiple films from different angles in order to try to detect either it is actual concrescence or a superimposed tooth.

However, it may be still difficult to distinguish between them. So, the actual diagnosis is during tooth extraction. Where in case of concrescent teeth, during the extraction of one of them, the elevation and luxation of teeth will not result in its mobility. An abnormal resistance is detected. To conclude, the diagnosis of concrescence can be considered if: 1- The roots of one tooth appear inseparable from the other radio graphically even with the help of multiple angulations. 2- The abnormal resistance to mobility during the extraction procedures.

How to deal with the concrescence during extraction:

If the dentist suspect that a tooth planned to be extracted is concrescent, lots of modifications should be made during the surgical technique to prevent any undesirable complications. According to Mader, there is two possibilities, 1- If the cemental union is not too large and too strong, so, the union may fracture during the extraction of one of teeth and produce no problems.

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2- If a more solid attachment exists between the teeth, the cemental union will not fracture during the extraction; therefore both teeth will be extracted. If the patient has the 2nd type of Mader classification, 1- The patient should be informed before extraction that both teeth will be extracted and not only a single tooth. By this way the patient will be psychologically adapted to the condition. Of course, this is better than his unpleasant surprise during the surgery.

2- The dentist should be careful during this extraction. He should not use extensive force during this extraction to prevent any complications.

3- Accurate postoperative management should be done, by cleansing the wound and using sutures to help the wound healing.

As a conclusion to be a successful dentist it is important to accurately diagnose each case with preventing the unnecessary careless haste, take all the needed precautions to achieve patient's comfort and finally follow up each patient accurately.

Marina Fayek 09/3403

Concrescence

And Tooth extraction

Made by: Marina Fayek I.D: 09/3403 Group: six Under the supervision of: Prof.Dr.Salah