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Wei C, Wang D, Shen L, Lu P, Meng Z, Zhou R. Treatment opinions for dens invaginatus: A case series. Exp Ther Med 2024; 27:138. [PMID: 38476914 PMCID: PMC10928843 DOI: 10.3892/etm.2024.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
Dens invaginatus (DI) is a rare congenital dental malformation characterized by enamel or cementum folded into dentine. Such teeth are susceptible to caries, pulp infection or necrosis and periradicular lesion. The complex anatomy of this disease results in difficult treatment and a high rate of therapeutic failure. Therapeutic options, such as debriding and filling invagination, root canal treatment (RCT) and intentional replantation, vary according to the morphology and infection of the involved tooth. The present study reports five cases of DI with chronic apical periodontitis. The treatment strategies and procedures, including RCT, removing the invagination, intentional replantation and surgical treatment, are discussed according to the classification and the condition of pulp and periapical tissue. The study also reports the prognosis: All patients were followed up for ≥12 months and all teeth demonstrated periapical healing and clinical asymptomatic. In summary, appropriate treatment is based on accurate analysis of the anatomical variation in different types of DI and intentional replantation is a reliable and viable treatment to preserve the tooth.
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Affiliation(s)
- Chengshi Wei
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Dong Wang
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Lili Shen
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Ping Lu
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Zhen Meng
- Biomedical Laboratory, Medical School of Liaocheng University, Liaocheng, Shandong 252000, P.R. China
| | - Rongjing Zhou
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
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2
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Siqueira JF, Rôças IN, Hernández SR, Brisson-Suárez K, Baasch AC, Pérez AR, Alves FRF. Dens invaginatus: clinical implications and antimicrobial endodontic treatment considerations. J Endod 2021; 48:161-170. [PMID: 34902355 DOI: 10.1016/j.joen.2021.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023]
Abstract
Dens invaginatus or dens in dente is a developmental dental anomaly resulting from an invagination of the enamel organ into the dental papilla during odontogenesis. Radiographically, it is usually seen as a radiolucent invagination surrounded by a radiopaque area (enamel) limited to the tooth crown or extending into the root. Because the invagination is opened to the oral cavity, it can retain saliva, food remnants, and bacteria. In conditions that the enamel lining of the invagination is naturally absent or lost due to caries, bacterial cells and products can diffuse from the invagination through the dentin tubules to reach the pulp and cause disease. Management of teeth with dens invaginatus include preventive sealing or filling of the invagination, or, if the pulp is affected, therapeutical options include vital pulp therapy, nonsurgical root canal treatment, apexification or regenerative endodontic procedures, periradicular surgery, intentional replantation, or extraction. It is recommended that the invagination be always approached, regardless of the type of dens invaginatus. The root canal should be treated whenever the pulp is irreversibly inflamed or necrotic. Endodontic management of teeth with dens invaginatus is often tricky because of its anatomical complexity, and special and customized strategies should be devised. This review discusses the endodontic implications of this anomaly and the current treatment recommendations based on anatomic, pathologic, and technologic considerations.
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Affiliation(s)
- José F Siqueira
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil
| | - Isabela N Rôças
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil
| | - Sandra R Hernández
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil; Department of Endodontics, Francisco Marroquín University, Guatemala City, Guatemala
| | - Karen Brisson-Suárez
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil
| | - Alessandra C Baasch
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil; Department of Endodontics, Santa María University, Caracas, Venezuela
| | - Alejandro R Pérez
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil; Department of Endodontics, University Rey Juan Carlos. Madrid, Spain
| | - Flávio R F Alves
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil.
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3
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KÖSE E, AK R. Evaluation of C-shaped canal configuration in maxillary molars: A retrospective cone-beam computed tomography study. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.785232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Pradhan B, Gao Y, He L, Li J. Non-surgical Removal of Dens Invaginatus in Maxillary Lateral Incisor Using CBCT: Two-year Follow-up Case Report. Open Med (Wars) 2019; 14:767-771. [PMID: 31667354 PMCID: PMC6814960 DOI: 10.1515/med-2019-0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/12/2019] [Indexed: 02/05/2023] Open
Abstract
A 14-year female presented with an atypical looking tooth #7 with a sinus tract on tooth #8. A gutta-percha point inserted into the sinus tract confirmed the affected tooth #7. A radiographic examination of tooth showed a lateral radiolucency with respect to tooth #7. Cone-beam computed tomographic imaging was done for the three-dimensional reconstruction analysis. Dens invaginatus (Oehler's type III) with pulp necrosis and chronic apical periodontitis was the definitive diagnosis. Use of the dental operating microscope and ultrasonics helped in the removal of the invaginated structure. At the two year follow-up, no clinical and radiographic evidence of infection was observed.
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Affiliation(s)
- Babita Pradhan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics West China Hospital of Stomatology, Sichuan University, #14, 3rd Section of RenMin South Road,Chengdu 610041, Chengdu, China
| | - Yuan Gao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics West China Hospital of Stomatology, Sichuan University, #14, 3rd Section of RenMin South Road,Chengdu 610041, Chengdu, China
| | - Libang He
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics West China Hospital of Stomatology, Sichuan University, #14, 3rd Section of RenMin South Road,Chengdu 610041, Chengdu, China
- E-mail:
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics West China Hospital of Stomatology, Sichuan University, #14, 3rd Section of RenMin South Road,Chengdu 610041, Chengdu, China
- E-mail:
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5
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Sharma S, Wadhawan A, Rajan K. Combined endodontic therapy and peri-radicular regenerative surgery in the treatment of dens invaginatus type III associated with apicomarginal defect. J Conserv Dent 2018; 21:696-700. [PMID: 30546221 PMCID: PMC6249934 DOI: 10.4103/jcd.jcd_311_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dens invaginatus (DI) is a dental developmental abnormality, probably resulting from an infolding of the dental papilla during tooth development. The following case report presents a case of Type III DI with apicomarginal defect and peri-radicular lesion, diagnosed with cone-beam computed tomography scan and treated with combined orthograde endodontic therapy and peri-radicular regenerative surgery. Follow-up examination at 2 years revealed uneventful healing and improvement in the status of the tooth-supporting structures.
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Affiliation(s)
- Sidhartha Sharma
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Wadhawan
- Department of Periodontics, Subharti Dental College, Meerut, Uttar Pradesh, India
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Management of dens invaginatus in a maxillar lateral incisor with open apex and persistent sinus tract: A case report. BALKAN JOURNAL OF DENTAL MEDICINE 2018. [DOI: 10.2478/bjdm-2018-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background/Aim: Dens invaginatus is a developmental anomaly of teeth. The endodontic treatment of these teeth may be difficult because of adversity in accessing the root canals and also complicated variations of internal structure. In this case, the report is presented the nonsurgical management and follow-up of a tooth with class II dens invaginatus with an open apex and sinus tract. Case Report: In the radiographic examination, there are two root canals; a primary (main) canal and an invaginated canal. The main canal wide-open at the portal of exit and associated with a large chronic periapical lesion extending to the apex of the maxillary left central incisor. An invaginated canal was not reaching the apex. In a clinical examination, a sinus tract was detected in the labial gingiva. After apexification with using MTA was applied, the endodontic treatment was completed. In 12 month recall, a gray discoloration was detected and internal bleaching with 35% hydrogen peroxide was applied. Finally, the tooth was restored using composite resin. 12 months follow-up radiographs revealed resolution of periapical radiolucency, trabecular bone formation, and closure of the root apex with the totally asymptomatic tooth. Conclusions: The case report shows that tooth with DI that has wide apex and sinus tract can be treated with non-surgical methods, such as immature tooth without anomalies.
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7
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Zhu J, Wang X, Fang Y, Von den Hoff JW, Meng L. An update on the diagnosis and treatment of dens invaginatus. Aust Dent J 2017; 62:261-275. [PMID: 28306163 DOI: 10.1111/adj.12513] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 12/15/2022]
Affiliation(s)
- J Zhu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
- Affiliated Zhongshan Hospital; Sun Yat-sen University; Zhongshan China
| | - X Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - Y Fang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - JW Von den Hoff
- Department of Orthodontics and Craniofacial Biology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - L Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
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Sinha DJ, Sinha AA, Prakash P, Jaiswal N. Endodontic Management of Maxillary First Molar with Five Root Canals, Including Two Distobuccal Root Canals: A Case Report. THE BULLETIN OF TOKYO DENTAL COLLEGE 2016; 57:37-41. [PMID: 26961335 DOI: 10.2209/tdcpublication.57.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Multiple canals in the root are part of the normal morphology of the tooth. A canal may sometimes be overlooked, however, and this may lead to failure of treatment. The first step in successful endodontic treatment, therefore, is gaining access to the pulp chamber and locating all the canals. In order to achieve this goal, practitioners need to be familiar with all possible variations in root canal morphology, and should thoroughly explore roots to ensure that all canals are identified, debrided, and obturated. Here, we report the diagnosis, treatment planning, and endodontic management of a maxillary first molar with five root canals, including two distobuccal root canals, in a 22-year-old woman.
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Affiliation(s)
- Dakshita Joy Sinha
- Department of Conservative Dentistry and Endodontics, Kothiwal Dental College Research Centre and Hospital
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Kharangate N, Figueiredo NR, Fernandes M, Lambor R. Bilateral dens invaginatus in the mandibular premolars - Diagnosis and treatment. Contemp Clin Dent 2015; 6:428-31. [PMID: 26321850 PMCID: PMC4550002 DOI: 10.4103/0976-237x.161911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dens invaginatus (DI) is a developmental anomaly that results from an infolding of the dental papilla during tooth development and simulates the appearance of a tooth within another tooth. It shows a wide spectrum of variations in morphology and usually affects the maxillary lateral incisors. This study presents an unusual case of an Oehlers’ Type I DI involving the bilateral mandibular first and second premolars, which presented as an incidental radiographic finding in the first premolars and was associated with a periapical lesion in the second premolars which was successfully treated using nonsurgical endodontics.
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Affiliation(s)
- Nupur Kharangate
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Nigel R Figueiredo
- Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Marina Fernandes
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Rajan Lambor
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
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Wall A, Ng S, Djemal S. The value of cone beam CT in assessing and managing a dilated odontome of a maxillary canine. DENTAL UPDATE 2015; 42:126-8. [PMID: 26058225 DOI: 10.12968/denu.2015.42.2.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A case of an unusual anomaly in a maxillary canine is described. A deep enamel invagination resulted in pulpal necrosis, longstanding infection and development of an associated radicular cyst. Diagnostic X-ray imaging was invaluable in demonstrating the complex root anatomy of the dilated odontome. In particular, a cone beam CT scan helped in the formulation of an appropriate treatment plan. Clinical Relevance: Three-dimensional imaging using cone beam CT was valuable in this case to demonstrate the complicated anatomy of a rare dental anomaly, and to help plan treatment.
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Pallivathukal RG, Misra A, Nagraj SK, Donald PM. Dens invaginatus in a geminated maxillary lateral incisor. BMJ Case Rep 2015; 2015:bcr-2015-209672. [PMID: 26002668 DOI: 10.1136/bcr-2015-209672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dens invaginatus (DI) and gemination are two developmental abnormalities that are well reported in the dental literature, but their coexistence in a single tooth is rare. Such situations worsen the risk factors associated with these anomalies, and the treatment plan should be customised as they possess altered morphology and anatomy. A 19-year-old girl came for evaluation of a cracked tooth in the front region of the upper jaw. The tooth showed clinical features of gemination and radiographic features of DI, and was diagnosed as DI in geminated maxillary lateral incisor. The differential diagnoses based on clinical appearance without radiographic investigation may warrant the treatment approach if these two abnormalities coexist in a single tooth. The report also highlights the importance of three-dimensional imaging in diagnosis and treatment planning of teeth with altered pulp canal anatomy. There are few reported cases in the literature detailing the treatment options for these two anomalies occurring in the same tooth.
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Affiliation(s)
| | - Alok Misra
- Faculty of Dentistry, Department of Conservative and Endodontics, Melaka-Manipal Medical College, Melaka, Malaysia
| | - Sumanth Kumbargere Nagraj
- Faculty of Dentistry, Department of Oral Medicine, Oral Diagnosis and Oral Radiology, Melaka-Manipal Medical College, Melaka, Malaysia
| | - Preethy Mary Donald
- Faculty of Dentistry, Department of Oral Medicine, Oral Diagnosis and Oral Radiology, Melaka-Manipal Medical College, Melaka, Malaysia
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Sharma D, Kaur R, Monga S, Kaur S, Kundra R. Diagnostic imaging: Morphological and eruptive disturbances in the permanent teeth. World J Stomatol 2015; 4:72-80. [DOI: 10.5321/wjs.v4.i2.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/04/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
This paper reviewed the literature on newer three-dimensional imaging techniques and their applications in diagnosis and treatment planning of various dental anomalies. Developmental anomalies can occur during any of the developmental stages and are manifested clinically after the tooth is fully formed. These dental anomalies may involve a single tooth, a group of teeth, or the entire dentition. Two-dimensional diagnostic imaging, including periapical, occlusal, panoramic, or cephalometric radiographs are essential in localization and management of morphological and eruptive disorders. However, due to their inherent limitations such as insufficient precision because of unusual projection errors and lack of information about spatial relationships, these methods are considered unreliable. Thus, the use of newer image acquisition techniques that allow comprehensive three dimensional imaging and visualization of dental abnormalities is highly recommended for making a confirmatory diagnosis. The significance of accurate endodontic, surgical and orthodontic treatment planning in dental abnormalities cannot be overstated as it pertains to critical anatomic landmarks such as proximity to adjacent teeth or the mandibular canal. The precise information on spatial relationships provided by multiplanar imaging helps the dental surgeon to establish more accurate diagnosis, management strategies and also increases the patient safety. This review highlights the use of high-end diagnostic imaging modalities in diagnosis of the various morphologic and eruptive dental abnormalities.
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Temilola DO, Folayan MO, Fatusi O, Chukwumah NM, Onyejaka N, Oziegbe E, Oyedele T, Kolawole KA, Agbaje H. The prevalence, pattern and clinical presentation of developmental dental hard-tissue anomalies in children with primary and mix dentition from Ile-Ife, Nigeria. BMC Oral Health 2014; 14:125. [PMID: 25323952 PMCID: PMC4210612 DOI: 10.1186/1472-6831-14-125] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study of dental anomalies is important because it generates information that is important for both the anthropological and clinical management of patients. The objective of this study is to determine the prevalence and pattern of presentation of dental hard-tissue developmental anomalies in the mix dentition of children residing in Ile-Ife, a suburban region of Nigeria. METHODS Information on age, sex and socioeconomic status was collected from 1,036 children aged four months to 12 years through a household survey. Clinical examination was conducted to assess the presence of dental anomalies. Associations between age, sex, socioeconomic status, prevalence, and pattern of presentation of the developmental hard-tissue dental anomalies were determined. RESULT Two hundred and seventy six (26.6%) children had dental anomalies. Of these, 23.8% had one anomaly, 2.5% had two anomalies, and 0.3% had more than two anomalies. Of the children with anomalies, 49.3%were male, 50.7%were female, and 47.8%, 28.6% and 23.6% were children from low, middle and high socioeconomic classes, respectively. More anomalies were seen in permanent than primary dentition. Anomalies of tooth structure were most prevalent (16.1%); anomalies which affect tooth number were least prevalent (1.3%). Dens evaginatus, peg-shaped lateral, macrodontia, and talon cusp were more prevalent in the permanent dentition, and dens evaginatus peg-shaped lateral and macrodontia were more prevalent in the maxilla. There were significantly more macrodontia anomalies in males and in children of high socioeconomic status. CONCLUSION This large survey of dental hard-tissue anomalies found in the primary dentition and mixed dentition of children in Nigeria provides anthropological and clinical data that may aid the detection and management of dental problems of children in Nigeria.
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Affiliation(s)
| | - Morenike Oluwatoyin Folayan
- />Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- />Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olawunmi Fatusi
- />Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- />Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Nneka Onyejaka
- />Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Elizabeth Oziegbe
- />Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- />Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Titus Oyedele
- />Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Kikelomo Adebanke Kolawole
- />Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- />Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Hakeem Agbaje
- />Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Abstract
AbstractThe aim of the study was to evaluate 10-years of clinical material referring to the rare dental abnormality of double teeth. The study material consisted of case records, operation-books and radiographic or photographic documentation on patients treated in the Department of Oral Surgery, Silesian Medical University, Katowice, from the 1st of June 2000 to the 31st of May 2010. The following features were considered important: age and sex, the reason why the patient reported for treatment, general state of health, the time of recognition and type of double teeth, location of double teeth, complaints and disturbances connected with double teeth, types of radiographs, the radiographic and macroscopic appearance of double teeth and treatment method. Diagnoses were as follows: eight conrescent teeth, two fused teeth, two geminated teeth and one invaginated tooth. The anomaly of a deciduous tooth was referred to in one case only. Double teeth were most often seen in the region of maxillary incisors and molars but rarely in the mandible. The region of incisors was affected chiefly in children and the region of molars in adults. Double incisors are usually recognized prior to treatment whereas double molars as late as during their extraction. In many cases, neither intraoral radiographs nor pantomographs help to confirm double teeth or provide sufficient information to plan the treatment. In such a situation, CT or CBCT should be used in addition to imaging diagnostics. Double teeth among incisors are usually accompanied by occlusal disorders. Therefore the therapeutic management is conducted by a team, including orthodontists.
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An Immature Type II Dens Invaginatus in a Mandibular Lateral Incisor with Talon's Cusp: A Clinical Dilemma to Confront. Case Rep Dent 2014; 2014:826294. [PMID: 24660071 PMCID: PMC3934391 DOI: 10.1155/2014/826294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/15/2013] [Indexed: 12/02/2022] Open
Abstract
Dens invaginatus (DI) is a malformation of teeth probably resulting from an infolding of the dental papilla during tooth development. DI is classified as type I, II, and III by Oehlers depending on the severity of malformation. The maxillary lateral incisor is the most commonly affected tooth. Structural defects do exist in the depth of the invagination pits, and as a consequence, the early development of caries and the subsequent necrosis of the dental pulp, as well as abscess and cyst formation are clinical implications associated with DI. Occasionally, we can see more than one developmental anomaly occurring in a single tooth. In such cases it becomes important to identify the anomalies and initiate a proper treatment plan for good prognosis. In this paper, an unusual case of DI which clinically presented as a huge talons cusp affecting a mandibular lateral incisor tooth is described. This case report illustrates grinding of the talons cusp followed by nonsurgical endodontic management of dens invaginatus type II with an immature apex and periapical lesions, in which Mineral Trioxide Aggregate (MTA) shows a complete periapical healing with bone formation at the site of the lesions.
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Vier-Pelisser FV, Morgental RD, Fritscher G, Ghisi AC, Borba MGD, Scarparo RK. Management of Type III Dens Invaginatus in a Mandibular Premolar: A Case Report. Braz Dent J 2014; 25:73-8. [DOI: 10.1590/0103-6440201302351] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 02/12/2014] [Indexed: 02/08/2023] Open
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.
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G. S, Jena A. Prevalence and Incidence of Gemination and Fusion in Maxillary Lateral Incisors in Odisha population and Related Case Report. J Clin Diagn Res 2013; 7:2326-9. [PMID: 24298521 PMCID: PMC3843463 DOI: 10.7860/jcdr/2013/5677.3516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 06/05/2013] [Indexed: 11/24/2022]
Abstract
AIM A survey was conducted to analyze the prevalence and incidence of dental anomalies in relation to maxillary lateral incisors in the Odisha population. A multidisciplinary approach for aesthetic management of a geminated tooth is described. MATERIAL AND METHODS A total of 1062 subject, aged between 15-30 years (724 males and 338 Females) were randomly screened at Institute of Dental Sciences, Bhubaneswar, Odisha India. Each subject was examined clinically and radiovisuographically for dental anomalies in relation to maxillary lateral incisors. In the related case described, endodontic management and aesthetic correction of geminated maxillary lateral incisors was done. RESULTS Five dental anomalies i.e. gemination, fusion, missing lateral incisors (both unilateral and bilateral), peg shaped incisors (unilateral and bilateral), and dens in dente were observed. Anomalies found were Peg shaped; 2.82%, Missing;1.88%, Gemination;0.28%, Fusion;0.18% and Dens in Dente;0.18%. CONCLUSION Comparison of these results with that of other studies indicated that anomalies in lateral incisors occur at different frequencies among various countries and communities in the world. In the case since maxillary lateral incisors are in the aesthetic zone, recognizing these anomalies will facilitate a successful treatment.
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Affiliation(s)
- Shashirekha G.
- Reader, Department of Conservative Dentistry & Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, 751003, Odisha, India
| | - Amit Jena
- Reader, Department of Conservative Dentistry & Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, 751003 Odisha, India
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18
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Purra AR, Mushtaq M, Robbani I, Farooq R. Spiral computed tomographic evaluation and endodontic management of a mandibular second molar with four roots. A case report and literature review. IRANIAN ENDODONTIC JOURNAL 2013; 8:69-71. [PMID: 23717333 PMCID: PMC3662040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 06/12/2012] [Accepted: 07/28/2012] [Indexed: 11/23/2022]
Abstract
The vast majority of mandibular second molars have two roots with three root canals; however, variations in molar root canal anatomy are not uncommon. To the best of our knowledge, four rooted mandibular second molar with three mesial roots and one distal root has never been reported. Herein, we present the endodontic management of a four rooted mandibular second molar tooth, diagnosed with the assistance of spiral computed tomography (SCT) with a brief review of literature.
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Affiliation(s)
- Aamir Rashid Purra
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital Srinagar, India
| | - Mubashir Mushtaq
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital Srinagar, India,Corresponding author at: Mubashir Mushtaq, Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital Srinagar, Kashmir, India, Tel.: +91-9205021057, E-mail:
| | - Irfan Robbani
- Department of Radio diagnosis, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India
| | - Riyaz Farooq
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital Srinagar, India
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19
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Endodontic Treatment of Type II Dens Invaginatus in a Maxillary Lateral Incisor: A Case Report. Case Rep Dent 2012; 2012:153503. [PMID: 23213576 PMCID: PMC3507043 DOI: 10.1155/2012/153503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 10/27/2012] [Indexed: 11/17/2022] Open
Abstract
Dens invaginatus is a developmental anomaly that results in an enamel-lined cavity intruding into the crown or root before the mineralization phase. It typically affects permanent maxillary lateral incisors, central incisors, and premolars. This paper describes the root canal treatment of Oehlers' type II dens invaginatus in maxillary left lateral incisors. A 16-year-old boy presented to the Faculty of Dentistry, University of Kocaeli, to receive his dental treatments. During the caries removal, the pulp was exposed then anendodontic treatment was initiated. Two canals, one of which represented the invagination, were instrumented, irrigated, and then obturated with a lateral condensation technique.
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20
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Kfir A, Telishevsky-Strauss Y, Leitner A, Metzger Z. The diagnosis and conservative treatment of a complex type 3 dens invaginatus using cone beam computed tomography (CBCT) and 3D plastic models. Int Endod J 2012; 46:275-88. [PMID: 23137215 DOI: 10.1111/iej.12013] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 08/24/2012] [Indexed: 12/15/2022]
Abstract
AIM To investigate the use of 3D plastic models, printed from cone beam computed tomography (CBCT) data, for accurate diagnosis and conservative treatment of a complex case of dens invaginatus. SUMMARY A chronic apical abscess with a draining sinus tract was diagnosed during the treatment planning stage of orthodontic therapy. Radiographic examination revealed a large radiolucent area associated with an invaginated right maxillary central incisor, which was found to contain a vital pulp. The affected tooth was strategic in the dental arch. Conventional periapical radiographs provided only partial information about the invagination and its relationship with the main root canal and with the periapical tissues. A limited-volume CBCT scan of the maxilla did not show evidence of communication between the infected invagination and the pulp in the main root canal, which could explain the pulp vitality. A novel method was adopted to allow for instrumentation, disinfection and filling of the invagination, without compromising the vitality of the pulp in the complex root canal system. The CBCT data were used to produce precise 3D plastic models of the tooth. These models facilitated the treatment planning process and the trial of treatment approaches. This approach allowed the vitality of the pulp to be maintained in the complex root canal space of the main root canal whilst enabling the healing of the periapical tissues. KEY LEARNING POINTS Even when extensive periapical pathosis is associated with a tooth with type III dens invaginatus, pulp sensibility tests should be performed. CBCT is a diagnostic tool that may allow for the management of such teeth with complex anatomy. 3D printed plastic models may be a valuable aid in the process of assessing and planning effective treatment modalities and practicing them ex vivo before actually performing the clinical procedure. Unconventional technological approaches may be required for detailed treatment planning of complex cases of dens invaginatus.
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Affiliation(s)
- A Kfir
- Department of Endodontology, Tel Aviv University, Tel Aviv, Israel.
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21
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Endodontic management of mandibular third molar with three mesial roots using spiral computed tomography scan as a diagnostic aid: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:e6-10. [PMID: 22762918 DOI: 10.1016/j.oooo.2011.10.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 10/15/2011] [Accepted: 10/23/2011] [Indexed: 11/24/2022]
Abstract
Aberrant root canal anatomy is diagnostically and clinically challenging for clinicians. The most common root canal configuration of human molars is 2 roots and 3 canals, but various combinations may still exist. Third molars are known to have the most unusual anatomy among human teeth. Restorative, prosthetic, and orthodontic considerations often require endodontic treatment of third molars in order for them to be retained as functional components of the dental arch. The present case report demonstrates unusual root canal morphology of the mandibular third molar. Roentgenographic examination, which included spiral CT scan, revealed 3 separate mesial roots in tooth #48 with 3 independent canals and 3 canal orifices, indicating an endodontic rarity. The present case report puts impetus on exploration of additional canals using advanced diagnostic aids, such as spiral computed tomography, which can have a huge impact on the successful outcome of endodontic therapy.
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22
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Falcao LDS, de Freitas PS, Marreiro RDO, Garrido ADB. Management of dens invaginatus type III with large periradicular lesion. J Contemp Dent Pract 2012; 13:119-24. [PMID: 22430705 DOI: 10.5005/jp-journals-10024-1106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM This study describes a clinical case of type III dens invaginatus with an extensive periradicular lesion treated successfully. BACKGROUND Dens invaginatus is a maldevelopment of the dental germ which occurs as a result of the invagination of the enamel organ. These cases may present difficulties with respect to its diagnosis and treatment because of canal morphology. The success of endodontic therapy requires a knowledge of dental anatomy and its anomalies. CASE REPORT A 17-year-old female patient is reported presenting right maxillary lateral incisor (tooth no. 7) classified as type III dens invaginatus with necrotic pulp and presence of an extensive radiolucid lesion. Endodontic treatment was recommended for tooth. However, intracanal exudate was present, suggesting a resistant infection. Enucleation of the lesion was performed as a complementary approach. The root canal obturation was carried out by the gutta-percha thermoplastification technique with root canal sealer, followed by restoration of the tooth. Healing of the lesion with hard tissue formation was confirmed at follow-up. CONCLUSION A combination of endodontic and surgical treatments were fundamental to the maintenance of the tooth. The treatment was considered successful. CLINICAL SIGNIFICANCE Root canal therapy of dens invaginatus should be based on a thorough clinical and radiographic evaluation. The knowledge of classification and anatomical variations of teeth with dens invaginatus are of great importance for correct treatment.
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Vier-Pelisser FV, Pelisser A, Recuero LC, Só MVR, Borba MG, Figueiredo JAP. Use of cone beam computed tomography in the diagnosis, planning and follow up of a type III dens invaginatus case. Int Endod J 2011; 45:198-208. [PMID: 21978185 DOI: 10.1111/j.1365-2591.2011.01956.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To present the case of a maxillary left lateral incisor with Oehlers' type III dens invaginatus in which cone beam computed tomography (CBCT) was used as an adjunctive resource in the diagnosis as well as in the planning and 2-year follow-up of the nonsurgical/surgical treatment. SUMMARY The tooth had two root canals: a primary (main) canal with vital pulp that appeared to be closed apically and an invaginated canal that was necrotic, wide-open at the portal of exit and associated with a large chronic periapical lesion extending to the apex of the maxillary left central incisor. Radiographic tracking of a sinus tract in the labial gingiva of the affected tooth with a gutta-percha point revealed its origin to be the invagination. The CBCT scans revealed that the periapical radiolucency was significantly larger than seen radiographically as well as an increased thickness of the buccal cortical plate. Conventional root canal treatment of the primary canal was undertaken. As nonsurgical access to the invaginated canal was not possible, endodontic surgery was performed for curettage of the lesion, root-end cavity preparation using ultrasonic tips and root canal filling with white mineral trioxide aggregate (MTA). CBCT scanning after 17 months and clinical and radiographic follow-up after 24 months revealed complete periapical repair and absence of symptoms. KEY LEARNING POINTS The combination of nonsurgical and surgical treatments produced periapical repair in a tooth with type III dens invaginatus with two root canals. CBCT may aid the diagnosis as well as the management plan and follow-up of teeth with this developmental anomaly.
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Affiliation(s)
- F V Vier-Pelisser
- Post-Graduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brazil.
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24
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Chakradhar Raju RVS, Sathe N, Morisetty PK, Veeramachaneni C. Endodontic management of a maxillary first molar with unusual location of second mesio buccal orifice. J Conserv Dent 2011; 13:162-4. [PMID: 21116395 PMCID: PMC2980616 DOI: 10.4103/0972-0707.71652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/15/2010] [Accepted: 05/25/2010] [Indexed: 11/04/2022] Open
Abstract
Maxillary first molar can have a mesio-buccal-2 (MB2) orifice located palatally, but adjacent to the mesio buccal orifice. An awareness and understanding of this root canal morphology can contribute to the successful outcome of root canal treatment. This report discusses endodontic treatment of a maxillary first molar with unusual location of second mesio buccal orifice. Conventional diagnostic aids such as radiographs play an important role in assessment of complex root canal morphologies. These modalities, however, do not provide detailed information of the complexity as a result of their inherent limitations. This article discusses the variations in the orifice location and the use of latest adjuncts in successfully diagnosing and negotiating them.
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Affiliation(s)
- R V S Chakradhar Raju
- Department of Conservative dentistry, Mamata Dental College, Khammam, Andhra Pradesh, India
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25
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Kaneko T, Sakaue H, Okiji T, Suda H. Clinical management of dens invaginatus in a maxillary lateral incisor with the aid of cone-beam computed tomography - a case report. Dent Traumatol 2011; 27:478-83. [DOI: 10.1111/j.1600-9657.2011.01021.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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26
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Borges AH, Semenoff Segundo A, Nadalin MR, Pedro FLM, da Cruz Filho AM, Sousa-Neto MD. Conventional Treatment of Maxillary Incisor Type III Dens Invaginatus with Periapical Lesion: A Case Report. ISRN DENTISTRY 2010; 2011:257609. [PMID: 21991460 PMCID: PMC3170019 DOI: 10.5402/2011/257609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 09/26/2010] [Indexed: 12/31/2022]
Abstract
Dens invaginatus is a developmental dental anomaly clinically characterized by a palatine furrow that can be limited to the coronal pulp or may extend to the radicular apex. The purpose of this paper was to present a clinical case of type III dens invaginatus, identified on the maxillary right central incisor in anterior periapical radiographs, in which the tooth was submitted to conventional endodontic treatment. The results obtained after five years of clinical and radiographic followup demonstrated that conventional endodontic treatment is a clinically viable alternative in cases of type III dens invaginatus.
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Affiliation(s)
- Alvaro Henrique Borges
- School of Dentistry, University of Ribeirão Preto (UNAERP), 14096-900 Ribeirão Preto, SP, Brazil
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27
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Affiliation(s)
- Roy George
- Griffith University School of Dentistry and Oral Health, Southport, Queensland, Australia
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28
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Singla M, Aggarwal V. C-Shaped palatal canal in maxillary second molar mimicking two palatal canals diagnosed with the aid of spiral computerized tomography. ACTA ACUST UNITED AC 2010; 109:e92-5. [DOI: 10.1016/j.tripleo.2010.01.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
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29
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Endodontic management of a mandibular first molar with three distal canals confirmed with the aid of spiral computerized tomography: A case report. ACTA ACUST UNITED AC 2009; 108:e77-81. [DOI: 10.1016/j.tripleo.2009.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 06/20/2009] [Accepted: 06/25/2009] [Indexed: 11/18/2022]
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30
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Chung MP, Chen CP, Shieh YS. Floating retained root lesion mimicking apical periodontitis. ACTA ACUST UNITED AC 2009; 108:e63-6. [PMID: 19716723 DOI: 10.1016/j.tripleo.2009.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 05/12/2009] [Indexed: 10/20/2022]
Abstract
A case of a retained root tip simulating apical periodontitis on radiographic examination is described. The retained root tip, originating from the left lower first molar, floated under the left lower second premolar apical region mimicking apical periodontitis. It appeared as an ill-defined periapical radiolucency containing a smaller radiodense mass on radiograph. The differential diagnosis included focal sclerosing osteomyelitis (condensing osteitis) and ossifying fibroma. Upon exicisional biopsy, a retained root associated with granulation tissue was found. After 1-year follow-up, the patient was asymptomatic and the periradicular lesion was healing. Meanwhile, the associated tooth showed a normal response to stimulation testing.
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Affiliation(s)
- Ming-Pang Chung
- Department of Operative Dentistry and Endodontics, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
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31
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Demartis P, Dessì C, Cotti M, Cotti E. Endodontic treatment and hypotheses on an unusual case of dens invaginatus. J Endod 2009; 35:417-21. [PMID: 19249608 DOI: 10.1016/j.joen.2008.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 11/30/2008] [Accepted: 12/12/2008] [Indexed: 11/16/2022]
Abstract
This work describes a case of "dens invaginatus" and analyzes the possible aspects of this malformation. An unusual type of dens invaginatus was detected in a young patient corresponding to the maxillary lateral incisor and showing extensive periradicular radiolucency and a vestibular fistula. The radiographic and tomographic examination revealed two apices: one wide open in the distal part of the root and the other normally formed in the mesial. Nonsurgical endodontic treatment was performed by using the "one-step apexification technique," filling both apexes with mineral trioxide aggregate followed by composite resin. The follow-up examination 6 months later showed the healing of the radiolucent area and the healing of the sinus tract. Hypotheses on which was the type of dens invaginatus we had to deal with are formulated.
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Affiliation(s)
- Paola Demartis
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
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32
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Aggarwal V, Singla M, Logani A, Shah N. Endodontic Management of a Maxillary First Molar with Two Palatal Canals with the Aid of Spiral Computed Tomography: A Case Report. J Endod 2009; 35:137-9. [DOI: 10.1016/j.joen.2008.10.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 09/29/2008] [Accepted: 10/05/2008] [Indexed: 11/15/2022]
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