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{{Infobox medical condition (new) |
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{{Underlinked|date=December 2017}} |
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| name = Concrescence |
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{{Infobox disease | |
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| field = [[Dentistry]] |
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[[File:Concrescencia_dentaria.jpg | thumb | right | Dental concrescence between a 2M (erupted) and a higher 3M (retained)]] |
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'''Concrescence''' is |
'''Concrescence''' is an uncommon developmental condition of [[teeth]] where the [[cementum]] overlying the roots of at least two teeth fuse together without the involvement of dentin.<ref name="Romito">{{cite journal |last1=Romito |first1=Laura M. |title=Concrescence: report of a rare case |journal=Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology |date=March 2004 |volume=97 |issue=3 |pages=325–327 |doi=10.1016/j.tripleo.2003.10.015}}</ref><ref name="four">{{cite journal |last1=Delanora |first1=Leonardo Alan |last2=Simon |first2=Maria Eloise de Sá |last3=Rodriguez |first3=Eder Alberto Sigua |last4=Faverani |first4=Leonardo Perez |last5=Pavan |first5=Angelo Jose |title=Can concrescence diagnosis be obtained merely by clinical and imaging examination? from clinical case to histology |journal=Research, Society and Development |date=10 August 2020 |volume=9 |issue=9 |pages=e41996893–e41996893 |doi=10.33448/rsd-v9i9.6893|doi-access=free }}</ref> Usually, two teeth are involved with the upper second and third [[Molar (tooth)|molars]] being most commonly fused together.<ref name="Gunduz et al 2006">{{cite journal |doi=10.1038/sj.bdj.4813191 |pmid=16474352 |title=Concrescence of a mandibular third molar and a supernumerary fourth molar: Report of a rare case |journal=British Dental Journal |volume=200 |issue=3 |pages=141–2 |year=2006 |last1=Gunduz |first1=K |last2=Sumer |first2=M |last3=Sumer |first3=A P |last4=Gunhan |first4=O |s2cid=20376985 }}</ref> The prevalence ranges 0.04–0.8% in permanent teeth, with the incidence being highest in the posterior maxilla.<ref name="Fernandes & Sar Dessai 1999">{{cite journal |last1=Fernandes |first1=A |last2=Sar Dessai |first2=G |title=Endodontic Miscellany: Concrescence - a case report |journal=Endodontology |date=1999 |volume=11 |issue=2 |pages=65–6 |doi=10.4103/0970-7212.347464 |url=http://medind.nic.in/eaa/t99/i2/eaat99i2p65.pdf |doi-access=free }}{{Dead link|date=December 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref name="four" /><ref name="Romito" /> |
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== |
== Signs and symptoms == |
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* |
* Problems with tooth positioning causing cheek biting and traumatic ulcers.<ref name="Fernandes & Sar Dessai 1999"/> |
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* Involved teeth may have difficulty erupting or may not erupt completely.<ref name="Fernandes & Sar Dessai 1999"/> |
* Involved teeth may have difficulty [[Tooth eruption|erupting]] or may not erupt completely.<ref name="Fernandes & Sar Dessai 1999"/> |
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* |
* Possible gum disease (localized periodontal destruction due to aetiological factors, e.g. funnel development leading to plaque accumulation)<ref name="Venugopal et al 2013">{{cite journal |doi=10.4103/0972-124X.115647 |pmid=24049342 |pmc=3768192 |title=Paramolar concrescence and periodontitis |journal=Journal of Indian Society of Periodontology |volume=17 |issue=3 |pages=383–6 |year=2013 |last1=Venugopal |first1=Sanjay |last2=Smitha |first2=BV |last3=Saurabh |first3=Sprithyani |doi-access=free }}</ref> |
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* Cavities (caries) due to predisposition from crowded teeth and misalignment.<ref name="Venugopal et al 2013" /> |
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* May cause fracture of the tuberosity or floor of the maxillary sinus.{{fact}} |
* May cause fracture of the tuberosity or floor of the [[maxillary sinus]].{{fact|date=December 2017}} |
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== |
== Cause == |
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The exact cause of concrescence is unknown.<ref name="four" /> However, it may develop during root formation (true/primary concrescence) or after root formation (acquired/secondary concrescence).<ref name="four" /> Factors that may cause concrescence include injuries (trauma), crowding of teeth, inflammation, or infection.<ref name="four" /> Concrescence appears to have no particular predisposition for age, gender, or ethnicity.<ref name="four" /> |
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This condition arises as the result of traumatic injury or overcrowding of teeth.<ref name="Fernandes & Sar Dessai 1999"/> True concrescence occurs during root formation phase, whereas acquired concrescence occurs after the radicular phase of development is complete.<ref name="Gunduz et al 2006"/> |
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The postinflammatory pattern frequently involves carious molars in which the root ends (apices) overlie the roots of impacted third molars, most common with the distally angulated third molars. The resultant large pulpal exposure often permits pulpal drainage, leading to a resolution of a portion of the intrabony pathosis. Cemental repair then occurs.<ref name=":0">{{Citation |last=Neville |first=Brad W. |title=Bone Pathology |date=2019 |url=http://dx.doi.org/10.1016/b978-0-323-55225-7.00014-2 |work=Color Atlas of Oral and Maxillofacial Diseases |pages=367–410 |access-date=2023-12-20 |publisher=Elsevier |last2=Damm |first2=Douglas D. |last3=Allen |first3=Carl M. |last4=Chi |first4=Angela C.}}</ref> |
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== Diagnosis == |
== Diagnosis == |
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Clinically, concrescence is difficult to diagnose due to lack of involvement of tooth enamel resulting in a tooth crown that appears normal.<ref name="Venugopal et al 2013" /> [[Radiographs]] taken at different angles can aid in the detection of concrescence, since the condition may be misdiagnosed as radiographic overlap of superimposed teeth.<ref name="Fernandes & Sar Dessai 1999"/><ref name="Venugopal et al 2013" /> Radiographically, teeth appear joined together with the absence of periodontal ligament or interdental bone between them.<ref name="four" /> Cone beam computed tomography (CBCT) may assist in diagnosis and treatment planning, but cannot provide a definitive diagnosis.<ref name="four" /> [[Histological]] examination of extracted teeth is necessary to confirm the diagnosis and distinguishing concrescence from differential diagnoses of gemination or fusion by observing lack of dentinal confluence between fused teeth.<ref name="four" /> |
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== Treatment == |
== Treatment == |
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If the condition is not affecting patient, no treatment is needed. Concrescence teeth could be reshaped and replaced with full crowns. |
If the condition is not affecting the patient, no treatment is needed. Concrescence teeth could be reshaped and replaced with full [[Crown (dentistry)|crowns]]. If the teeth are having recurrent problems, are non-restorable, or are painful, tooth [[Dental extraction|extraction]] should be considered to prevent further periodontal destruction leading to tooth loss.<ref name="Gunduz et al 2006"/><ref name="Fernandes & Sar Dessai 1999"/><ref name="Venugopal et al 2013"/> However, a consequence of extraction is that the conjoined tooth also must often be removed.<ref>{{cite book |last1=Schuurs |first1=Albert |title=Pathology of the hard dental tissues |date=2013 |publisher=Wiley-Blackwell, A John Wiley & Sons, Ltd., Publication |location=Chichester, West Sussex Oxford Ames, Iowa |isbn=9781405153652}}</ref> |
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Post-inflammatory concrescence must be kept in mind whenever extraction is planned for non-vital teeth with apices that overlie the roots of an adjacent tooth. Significant difficulties with extraction can be experienced during removal of a tooth that is unexpectedly joined to its neighbor. Surgical separation often is required to complete the procedure without loss of a significant portion of the surrounding bone.<ref name=":0" /> |
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If the cemental union between affected teeth is slight, the teeth may separate during extraction of one of the teeth and may never be noticed. If the union is large or firm, the planned extraction of one of the teeth may inadvertently result in the removal of its mate. A clinician’s awareness of the characteristics of this odontogenic anomaly may help avert adverse outcomes in the treatment of concrescent teeth.<ref name="Romito" /> |
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==References== |
==References== |
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{{Reflist}} |
{{Reflist}} |
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== External links == |
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==Further reading== |
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{{Medical resources |
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*Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.{{full}} |
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| DiseasesDB = |
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| ICD10 = {{ICD10|K|00|2|k|00}} |
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| ICD9 = {{ICD9|520.2}} |
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{{Tooth disease}} |
{{Tooth disease}} |
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[[Category:Developmental tooth pathology]] |
[[Category:Developmental tooth pathology]] |
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{{disease-stub}} |
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Latest revision as of 16:18, 13 August 2024
| Concrescence | |
|---|---|
| Specialty | Dentistry |
Concrescence is an uncommon developmental condition of teeth where the cementum overlying the roots of at least two teeth fuse together without the involvement of dentin.[1][2] Usually, two teeth are involved with the upper second and third molars being most commonly fused together.[3] The prevalence ranges 0.04–0.8% in permanent teeth, with the incidence being highest in the posterior maxilla.[4][2][1]
Signs and symptoms
[edit]- Problems with tooth positioning causing cheek biting and traumatic ulcers.[4]
- Involved teeth may have difficulty erupting or may not erupt completely.[4]
- Possible gum disease (localized periodontal destruction due to aetiological factors, e.g. funnel development leading to plaque accumulation)[5]
- Cavities (caries) due to predisposition from crowded teeth and misalignment.[5]
- May cause fracture of the tuberosity or floor of the maxillary sinus.[citation needed]
Cause
[edit]The exact cause of concrescence is unknown.[2] However, it may develop during root formation (true/primary concrescence) or after root formation (acquired/secondary concrescence).[2] Factors that may cause concrescence include injuries (trauma), crowding of teeth, inflammation, or infection.[2] Concrescence appears to have no particular predisposition for age, gender, or ethnicity.[2]
The postinflammatory pattern frequently involves carious molars in which the root ends (apices) overlie the roots of impacted third molars, most common with the distally angulated third molars. The resultant large pulpal exposure often permits pulpal drainage, leading to a resolution of a portion of the intrabony pathosis. Cemental repair then occurs.[6]
Diagnosis
[edit]Clinically, concrescence is difficult to diagnose due to lack of involvement of tooth enamel resulting in a tooth crown that appears normal.[5] Radiographs taken at different angles can aid in the detection of concrescence, since the condition may be misdiagnosed as radiographic overlap of superimposed teeth.[4][5] Radiographically, teeth appear joined together with the absence of periodontal ligament or interdental bone between them.[2] Cone beam computed tomography (CBCT) may assist in diagnosis and treatment planning, but cannot provide a definitive diagnosis.[2] Histological examination of extracted teeth is necessary to confirm the diagnosis and distinguishing concrescence from differential diagnoses of gemination or fusion by observing lack of dentinal confluence between fused teeth.[2]
Treatment
[edit]If the condition is not affecting the patient, no treatment is needed. Concrescence teeth could be reshaped and replaced with full crowns. If the teeth are having recurrent problems, are non-restorable, or are painful, tooth extraction should be considered to prevent further periodontal destruction leading to tooth loss.[3][4][5] However, a consequence of extraction is that the conjoined tooth also must often be removed.[7]
Post-inflammatory concrescence must be kept in mind whenever extraction is planned for non-vital teeth with apices that overlie the roots of an adjacent tooth. Significant difficulties with extraction can be experienced during removal of a tooth that is unexpectedly joined to its neighbor. Surgical separation often is required to complete the procedure without loss of a significant portion of the surrounding bone.[6]
If the cemental union between affected teeth is slight, the teeth may separate during extraction of one of the teeth and may never be noticed. If the union is large or firm, the planned extraction of one of the teeth may inadvertently result in the removal of its mate. A clinician’s awareness of the characteristics of this odontogenic anomaly may help avert adverse outcomes in the treatment of concrescent teeth.[1]
References
[edit]- ^ a b c Romito, Laura M. (March 2004). "Concrescence: report of a rare case". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 97 (3): 325–327. doi:10.1016/j.tripleo.2003.10.015.
- ^ a b c d e f g h i Delanora, Leonardo Alan; Simon, Maria Eloise de Sá; Rodriguez, Eder Alberto Sigua; Faverani, Leonardo Perez; Pavan, Angelo Jose (10 August 2020). "Can concrescence diagnosis be obtained merely by clinical and imaging examination? from clinical case to histology". Research, Society and Development. 9 (9): e41996893–e41996893. doi:10.33448/rsd-v9i9.6893.
- ^ a b Gunduz, K; Sumer, M; Sumer, A P; Gunhan, O (2006). "Concrescence of a mandibular third molar and a supernumerary fourth molar: Report of a rare case". British Dental Journal. 200 (3): 141–2. doi:10.1038/sj.bdj.4813191. PMID 16474352. S2CID 20376985.
- ^ a b c d e Fernandes, A; Sar Dessai, G (1999). "Endodontic Miscellany: Concrescence - a case report" (PDF). Endodontology. 11 (2): 65–6. doi:10.4103/0970-7212.347464.[permanent dead link]
- ^ a b c d e Venugopal, Sanjay; Smitha, BV; Saurabh, Sprithyani (2013). "Paramolar concrescence and periodontitis". Journal of Indian Society of Periodontology. 17 (3): 383–6. doi:10.4103/0972-124X.115647. PMC 3768192. PMID 24049342.
- ^ a b Neville, Brad W.; Damm, Douglas D.; Allen, Carl M.; Chi, Angela C. (2019), "Bone Pathology", Color Atlas of Oral and Maxillofacial Diseases, Elsevier, pp. 367–410, retrieved 2023-12-20
- ^ Schuurs, Albert (2013). Pathology of the hard dental tissues. Chichester, West Sussex Oxford Ames, Iowa: Wiley-Blackwell, A John Wiley & Sons, Ltd., Publication. ISBN 9781405153652.
External links
[edit]
Look up concrescence in Wiktionary, the free dictionary.