Diagnostic Dilemmas and Management Strategies in Conjoined Primary Teeth: A Case Series on Fusion and Gemination

Abstract

Introduction: Conjoined primary teeth (fusion and gemination) are developmental anomalies that pose diagnostic ambiguity with direct
implications for treatment planning. Their co-occurrence in the same primary dentition and the limitations of any single diagnostic modality have rarely been described in a single case series.

Case Presentations: Three paediatric patients (aged 5 to 8 years) with conjoined primary anterior teeth were evaluated. A three-step diagnostic approach was applied including Intraoral periapical radiography, Mader's two-tooth rule, and developmental groove analysis. Case 1 (teeth 51, 52): non-vital fused teeth, treated with pulpectomy. Case 2 (teeth 72, 73): asymptomatic fusion with delayed exfoliation causing eruption obstruction, managed by extraction. Case 3 (teeth 71, 72): diagnostic dilemma between fusion and gemination with intact pulp, treated with glass ionomer cement restoration and scheduled for follow-up.

Conclusion: No single diagnostic modality reliably differentiates fusion from gemination in all cases. A three-step validation protocol enhances diagnostic accuracy. Treatment should be guided by pulpal status and eruption dynamics rather than anomaly classification alone. Paediatric dentists must maintain clinical vigilance for conjoined teeth across all primary dentition presentations.