Dens Invaginatus in Patients With Cleft Lip and Palate: A Case Series

Abstract

Dens invaginatus is a rare developmental anomaly characterized by an infolding of the enamel organ within the crown or root of a tooth, and it is an example of a dental anomaly that has a higher incidence in patients with CL/P. If undiagnosed, dens invaginatus can lead to severe, acute pain and pulpal necrosis since it can permit direct entry of bacteria into the dental pulp. Treatment of dens invaginatus includes prophylactic sealant or composite restoration, endodontic therapy if pulpal involvement has already occurred, or extraction if aberrant tooth morphology precludes endodontic therapy. Few studies report on the incidence of dens invaginatus in patients with CL/P. The purpose of this article is to describe 4 cases of dens invaginatus in patients with CL/P which were encountered in a cleft-craniofacial orthodontic clinic. Each case describes dens invaginatus in a maxillary lateral incisor, and treatments ranged from sealant application to endodontic therapy to extraction. These cases highlight the importance of awareness of this dental anomaly among cleft team providers to facilitate early diagnosis in patients with CL/P.

Relationship of complete unilateral and bilateral cleft palate with malposition and malformation of maxillary lateral incisors

“…Patients with impacted teeth require surgery and multidisciplinary orthodontic treatment to align the teeth with the dental arch. [36][37][38] Maxillary lateral incisor rotation and ectopic eruption on the palatal side had the same percentage of 10% in this study. Tooth rotation is defined as the displacement of mesiolingual or distolingual teeth around their longitudinal axis.…”

Dental caries and periodontitis risk factors in cleft lip and palate patients

“…In addition, maxillary malformation, high incidence of supernumerary teeth and malposition of teeth result in crowding and dental malocclusion ( 34 ) which limits the use of toothbrush and antiseptic mouthwash and the natural cleaning of teeth by the tongue and saliva ( 35 ). Furthermore, tooth morphologic abnormalities like dens invaginatus also provide a favorable living environment for bacteria and fungi, which might be related to the pathogenesis and progression of dental caries ( 36 , 37 ).…”

“…Crowded teeth favor the accumulation of dental plaque and make the removal difficult for CLP patients. In addition, dens invaginatus such as radicular lingual groove always found in maxillary lateral incisor has higher prevalence in patients with CLP ( 37 ), it creates a pathological dental pocket. Such a pocket resulted from an infolding of the enamel into dentine destroys the connection between periodontal tissue and cementum and allows bacteria propagate within, which can't be easily removed ( 26 , 61 , 62 ).…”

Dens Invaginatus: Literature Review and Case Report

“…They are most commonly situated in permanent maxillary lateral incisors, followed by maxillary central incisors, then canine and premolar. These lesions have rarely been detected in temporary deciduous teeth [4].…”