case_images: PMC9452987_01
case_images: Preoperative CBCT examination. (a) A fourth molar in the mandible left third molar distal; (b-d) the relationship between roots and mandibular canal in coronal, transversal, and sagittal planes.
case_images: CRID2022-3771299.001.jpg
case_images: PMC9452987_01_CRID2022-3771299.001.jpg
case_images: fig1
case_images: CBCT radiograph revealed that teeth 38# and 39# were vertical median impaction in the left mandibular region, and showed a concrescence between an impacted third molar and a supernumerary fourth molar (Figure 1) they shared similar shape but self-governed root canal system. Besides, teeth 48# was impacted at horizontal-low level (Figure 1). Acteon group France, France)-based anesthesia blocking the inferior alveolar, lingual, and buccal nerve. A mucoperiosteal flap was prepared and raised, and then ostectomy and odontomy were performed using handpiece (Figure S1) and sterile saline irrigation.
case_images: Surgery process and follow-up. (a) No wisdom teeth erupting, bleeding, or purulent secretion in the mouth. (b-f) Teeth extraction and alveolar reconstruction. (g) The fragment of teeth. (h, i) Removed stitches without severe complication and the defect of the alveolar socket healed well.
case_images: CRID2022-3771299.002.jpg
case_images: PMC9452987_01_CRID2022-3771299.002.jpg
case_images: fig2
case_images: Antiflogistic and analgesics therapy were applied for 3-5 days (Figures 2(a)-2(g)). After 7 days, the sutures were removed without severe complications (Figures 2(h)-2(i)).
case_images: Photomicrographs of histological sections stained with the hematoxylin-eosine stain exhibiting the point of cementum fusion, revealing a real concrescence. Images obtained using (a) a 10x microscope and (b) a 20x microscope.
case_images: CRID2022-3771299.003.jpg
case_images: PMC9452987_01_CRID2022-3771299.003.jpg
case_images: fig3
case_images: The histological examination revealed fusion of cementum between the mandibular third molar and supernumerary fourth molar which is diagnostic for concrescence (Figure 3).
case_images: (a) Immediate postoperative panoramic examination showed the empty tooth socket; (b) after six months, CBCT examination showed good bone formation, and the alveolar bone healed well. (c) Transverse section shows increased bone density in empty alveolar bone; (d, e) Coronal and sagittal plane shows increased height of the alveolar bone.
case_images: CRID2022-3771299.004.jpg
case_images: PMC9452987_01_CRID2022-3771299.004.jpg
case_images: fig4
case_images: CBCT examination showed increased bone density (Figure 4).