Conservative Management of Type III Dens in Dente Using Cone Beam Computed Tomography

Abstract

Dens in dente, also known as dens invaginatus, dilated composite odontoma, or deep foramen caecum, is a developmental malformation that usually affects maxillary incisor teeth, particularly lateral incisors. It may occur in teeth anywhere within the jaws, other locations are comparatively rare. It can occur within both the crown and the root, although crown invaginations are more common. The use of cone beam computed tomography (CBCT) is very helpful in endodontic diagnosis of complex anatomic variations. In this case we demonstrate the use of CBCT in the evaluation and endodontic management of a Type III dens in dente (Oehler's Type III).

Cone Beam Computed Tomography in the Diagnosis of Dens Invaginatus: Case Report

“…These limitations can be overcome with the use of CBCT (Pradeep et al; Teixeidó et al & Capar et al), which is an important tool in the diagnosing, treatment planning and monitoring of complex DI (Pradeep et al;Ceyhanli et al;Kaya-Büyükbayram et al;Vier-Pelisser et al, 2014). As a three-dimensional images, CBCT has several other advantages over conventional radiography, like elimination of overlapping of anatomical structures, and management of various dental malformations and endodontics (Mishra et al; Muppa et al; Teixeidó et al; Nosrat & Schneider), allowing accurate visualization of internal and external anatomy of teeth affected by DI (Capar et al; Nosrat & Schneider) and associated tissues (Kaneko et al, 2011;Kfir et al).…”

“…Thus, early diagnosis is essential to avoid more complex treatments (Ceyhanli et al; Capar et al). The treatment options for DI include preventive sealing or filling of the invagination, surgical or nonsurgical root canal treatment, intentional replantation, and extraction (Bansal & Pratap;Kaneko et al, 2011;Pradeep et al;Jaya et al;Kfir et al;Brooks & Ribera;Capar et al;Zubizarreta Macho et al). According to Vier-Pelisser et al, (2014) extraction is indicated in teeth with large anatomical irregularities, which precludes endodontic and supernumerary treatment.…”

“…Endodontic applications of CBCT include the diagnosis of periapical lesions, more detailed visualization of root anatomy, elucidation of internal and external resorption, and detection of root fractures (Tyndall & Rathore, 2008;Kaneko et al, 2011). CBCT also operates with a lower radiation dose as compared to multi-slice computed tomography (Tyndall & Rathore;Durack & Patel;Kaneko et al, 2011;Pradeep et al;Jaya et al;Kfir et al;Teixeidó et al) although higher than that of conventional dental radiography techniques (Kfir et al; Capar et al). This paper describes the use of CBCT as an effective diagnostic tool for the DI well as in the treatment planning.…”

“…According to the literature, the frequency varies from 0.04 % to 10 % (Hovland, 1977;Hülsmann;Pradeep et al;Jaya et al;Brooks & Ribera, 2014;Ceyhanli et al, 2014;Kaya-Büyükbayram et al;Teixeidó et al;Zubizarreta Macho et al, 2015), predominating in female (3:1) (Alani & Bishop, 2008;Mishra et al), affecting either the deciduous or the permanent dentition (Alani & Bishop; Jaya et al). The most affected permanent teeth are the maxillary lateral incisors (Oehlers, 1957;Cohenca & Berg, 2013;Jaya et al;Kfir et al;Brooks & Ribera;Ceyhanli et al;Kaya-Büyükbayram et al, Muppa et al;Vier-Pelisser et al, 2014;Capar et al;Zubizarreta Macho et al;Nosrat & Schneider), frequently bilaterally (43 %) (Hülsmann; Durack & Patel; Mishra et al; Pradeep et al; Cohenca & Berg; Jaya et al; Zubizarreta Macho et al), followed by central incisors, including supernumerary teeth, maxillary cuspids, mandibular incisors, and mandibular premolars affecting the molars rarely (Oehlers; Cohenca & Berg; Jaya et al), rarely affecting the molars (Bansal & Pratap, 2010;Matsusue et al, 2011).…”

“…Dens invaginatus (DI), also known as dens in dente, dilated composite odontoma, invaginated odontoma, dilated gestant odontoma, tooth inclusion or dentoid in dente (Hülsmann, 1997;Durack & Patel, 2011;Pradeep et al, 2012), is a developmental tooth anomaly characterized by invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues (Jaya et al, 2013;Kfir et al, 2013;Kaya-Büyükbayram et al, 2014;Muppa et al, 2014;Teixeidó et al, 2014;Capar et al, 2015;Nosrat & Schneider, 2015).…”