Concrescence represents 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 presence of concrescent teeth may influence teeth extraction as well as periodontal, endodontic, orthodontic and even prosthodontic diagnosis and treatment planning. Unexpected complications arising from this condition may lead to legal complications. Therefore, consideration should be given to the possible occurrence, recognition, and implications of this anomaly in diagnosis and treatment planning.The purpose of this article is to report a case of teeth concrescence between an impacted third molar and an erupted second molar with grade III mobility that was identified post-extraction, with a review of literature. Introduction Concrescence of teeth is actually a form of fusion that occurs during root formation or after the radicular phase of development is complete. In order for concrescence to take place, the roots of the affected teeth must be in close proximity to each other, and an excess layer of cementum must be deposited to form the union between the roots of the adjacent teeth (1, 2, 3, 4). Therefore, the union is only in the cementum of the adjacent teeth (5, 6). One case was reported showing concrescence of the crown of an impacted tooth and the roots of the erupted tooth (4). The degree of union may vary from one small site to a solid cemental mass along the entire extent of the root. Two adjacent roots become fused by deposition of cementum between them after the resorption of interdental bone, which may be secondary to traumatic injury, crowding or chronic inflammation (e.g., carious lesion) (7). Concrescence typically affects maxillary molars, especially maxillary second and third molars, but its prevalence is not influenced by age, gender, or race (8).In this case the roots of third molar are located with-in the furcation area of second molar. This type of concrescence is not reported before. Case Report A 35-year-old female patient presented at our private dental clinic (Sri Prasanna Kamakshi Super Specialty Dental Clinic, Kavali, Nellore District, INDIA) with a complaint of painful mobile tooth in the upper right back teeth region lasted for three days. She mentioned history of dull continuous pain which aggravated on mastication and relieved temporarily on medication (Dinal_Plus: Combination of Diclofinac Sodium, -50mg and Paracetamol, -500mg) twice daily for 3 days. The patient also mentioned history of mobility of same tooth since six months which gradually increased till the date of examination. This was her first visit to a dentist. The patient reported her past medical history to be negative. No history of any drug or food allergy. A clinical examination was performed. The examination identified few teeth to be non restorable due to caries or periodontal disease. No unusual pathological conditions were noted. Tooth # 17 showed grade III mobility with clinical attachment loss of greater than 6mm in all the six sites (Mesiobuccal, Midbuccal, Distobuccal, Mesiopalatal, Midpalatal and Distopalatal), and tender on percussion with purulent discharge from the sulcus on digital pressure along with a caries with pulpal involvement on the distal aspect. Tooth # 18 is missing. The reason might be congenital missing or impacted which is not confirmed by radiographic investigation due to unavailability of the radiographic equipment in the clinic. With proper sterilization tooth # 17 was extracted with slow luxation and bimanual palpation of the alveolar ridge. The right maxillary second molar was extracted without fracture of the tuberosity and with the third molar still fused to it. Both teeth were extracted through the site occupied by tooth # 17 with out tearing of the alveolar mucosa distal to tooth # 17 and there is no sinus perforation. The patient was explained about the situation and was
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