Management of Type III Dens Invaginatus in a Mandibular Premolar: A Case Report

Abstract

Dens invaginatus is a well-known malformation of teeth, which probably results from an invagination of enamel organ into dental papilla during tooth development. The endodontic treatment of invaginated teeth may be challenging due to difficulties in accessing the root canals and also due to complex variations of internal morphology. This article presents the endodontic management and follow-up in a rare case of right mandibular second premolar with Oehlers' type III dens invaginatus. The result of cold pulp testing was positive for this tooth but it was associated to a sinus tract and periapical lesion. Herein, it is described the root canal therapy of this tooth combined with periapical surgery, emphasizing the importance of proper diagnosis and planning by using cone beam computed tomography (CBCT). This case report presents the proper periapical healing 6 months after the combination of nonsurgical and surgical treatments. It also shows that CBCT is an important auxiliary examination to avoid errors in diagnosis and subsequent treatment of dental anomalies.

Management of Oehler’s Type III Dens Invaginatus Using Cone Beam Computed Tomography

“…Surgical endodontics in addition to conventional endodontics should be considered only for large periapical lesions not resolved nonsurgically or in cases which cannot be treated nonsurgically due to failure to gain a coronal access. Surgery will provide a disinfection and retrograde seal to the apical portion of the invagination and/root canal which will otherwise retain a source of infection [ 2 , 5 – 7 , 9 , 10 , 16 – 18 ]. The surgical endodontic procedures include apical resection, apical curettage, and retrograde restoration.…”

“…The reported prevalence of adult teeth affected by DI is between 0.3 and 10%. This variation in reported prevalence is attributed to methodological differences in cohort studies, the identification criteria used, and diagnostic difficulties [ 2 , 6 , 7 ].…”

“…If undetected in the early stages this leads to pulp/periodontal pathosis as there are channels between the invagination and the pulp space. The presence of hypomineralized enamel surrounding the invagination predisposes to early involvement of the pulp space through the invagination [ 2 , 4 , 5 , 7 , 10 – 12 ].…”

Management of dens invaginatus in a maxillar lateral incisor with open apex and persistent sinus tract: A case report

“…Dens invaginatus (DI) is a developmental malformation of teeth, that perhaps results from an invagination of enamel organ into dental papilla 1 . DI, further known as 'dens in dente' can spread out to the roots and the pulp cavity, occasionally attaining the apex 2 .…”

Accessibility to the knowledge on anatomical variations from dentomaxillofacial CBCT

“…There exists a very limited range of available subjects of interest accessible for free. Especially there exist no free articles on syndromes except cleidocranial dysplasia[67] (around 5000 syndromes exist in oral and maxillofacial area), and cleft palate patients, on oncology related studies (i.e., osteonecrosis), on bone diseases in oral and maxillofacial area (only 4 diseases presented[40,53,55,56]), on teeth anomalies not related to endodontics (only 1 study on dens invaginatus[41]), on paranasal sinuses (only 2 studies on maxillary sinus[45,47]). There exists no free study on temporal bone, or on soft tissue calcifications on CBCT.…”