ISSN 0975-8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011:3(1):75-76

CASE REPORT

Concrescence - A Report of Two Cases

Sagar Khanna, Simarpreet Virk Sandhu, Himanta Bansal, Vijaypal Khanna

Abstract
Concrescence is an uncommon developmental anomaly in which juxtaposed teeth are united in the
cementum but not in the dentin. The incidence of concrescent teeth is reported to be highest in the posterior
maxilla. The purpose of this article is to report two cases of concrescence between an impacted third molar
and an erupted second molar that was identified post extraction.
Key Words: Concrescence;Developmental Anomaly;Cemental Union;Hypercementosis.
Received on: 13/ 06/2010 Accepted on: 13/09/2010

Introduction
Altered morphology of teeth can be due
to perturbations in the genetic process of
odontogenesis. Developmental alterations in
tooth shape include concrescence. Concrescence
represents a rare developmental anomaly in
which two fully formed teeth are joined along
the root surfaces by cementum.(1, 2) The
cardinal radiologic sign of concrescence is close
proximity of adjacent teeth with no detectable
intervening periodontal ligament space shadow.
When developmental, it might be associated with
failed eruption of one or more teeth. When
acquired, it may be associated with gross
hypercementosis. Maxillary molars are the teeth
most frequently involved, especially a third
molar and a supernumerary tooth. It is a rare
dental anomaly that may be inadvertently
diagnosed during tooth extraction.(2) The
presence of concrescent teeth may influence
surgical procedures along with periodontal,
endodontic diagnosis and treatment. So, to
reduce the risk of complications associated with
the condition, concrescence should be carefully
identified and treatment plan should be
subsequently altered. (1) The purpose of this
article is to report two cases of concrescence
between maxillary second and third molar.
Case Report 1
A 47-year-old female patient reported to
the dental office for extraction of upper left
second molar in the otherwise edentulous
maxillary arch, in order to get a complete denture
fabricated. Intra oral periapical radiograph
revealed presence of an impacted 3rd molar in
close proximity to the 2nd molar. Under local
anesthesia an attempt to extract the second molar
was made, but the tooth was firm. The tooth was
patiently luxated and subsequently extracted. On
examination of the extracted specimen, the root
of the second molar was bulbous and
hypercementosed, fused with the impacted third
molar, which was extracted along with the
second molar (Fig1). IOPA of the fused
specimen showed no detectable intervening
periodontal ligament space shadow (Fig2).
Figure1 Figure 2
Case Report 2
A 47-year-old female patient reported to
the dental office for extraction of the only
standing upper left second molar in the maxillary
arch, in order to get a complete denture
fabricated. Intra oral periapical radiograph
revealed presence of an impacted third molar in
close proximity to the second molar. Under local
anesthesia we tried to extract the second molar,
but the tooth was firm to be extracted. The tooth
was patiently luxated and subsequently
extracted. On examination of the extracted
specimen, the root of the second molar was
bulbous and hypercementosed, fused with the
impacted microdont third molar, which was
extracted along with the second molar (Fig3).
Radiograph was taken which suggested
concrescence of teeth (Fig4).
Figure 3 Figure 4
Discussion
Concrescence is one of the common
anomalies of shape of teeth occurring in
posterior maxilla characterized by union between
adjacent teeth, through cementum only and not
dentin.(3) This may occur during development

©INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 3 ISSUE 1 JANUARY-MARCH 2011 75

ISSN 0975-8437
“true concrescence” or after development
“acquired concrescence”. The mechanisms
involved are unclear but it has been speculated
that restriction of space during development,
local infections trauma and excessive occlusal
forces may play a role in this anomaly. (4)
It is the form of fusion between teeth
that occurs during root formation i.e.
developmental, or after the root development is
complete. The exact etiology is unknown
concrescence can be due to trauma or chronic
inflammation which leads to resorption of
interdental bone and deposition of cementum
between the roots.(1) Both primary and
secondary teeth may be involved. This dental
anomaly has a higher incidence of occurrence in
the posterior maxilla. The detection of
concrescence is important because of the
complications it can cause during exodontia.
Detecting concrescence clinically is practically
impossible and at times misdiagnosed
radiographically as a simple radiographic
superimposition of roots of adjacent teeth.(4)
Therefore, it is important to consider
concrescence when the roots adjacent teeth are
not easily distinguishable on a radiograph.
Preoperative radiographs with different
angulation should be taken to help in diagnosis,
which was not done in the cases reported here. It
is prudent to take preoperative radiographs in all
surgical procedures. This is imperative to prevent
potential complications such as fracture of the
tuberosity or floor of the sinus.(5)
Conclusion
Clinicians should be aware of this
dental anomaly and should consider
concrescence, if difficulty is encountered while
extracting a tooth in the maxillary posterior
region, to avoid the complications such as
Source of Support: Nil, Conflict of Interest: None Declared
©INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 3 ISSUE 1 JANUARY-MARCH 2011
INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011:3(1):75-76
fracture of tuberosity or floor of maxillary sinus.
Routine radiographs should be taken prior to
extractions, to avoid any such complications and
to alter the treatment plan if required. The
treatment should be planned recognizing these
challenges and should be targeted at providing
the best possible service to the patient.
Authors Affiliations: 1) Dr. Sagar Khanna, B.D.S,
Intern, 2) Dr. Simarpreet Virk Sandhu, M.D.S,
M.A.M.S, Professor & Head, 3) Dr. Himanta Bansal,
M.D.S, D.N.B, Reader, Department of Oral and
Maxillofacial Pathology, Genesis Institute of Dental
Sciences and Research, Ferozepur, 4. Dr. Vijaypal
Khanna, M.D.S, Oral and Maxillofacial Surgeon,
Dental Health Centre, Amritsar, Punjab, India.
References
1. Gunduz K, Sumer M, Sumer A, Gunhan O.
Concrescence of a mandibular third molar and a
supernumerary fourth molar: Report of a rare
case. British Dental Journal 2006;200(3):141-2.
2. Sugiyama M, Ogawa I, Suei Y, Tohmori H,
Higashikawa K, Kamata N. Concrescence of
teeth: cemental union between the crown of an
impacted tooth and the roots of an erupted tooth.
Journal of Oral Pathology & Medicine 2007; 36
(1): 60-2.
3. Romito LM. Concrescence: Report of a rare case.
Oral Surgery, Oral Medicine, Oral Pathology,
Oral Radiology & Endodontics2004;97(3):325-7.
4. Gernhofer K. Concrescence of a maxillary
second and third molar. Journal of the California
Dental Association2009;37(7):479-81.
5. Badjate S, Cariappa K. Concrescence: report of
rare complication. The New York State Dental
Journal2008;74(1):56-7.
Address for Correspondence
Dr. Simarpreet Virk Sandhu, M.D.S, M.A.M.S,
Professor & Head,
Department of Oral and Maxillofacial Pathology,
Genesis Institute of Dental Sciences & Research,
Ferozepur, Punjab,India-152001.
E-mail:s_vrk@yahoo.com
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