CBL ENGLISH BLOK 5

Question
1. What is the diagnosis for the patient? explain it!
2. What is the description clinic of the cases?
3. What is the etiology fo the abnormality in scenario?
4. What is the patofisiology in this cases?
5. What is the classification of this cases?
6. What is complication disease in this cases?
7. What the other possible clinical problems?
8. How to diagnosis in this cases?
9. What are the tooth abnormality beside of the fusion teeth?
10. How is the management of patient in scenario?
11. What is the similar of differential diagnosis which mean in
clinical appearance?
1. Dental fusion
- Is a disorder in which to teeth join together in the protective
layer of the tooth or enamel, a substain between the coating and
the root or between the two.
- Are also none has the double teeth, double formation fused
teeth or multiple teeth that are primary developmental
abnormalities.
- Is one of the rare anomaly of the germ, it is due to the union of
two separate tooth germ. It is also result of mutation during the
embriological of teeth.
- Tooth fusion can occur in bud of permanent teeth and deciduous
teeth and also often in front teeth. Incident in primary teeth is
around 0,5% , a while in permanent teeth is about 0,1%.
- Is known as the process of the twinning of the 2 or more tooth
germ which develope separately in at the dentinal level but
become a single large tooth during odontogenesis at the time
when the crown is not yet mineralizing.
2. Description clinic of the cases
- Fusion teeth show the presence of large canal crown and
various forms including multiple root and root canals. The
presence of the large clinical crown and the absence of clear
groove.
- Has separate root canal merge in part or perfect in part. There
is a possibility of fusion due to local factor there is a suspition
that it can occur due to pressure or physical factor that cause
contact during tooth formation . The contact will cause
epithelial necrosis that separate the two teeth so that fusion
are occur.
- There is small groove between the mesial and distal section of
the ground and also fused teeth shown unusual configuration
of the pulp chamber and root canal.
- Fused teeth commonly have well defined, vertical, labial, and
lingual groove.
3. Etiology fo the abnormality in scenario Are not known, but can be
- Because of the pressure or physical strange that will give contact to the
developing tooth and then caries involve in the fusion teeth are seen along
the fusion tooth line and radiographic examination shows pulp involvement.
- physical of force or pressure between adjacent tooth germ,
- enviromental influences,
- Genetics factor Genetics factor in the occurance of fusion cannot be as
curtain although according to the family member that have experience it.
- viral infection during pregnancy,
- x-linked congentinal conditions,
- cleft lip and palate,
- lack of vitamins,
- lack of space in the dental arch
- Inter dental lamina persistent of two dental germ then the factor genetics
with autosomal dominant in heritence patterns low penetration.
- local metabolics interference during tooth bud differentiation,
- traumatics,
- inflammatory causes.
4. Patofisiology in this cases
Originally, separate tooth bud unit of the ground level or at
the crown and root level . A single large tooth during the
odontogenesis when the crown not yet mineralize and also other
believe this anomalies is persistent of dental lamina between
two or more buds.
Fusion teeth the result from the union of the adjancent tooth
germ of the developing teeth. When the two tooth germ
develope so close together that as the ground that contact and
fused before calcification.
This situation happen to early stage of odontogenesis.
Namely, possibility before the process of calcification of dental
tissue. Meanwhile, imperfect fusion is the union of portion of
the tooth dental germ.
5. Classification of this cases
Depend of the development of teeth, fusion can be classified two
types.
1) the complete fusion  begin before calcification and the crown
in corporates feature of both participating teeth with regard to
enamel, dentin, cementum, and pulp.
2) 2) the partial fusion  occur at later stage and the tooth might
exhibit separate crown and fusion maybe limited to the roots
alone with pulp canals fused or separate.
There is four types:
3) normal size root and radicular canal w/ widening in the cervical
portion.
4) a root that is large than normal a long its long and one large
share root canal.
5) two fusion crown with a double conical root.
6) two or more clearly distinct but join root with two separate
canal.
6. Complication disease in this cases
Fused teeth can result in a number of complication including
- dental caries,
- spacing,
- periodontal disease assosiated with the fusion line between two
teeth,
- dental maloclussion,
- delayed eruption of permanent teeth due to delayed in root
resorption and exfoliation fusion deciduous teeth.
- problem tooth aesthetic,
- hypodontia,
- supernumerary in germ permanent tooth
7. Other possible clinical problems
The fusion of teeth in the anterior region would be aesthetic
problems due to space and periodontal defect due to the presence
of deep groove which leads to plaque accumulation.
8. How to diagnosis
The examination can begin with a clinical and radiologycal
examination, CT scan can be done to see the state of the root
and pulp space, which is the cavity under the dentin layer
between the protective layer and the tooth root.
The radiologycal examination we can look the joining part is the
enamel layer or the other most layer of the hard to tissue and
dentin layer.
Have a shape very similar to gemination to distinguish them
simply count the number of teeth. If it turns out the number is
less than normal it can be as curtained that the abnormality is
dental fusion.
The radiology examination , can have separate, partialy
intergrated or complete intergrated canal.
9. Tooth abnormality beside of the fusion teeth *woelfel anatomi gigi E.8/343-363
a. Crown Abnormal Morphology
Malformation of third molar, Gemination, Hutchinson insisiv,
Molar mulberry, Tuberculum intermedium, Tuberculum sectum,
Microdontia, Macrodontia
b. Root Abnormal Morphology
Email pearl, Taurodontia, Dilaserasi, Dens in Dente, Concrescence,
Drawf root, Hipercementosis, Extra root
c. Dental Anomalies Position
Impaction, Transposition teeth, Rotation teeth, Ankylosis
d. Dental Development Malformation ( and discoloration )
Email Dysplasia (amelogenesis imperfecta, fluorosis,
hypomaturation), Dentin Dysplasia (dentinogenesis imperfecta,
tetracycline discoloration)
e. Tooth Deformation due to Injury After Eruption
Dental Attrition (bruxism), Dental Erosion, Dental Abrasion
10. Management of patient
Depending on location and area of fusion,
- Repair and limited tooth decay,
- protect and maintain excisting pulp tissue and tooth structure,
- maintaining the dental arches, mouth health & aesthetic face,
- patcing at the intersection of the two crown to prevent in the caries
- restoration to fix the aesthetic,
- ortodontic treatment or combine ,
- in anterior primary teeth which is separate the teeth extraction is
performance on the lateral incisor and maintaining the primary
canine teeth to prevent aesthetic and functional problem.
- surgical,
- conservative,
- Before the dentist do the treatment, the dentist must consider
many factor : fusion teeth are wider than the other teeth so that
can effect the aesthetic, involve surface contour.
11. The similar of differential diagnosis
Other tooth anomalies which similar to fusion teeth
1) Gemination is the single tooth bud attend to divide.
2) Supernumerary teeth is a teeth develope in addition to the
normal complement as a result of exces dental lamina in the
jaw.
3) Macrodontia is large teeth than normal.