HYBRID EVENT: You can participate in person at Madrid, Spain or Virtually from your home or work.

9th Edition of International Conference on Dentistry
and Oral Health

September 02-04, 2024 | Madrid, Spain

September 02-04, 2024 | Madrid, Spain
ICDO 2021

Julian Leow

Julian Leow, Speaker at Dentistry Conferences
Northwick Park Hospital, United Kingdom
Title: Fusion of an impacted third and supernumerary fourth molar tooth with concrescence of the second molar: a very rare case and novel treatment approach


Introduction: We report the very rare case of a symptomatic 41-year-old female presenting with fusion of an impacted third (LL8) and fourth (LL9) mandibular molar tooth with concrescence of the second molar tooth (LL7). We share our experience of pre-operative cone-beam computed tomography (CBCT) to aid surgical planning and the novel use of piezoelectric surgery.

Case Report: A 41-year-old female was referred to the oral and maxillofacial surgery clinic with left jaw pain and swelling. Panoramic radiography revealed an impacted LL8-LL9 fused tooth with concrescence of the LL7. Cone-beam computed tomography showed direct contact with the inferior dental nerve (IDN) and lingual aspect of the double tooth. The patient underwent surgical removal of the LL8-LL9 using piezoelectric surgery to separate the double tooth from the LL7 and minimise trauma to the IDN. The patient was reviewed two weeks post-operatively with no lip/chin/tongue paraesthesia and a well healing socket.

Discussion: Though initially used for osteotomies, piezosurgery has also found success in endodontic and third molar surgery. We present the first case of successfully using pre-operative CBCT in the planning of surgery and piezoelectric surgery to separate an impacted fused LL8-LL9 from a concrescent LL7 without causing trauma to the LL7 or intimately positioned IDN.


Dr. Leow studied Dentistry at King’s College London and graduated in 2017, after which he spent 1 year in general dental practice. Following this, he continued his training by working in hospitals as an Oral and Maxillofacial Dental Core Trainee. During this time, he received a Postgraduate Certificate in Medical Education and a Diploma of Membership of the Faculty of Dental Surgery with the Royal College of Physicians and Surgeons of Glasgow.