prevaience of fused and geminated teeth in jordanian aduits
TRANSCRIPT
Restorative Dentistry
Prevaience of fused and geminated teeth in Jordanian aduitsAbed Al-Hadi Hamasha, BDS, MS, ABOPH /̂Taiseer Al-Khateeb, BDS, MSc, FDSRCS^
Objectives: The purpose of this study was to address ttie prevalence cf dentai fusion and gemination in asample of Jordanian dental patients. Frequency distributions of these conditions among different types ofteeth are also presented. Method atid materials: The data were colleofed from examination of radio-graphs from a random sampie of periapicaifiims. In all, 9,373 teeth from 1,660 dental records at theFaculty cf Dentistry, irbid, Jordan, were evaluated, A tooth was recorded having gemination if ils crownwas enlarged with a ncrmai roct and the tooth count was normal, A tooth was recorded fused if the toothcrown and rcot were enlarged and the tooth count revealed a missing tooth. Results: Fusion and gemina-tion were detected in 18 and 21 teeth, respectiveiy, with prevalence of 0,19% and 0,22%, respectively.Therefore, dcubie teeth were fcund in 39 teeth with a prevalence of 0.42%, Maxiilary central Incisors werethe most commonly affected (3,6%), follcwed by mandibuiar third moiars (0,9%), Conclusion: Fusion andgemination are unccmmcn conditions, but they are important dental anomaiies that cculd affect any toothin the mouth. Recognizing the ccnditicn will facilitate the endodontic, prosthodontic, periodcntic, orthodon-tic, and surgical clinicai management of such teeth, (Quintessence Int 2004:35:556-559}
Key words: double teeth, fusion, gemination, Jordan, prevalence
Fusion is recognized as the union of fwo normallyseparated tooth buds with the resultant formation
of a joined tooth with confluence of dentin.Gemination was used in the past as a tiniversal termto describe tooth fusion and gemination. Geminationis currently recognized as an attempt by a single toothbud to divide, witb a resultant formation of either alarge tootb with a bifid crown (partial division) or twocompletely divided teeth throughout the crown androot,''^ Many investigators used the terms twining,double teeth, or connate teeth to describe either con-dition because of the difficulty in clinical differentia-
tion and because the definifion of fusion and gemina-tion is debatable.
Fusion is believed to occur due to physical force orpressure on adjacent teeth germs, which lead to theircontact and fusion before calcification,' The geneticbasis for the anomaly is autosomal dominant with re-duced penetrance,^ The etiology of gemination is un-known^; however, there is some evidence that the con-dition has a familial tendency.''
Understanding the prevalence of fused and gemi-nated teeth is very important to the dentist. Special at-tention should he made in considering root canaltreatment for fused canals especially if they are associ-ated with hending roots. Conservative dental manage-ment of fused or geminated teeth requires special con-sideration. If these teeth have to serve as abutmentsfor a fixed prosthesis, a modification of the prepara-tion should he made to improve esthetics, besidesmaintaining the healthy condition of the pulp,Periodontal treatment of double teeth requires moreattention, especially when the fusion occurs at theroot level. Orthodontic treatment of such teeth mightbe problematic since the roots of these teeth are resis-tant to total bodily movement.
556 Volume 35, Number 7, 2004
• Hamasha/Al-Khateeb
TABLE 1 Studies of the prevalence of double teeth in permanent teeth'
Study Year
McKibben and Brearley" 1971Ruprecht el al'^ 1985Salem'^ 1989Bruce et a l " 1994Backman and Wahlin'* 2001
•All studies described mixed teeth.
Country
Un lied StalesSaudi ArabiaSaudi ArabiaUnited StalesSweden
Samplesize
1,5001,5812,3932,267
793
No. ofdoubleteeth
7
7
2
8
2
(%)
0 3 0
Reviewing the dental literature on fusion and gemi-nation reveals that most of the published studies werereports of cases."-" Prevalence studies of double teethprimarily dealt with primary teeth.^^" Studies of theprevalence of double teeth in permanent dentitions aresummarized in Table 1. Tbe prevalences of double teetbvary fi-om 0.08% to 0.50/0, despite the variation in theage and country of the group examined. All these stud-ies'̂ -̂ 5 described tbe prevalence of gemination and fu-sion in mixed teeth. No study bas explored the preva-lence of the condition among different types of teetb.
Tbe purpose of this study was to investigate theprevalence of fusion and gemination in a group ofJordanian adults and to understand the distribution ofthese conditions among different age and sex groupsand among differenf types oí teeth.
METHOD AND MATERIALS
The Faculty of Dentistry, Jordan University of Scienceand Technology's (JUST) dental archive has recordsfor 12,395 private dental patients and 1,800 universityemployees, A random sample of 2,111 dental recordswas selected. Dental records that did not contain sat-isfactory periapicai radiographs for the whole mouthwere excluded (97). Other exclusions included pa-tients less than 18 years of age at the time of radio-graphic examination (272) and patients with poor-quality radiographs (82). The final sample consisted of1,660 dental records. All periapicai radiographs ofeach record showing different areas of the mouth wereexamined carefully, A total number of 3,024 goodquality films were examined from the selected 1,660records, which showed 9,373 teeth.
Two experienced examiners read ail the radio-graphs, utilizing a magnifying lens and a radiographviewer. A tooth was considered having gemination ifits crown was enlarged with a normal root and thetooth count was normal. A tooth was considered fusedif its crown and root were enlarged and tooth countrevealed a missing tooth.
All teeth presented in the radiographs wererecorded to either have fusion, geminafion, or neitherSamples of 100 periapicai radiographs were reexam-ined separately by eacb examiner and then again bytbe examiners together to cbeck for intra- and interex-aminer reliability. No major inconsistencies werefound, and minor questions were resolved at tbat timeby agreement. The data were entered and analyzedusing tbe computer program Statistical Package forSocial Science (SPSS 9.0).
RESULTS
A total number of 3,024 radiograpbs were examined,wbicb togetber, contained 9,373 teetb (5,633 [60.1%]from males; 3,744 [39.9%] from females). Ages rangedbetween 18 and 69 years, with a mean age of 25.1years (SD = 8.05), Fusion and gemination were de-tected in 18 and 21 teeth, respectively, out of a total of9,375 teetb examined witb prevalence of 0.19% and0.22%, respectively. Double teetb were found in 39teeth, resulting in a prevalence of 0.42%. Bilateral ormuitiple double teeth were not found. The prevalenceof fused and geminated teeth among different toothtypes is presented in Table 2. Maxiiiary centrai incisorswere the most commonly affected teetb (3.55%), fol-lowed by mandibular third molars (0.91%). Table 3presents tbe frequency distribution of double teetbamong differenf tooth types in the maxillary andmandibular arcbes. Of the 39 double teetb, 28 (71%)were presented in the anterior region and 29 (74%)were in tbe maxillary arcb.
Table 4 presents the distribution of double teethamong different sex groups. Males were found to havemore fused (10) and geminated (12) teeth than fe-males (8 and 9, respectively); however, the differencewas not statistically significant. The mean age of pa-tients with double teeth (26.9 years) was not signifi-cantly different from those with normal teeth (25.1years).
Quintessence international 557
Hamasha/Al-Khaieeb
TABLE 2 No. and percentage of teeth with fusion and gemination amongdifferent tooth types
Tooth type
MaxillaryCentral incisorLaterai incisorCanineFirst premolarSecond premoiarFirst molarSecond molarThird moiar
MandibuiarCentrai incisorLateral incisorCanineFirst premoiarSecond premolarFirst moiarSecond molarThird molar
Total
Examined
534
511
429
511
643
783
706
608
388
432392488645863781659
9,373
No. of teetin
Fused
1400t00D0
00000003
18
Geminated
542000
21
1110100
3
21
No. Ot aoubieteeth (%)
19(3,55)4 (0.67)2 (0.46)1 (0.19)0 (0.00)0 (0.00)2 (0.28)1 (0.16)
1 (0.25)1 (0.23)1 (0.25)0 (0.00)1 (0.15)0 (0.00)0 (0.00)6 (0.91)
39 (0.42)
TABLE 3 Frequency distribution of teeth withgemination and fusion among different tooth typesin maxillary and mandibular arches
Tooth type
Centrai incisorLateral incisorCanineFirst premolarSecond premoiarSecond molarTiiird moiarTotal
Maxillary
19(48.714(10,3)2(5.1)1 (2.6)0 (0.0)2(5.1)1 (2.6)
39 (83.3)
l̂o. ot teeth (%)
Mandibular
1 (2.6)1 (2,6)1 (2.6)0 (0.0)1 (2.6)0 (0.0)6(15.4)
10(16,7)
Total
20(51.3)5(12.8)3 17.7)1 (2.6)1 (2.6)2(5.1)7(18.0]
39(100.0)
TABLE 4 Distribution of double teeth amongdifferent sex groups
MaleFemaleTotal
P - .47.
Fusion
Yes No
10 5,6238 3,736
18 9,359
Gemination
Yes
129
21
No
5,6213.7359,356
Doubie teeth
Yes
221739
No
5,6113,7279,338
DISCUSSION
The periapical radiographs used in this study weretaken for a variety of dental purposes including fullmouth dental screening and diagnosis of dental prob-lems. Not all records belonged to fully dentate pa-tients, nor did all records contain full-mouth radi-ographs. The present study samples were adults whoare normally not fully dentate.
In reviewing tbe dental literature, few studies werereported on the occurrence of double teeth. Com-parison of the present resuhs with those in Table 1should be taken witb precaution for two reasons: (1)These studies deah with a sample of young children
with mixed dentition in which primary teeth were ex-amined together with the permanent teetb; and (2) noadjustment for the number of teeth examined was madein these studies. They assumed that each individual hasthe same number of teeth. The results from the presentstudy are eonsistent with those from the study of Bruceet al** and are higher than those of other studies.'•'•'̂
This study is the first to describe the prevalence offusion and gemination among different tootb types,providing more information on wbich type of tooth ismore susceptible to these anomalies and encouragingpractitioners to pay close attention during radio-graphic examinations.
558 Voiume35, Number 7, 2004
Hamasha/Al-Khateeb
CONCLUSiON
Fusion and gemination are uncommon conditions, butthey are important dental anomalies. Recognizing thecondition will facilitate the endodontic, prosthodontic,periodontic, orthodontic, and surgical treatment ofsuch teeth.
REFERENCES
1. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral andMaxillofacial Pathology, ed 2. Philadelphia: Saunders,2002:278-279.
2. Duncan WK, Helpin ML. Bilateral fusion and gemination:A literature analysis and case report. Oral Surg Oral MedOral Pathol 1987;64:82-87.
3. White S, Pharoah M. Oral Radiology Principles andInterpretation, ed 4. St Louis: Mosby, 2000:309-312.
4. Goaz P, White S. Oral Radiology and Interpretation, ed 3.St Louis: Mosby, 1994:348-350.
5. Dale A, Margot VD, George E, John GL. Orai and Maxil-lofacial Radiology. Philadelphia: Saunders, 1991:294-295.
6. Tomizawa M. Shimizu A. Hayashi S, Noda T. Bilateral max-illary fused primary incisors accompanied by succedaneoussupernumerary teeth: Report of a case. Int J Paediatr Dent2002:12:223-227
7 Milazzo A. Alexander SA. Fusion, gemination, oligodontiaand taorodontism. J Pedod 1982;6:194-199.
8. Milano M, Seyhold SV. McCandless G, Cammarata R.Bilateral fusion of the mandibular primary incisors: Reportof case. ASCD I Dent Child 1999;66:280-282.
9. Tasa GL. Lukacs JR. The prevalence and expression of pri-mary double teeth in western India. ASCD J Dent Child2001:68:196-200.
10. Magnusson TE. Hypodontia, hyperdontia, and double for-mation of primary teeth in Iceland. An epidemiologicalstudy. Acta Odontol Scand 1984:42:137-139.
11. McKibben DR, Brearley LJ, Radiographie determination ofthe prevalence of selected dental anomalies in children.ASCD J Dent Child 1971;28:390-398.
12. Ruprecht A, Batniji S. El-Neweihi E. Double teeth: Tbe inci-dence of fusion and gemination. J Pedod 1985;9:332-333.
13. Salem G. Prevalence of selected dentai anomalies in Saudichildren from Gizan region. Community Dent OralEpidemiol 1989:17:162-163,
14. Bruce C, Manning-Cox G, Stanback-Fryer C, Banks K,Gilliam M. A radiographie survey of dental anomalies inBlack pédiatrie patients. NDA J 1994:45:6-13.
15. Backman B, Wahlin YB. Variations in number and mor-phology of permanent teeth in 7-year-old Swedish children.Int J Paediatr Dent 2OO1;1I:11-17.
Quintessence International 559
Branemark and the Developmentof Osseointegration
3
Close to the Edge ^¡^¡^^ McGorencet
O,L- ISBN 1-85097-067-X;104 pages;84 illus (65 color];US$78
With candor and familiarity, this book tells the storyof Per-lngvar Brànemark's discovery of osseointe-gration and the challenges fie faced to find accep-tance for this concept within the scientific commu-nity. The biologic and biomechanical principlesinvolved in this approach to rehabilitation are sum-marized, and the various clinical applications forosseointegration—-from oral and maxillofacial pros-theses to limb and finger-joint replacements—aredescribed. Accounts of some of Branemark's firstimplant patients depict how this technique cantransform lives. Anyone interested in osseointegra-tion will find this book a fascinating read.
Contents1 Foundations2 The Battle for Approval3 On a Sound Footing4 Transformations in Dentistry5 Facing the World6 Hearing and Being Heard7 A Delicate Touch8 Solid Ground9 Sense and Sensibility
10 The Biomechanicai Approachn At the Cellular Level12 Training,Communications, and Collaboration
To OrderCall toll free
or FaxWebsite
Quintessence Publishing Co, Inc