Sometimes, a tooth will geminate--branch into two as it develops in the jaw. What results is one tooth, but with a cleft in it, giving an appearance that suggests two teeth. There is a large single root and a single root canal.
In cases of gemination, the number of teeth in the arch is normal. There are no extras or missing teeth.
Geminated teeth bring out the importance of symmetry and proportion in teeth. If a tooth is wider than its neighbors, even just a little, the smile looks "off." And human teeth have specific ratios of height to width; when this ideal ratio is altered, teeth don't look right either.
Another phenomenon is fusion, where two tooth buds unite during development. There may be two entirely distinct root canals, or even separate roots. And in cases of fusion, there is one less tooth in the arch.
Geminated and fused teeth present challenges for restorative dentists and orthodontists, as it is difficult to create a symmetrical smile. Re-contouring or crowing such teeth in conjunction with orthodontics can usually resolve the issues, but sometimes extraction and implant replacement must be considered. Such treatment is aggressive, but has the advantage that an implant crown can be made to the desired size and shape.
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