Non-surgical Endodontic Treatment for Dens Invaginatus Type III Using Cone Beam Computed Tomography and Dental Operating Microscope: A Case Report

Abstract

Dens invaginatus is a morphological abnormality of the tooth in which the coronal tooth enamel and dentin fold inwards towards the pulp cavity. Dens invaginatus type III (Oehlers: 1957) is characterized by infolding of the enamel and dentin as far as the root apex. This report describes a case of surgical and non-surgical endodontic therapy for a maxillary lateral incisor with type III dens invaginatus, necrotic pulp, and an associated large periradicular lesion. The patient was a 16-year-old man. Periapical radiographs suggested the presence of an untreated area of invagination. Cone beam computed tomography (CBCT) was then used for three-dimensional observation of the morphological details of this area. The CBCT scans revealed invagination and its relationship with the pulp chamber. A dental operating microscope was used to access two primary root canals and the area of invagination. The root canals were then localized, negotiated, enlarged, and filled with calcium hydroxide. Two months later, the canal and invagination were obturated with core-based gutta-percha (FlexPoint Neo: FP core-carrier technique) and restored. Cone beam computed tomography and microscopic techniques allow even complicated cases of dens invaginatus to be diagnosed and treated using non-surgical root canal management.

Diagnosis and Endodontic Management of Fused Mandibular Second Molar and Paramolar with Concrescent Supernumerary Tooth Using Cone-beam CT and 3-D Printing Technology: A Case Report

“…It is now possible to clearly identify points requiring attention in non-surgical endodontic treatment of teeth with a general morphology and to anatomically detect the cause of treatment failure because CBCT can be used to obtain a precise understanding of the 3-D structure of the teeth and dental pulp. There have been many reports on the usefulness of CBCT in the diagnosis and treatment-based management of teeth with a complicated morphology 2,6,8,11,12,14) . In the present case, too, it was possible to clearly distinguish morphological differences between the fusion of a molar and a paramolar and concrescence of a molar and a supernumerary tooth.…”

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

“…In this case, the CT has contributed to diagnosing radicular dens invaginatus, as reported by other authors. 9,12,14 However, confirmation of the diagnosis of type IIIb dens invaginatus could be completed only after histopathological analysis, which revealed the presence of an irregular central cavity that corresponded to the pulp cavity, containing remnants of pulp tissue, and at the periphery we observed a narrow channel with faulty walls circumventing the root dentin.…”

“…In already erupted teeth, the most common manifestations are related to greater predisposition to caries by biofilm accumulation in the area of invagination and consequent ease for damage-associated pulp. 2,5,[9][10][11] Moreover, they can cause occlusal traumas and esthetic effects. 5 In unerupted teeth affected by dens invaginatus, the most common sequelae are related to tooth eruption, as tooth impaction, retention or deviations in the eruption path of neighboring teeth, or occurrence of dentigerous cysts.…”

Nonsurgical endodontic treatment of an invaginatus maxillary lateral incisor: Three case reports

“…Dens invaginatus has been defined as a defect in tooth development, characterized by invagination of the enamel organ into the dental papilla before the calcification phase [2][3][4][5][6][7]. Several terms have been used to define this malformation such as dens in dente, dilated composite odontoma, dens invaginatus.…”

“…Its frequency is reported to be 0.04-10% by Heydari A, et al [3]. Many classifications were proposed but the one by Oehlers (1957) is probably the most clinically relevant [5].…”