From: Marga Ree
To: ROOTS
Sent: Saturday, October 08, 2005 5:28 AM
Subject: [roots] Treatment of a double tooth

Here is a 1,5 year follow-up of tooth # 11, which has a special history, because it used to be a double tooth, before
separation took place 1,5 year ago.

Because it is difficult to differentiate between a tooth fusion and gemination, the term double tooth has been
introduced (Schuurs AH, van Loveren C.  Double teeth: review of the literature.

ASDC J Dent Child. 2000 Sep-Oct;67(5):313-25. Review)

This 9 year old boy had been referred by his orthodontist. I performed a separation of the Siamese twin tooth, 2
roots were present with a pulpal communication. After separation and extraction of the mesial part, I did a direct
pulp capping with composite on the mesial side of the distal part. Follow-up after 6 (brackets in place) and 18
months respectively, 11 reacts to cold WNL, patient is free of signs and symptoms, radiographs reveal undisturbed
root development. Orthodontist will proceed with treatment, 21 has to be “reshaped” as well in the future.- Marga






Thank you Marga for your comments and your beautiful ducumented case.

My opinion is actually the same that endodontic treatment is hopefully not necessary. But IF what kind of trouble
would we be in. Separation is probably more difficult in this case. We also have a suggestion of treatment and that
is to rotate the tooth in mesio-distal direction.

That would give as the same as a trasplanted premolar placed in mesio-distal direction and a more corecct width of
the tooth in mesio-distal at the neck of the tooth.  And we have experience with that.As you understand we are very
early in planning the case and preciate very much your comment.I will read the article and give you feedback on what
we plan to do eventually.- Harald Prestegaard

What a neat case! When I was a GP I used to perform phase I ortho; I obtained a great deal of satisfaction from that.
I imagine that is closely akin to what you experienced with this case. Excellent. DougR

Fascinating Marga ... and great pix - Regards Simon

Dear Marga,

Abosulutely stunning work.  and a neat presentation, Sure the orthodontist  who refer cases know exactly what you can do with such cases.

The case that Harald showed has a different problem.. It's got those two  tooth fused together all the way up to the
root. I think you will have to  do endo on both of them and then put a crown or you may have to reimplant  one tooth
after seperating the other one from it. but ultimately it may  have to have a crown since the crwon size of
individual tooth is very less  compared to the opposite side.  don't you think so? - Vipin