Conservative management of macrodontia in the mixed dentition stage – a case report

Managing dental abnormalities resulting in the alteration of tooth size and shape can present as an aesthetic and functional challenge to the dental practitioner. Macrodontia, a term used to describe teeth that are larger than would normally be expected, is characterized by an increase in the mesio-distal and facio-lingual tooth dimensions.1 The aetiology of this condition is still not fully understood, but it may be caused by a disruption to apoptosis during tooth development.2 Fortunately, macrodontia is relatively rare,3 having a prevalence of 1.1% in the permanent dentition.4

True macrodontia can be classified into three types:5

Descriptive terminology of macrodontia can be confusing, but true macrodontia of a single tooth should not be confused with gemination or fusion of two teeth (double teeth) early in odontogenesis, giving the appearance of one larger tooth.8 The term fusion is used to describe two separately developing teeth united via dentine and/or enamel.9 A review of the literature by Tuna et al reported the aetiology of this anomaly to be necrosis of intervening epithelial tissue caused by pressure between two developing teeth.10 Where fusion occurs, macrodontia will present along with one or two pulp chambers and typically there will be one less tooth in the arch,11^,10 unless the fusion is between a normal and a supernumery tooth.12 Gemination can be defined as the formation of two teeth believed to arise from one dental follicle attempting to separate. In this case, there is usually only one pulp chamber and the correct number of teeth in the dental arch, if the double tooth is counted as one unit.11^,10 Often present is a notch or groove on the crown.9 The prevalence of double teeth in the Caucasian population is reported at 0.1–0.2% in the permanent dentition and most frequently the anterior segments are affected.4