Conservative endodontic treatment of a fused maxillary central and supernumerary tooth associated with acute apical abscess: A case report with three-year follow-up

Introduction: Dental fusion is a rare developmental anomaly caused by the union of two adjacent tooth germs, resulting in an enlarged tooth structure. It can occur in both primary and permanent dentitions and may predispose affected teeth to esthetic problems, malocclusion, periodontal, and endodontic complications. Accurate diagnosis-is critical for selecting an appropriate, often conservative, treatment strategy. Case report: A 55-year-old male presented with pain and swelling in the anterior maxilla. Clinical and radiographic examinations revealed complete fusion of the right maxillary central incisor with a supernumerary tooth, associated with an acute apical abscess and a periapical radiolucency. The tooth was managed conservatively with nonsurgical endodontic treatment, followed by definitive coronal restoration to ensure an adequate seal and functional rehabilitation. Follow-up evaluations at 6 months, 18 months, and 3 years confirmed clinical success, evidenced by the resolution of symptoms and absence of swelling. Simultaneously, radiographic assessment via serial images demonstrated a progressive reduction of periapical radiolucency, consistent with ongoing periapical osseous healing. Conclusions: This report demonstrates that even complex and rare developmental anomalies such as complete fusion with a supernumerary tooth can be successfully managed using a nonsurgical endodontic approach when diagnosis and treatment planning are guided by careful radiographic evaluation. Long-term follow-up supported sustained clinical success and radiographic healing, underscoring the value of accurate morphologic assessment and treatment planning in achieving predictable outcomes.