Dens invaginatus (Type III B)

Abstract

Dens invaginatus or ‘dens in dente’ is a developmental malformation of the tooth resulting from infolding of the dental papilla before calcification. This article presents a case of dens invaginatus occurring in maxillary right lateral incisor of a 45-year-old male patient. The patient presented with pain and clinically missing maxillary right canine. The tooth was found to be non-vital. Radiographic examination revealed the tooth-in-tooth appearance of lateral incisor with a dilated pulp chamber. The crown of impacted canine was found within the pulp chamber of lateral incisor. Owing to this unique clinical presentation, both the lateral incisor and the impacted canine were extracted. Histopathologic examination confirmed the diagnosis of Dens invaginatus Type III B. A brief review on etiopathogenesis, radiographic features and treatment of dens invaginatus has also been included.

A Rare Case of Radicular Dens in Dente diagnosed by Clinical, Radiographic, Tomographic, and Histopathological Examinations

“…Similarly, some authors also reported cases of impacted radicular dens invaginatus. 6,12 Radiographic analysis allowed the observation of an area with high radiopacity compatible with enamel around every dental element, including the radicular portion, a characteristic also observed by other authors, 10 which contributed to ruling out the possibility of this amorphous dental element, the gemination tooth, or the fusion with a supernumerary tooth. To obtain further evidence for the diagnosis, and allow the surgery to be performed accurately and safely, we nominated for CBCT.…”

“…4 Teeth with dens invaginatus may have esthetic compromise, occlusal problems, early development of caries and subsequent necrosis of the pulp, 5 or tooth impaction. 6 The treatment of dens invaginatus depends on the degree of invagination and morphological abnormalities, and may include prevention of dental caries and dental restoration to more radical procedures, such as endodontic treatment 5 or extraction of the affected tooth. 1,6,7 The early diagnosis of all forms of dens invaginatus is fundamental for the correct treatment.…”

“…6 The treatment of dens invaginatus depends on the degree of invagination and morphological abnormalities, and may include prevention of dental caries and dental restoration to more radical procedures, such as endodontic treatment 5 or extraction of the affected tooth. 1,6,7 The early diagnosis of all forms of dens invaginatus is fundamental for the correct treatment. In some cases, cone beam computed tomography (CBCT) might be necessary in addition to clinical and conventional radiograph examinations for a more precise diagnosis of tooth morphology.…”

Dens invaginatus in a geminated maxillary lateral incisor

“…There are other classifications of DI in the literature (Ulmansky and Hermel,7 Vincent-Townend,4 and Schulze and Brand8), but Oehler's classification is widely accepted for its simplicity and ease of practical application 9 10. The types of DI vary in frequency of occurrence with type 3 being the rarest, comprising 5%, compared to type 1 (79%) and type 2 (15%) 9 11…”

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

“…In teeth affected by DI, the invagination of enamel organ and the presence of malformed or absent enamel cause the accumulation of debris, facilitating the fast progression of dental caries and subsequent involvement of the pulp, leading to periapical or periodontal abscess (Kaneko et al, 2011;Kallianpur et al, 2012;Ceyhanli et al;Vier-Pelisser et al, 2014;Capar et al). Thus, the dental problems in DI are mainly related to the degree of bacterial invasion along the enamel invagination (Narayana et al, 2012).…”