Cone-beam CT imaging in the management of a double tooth

Abstract

BACKGROUND: The diagnosis and management strategies of double teeth have largely relied on clinical examination and conventional radiographic findings. Cone-Beam Computed Tomography (Cone-beam CT) was developed in the late 1990’s and, therefore, is a relatively recent addition to the imaging armamentarium for use in Maxillofacial Radiology. There have been no publications in the dental literature demonstrating the use of Cone-beam CT or 3D stereolithography in the diagnosis and surgical planning of the management of double teeth. CASE REPORT: An 11 year old girl presented with a double left lateral maxillary incisor. Conventional plain film radiography failed to provide the requisite information for pre-operative planning. Cone-beam Computed Tomography (Cone-beam CT) allowed determination of location of fusion, three-dimensional (3D) visualisation of pulpal anatomy and the construction of a 3D stereolithographic model for surgical planning. The double tooth was surgically divided in situ under local analgesia. The redundant distal unit was extracted and the residual mesial unit built up in composite resin following physiological mesial drift of displaced maxillary left canine. No endodontic therapy was required. FOLLOW-UP: At a 10-month follow-up visit, clinical and radiographic vitality and success was noted. CONCLUSION: The great amount of radiological information which Cone-beam CT can offer not only improves pre-operative and surgical planning, but the 3D models provided can be used to further educate and inform patients and guardians in the management of double teeth.