Management of an anomalous maxillary lateral incisor fused with a supernumerary tooth and a coronal dens invaginatus

An abnormal union of two or more tooth germs in the development process results in fusion of teeth. Such clinical situations present a diagnostic dilemma and a challenge in treatment planning. This article reports the endodontic and esthetic management of an atypical permanent maxillary lateral incisor fused with a supernumerary tooth and a coronal dens invaginatus. A 22-year-old female reported an abnormally large and discolored permanent maxillary left lateral incisor (#22). Cone-beam computed tomographic evaluation revealed a complex, labiolingually thin ribbon-shaped canal system in the central portion interconnected with two other canals along with a coronal dens invaginatus. A 2-year follow-up demonstrated satisfactory clinical and radiographic outcomes after the endodontic therapy and a veneer placement on the concerned tooth.