A retrospective comparative study of cone-beam computed tomography versus rendered panoramic images in identifying the presence, types, and characteristics of dens invaginatus in a Turkish population

Radiologic evaluation of associated symptoms and fractal analysis of unilateral dens invaginatus cases

OBJECTIVE

The aim of this study is to determine the age-based prevalence of dens invaginatus cases and to learn the radiologic findings. In addition, fractal analysis of the periapical regions of unilateral dens invaginatus cases and contralateral teeth was performed to determine the effect of possible microleakage on fractal dimension.

METHODS

A total of 136 patients (170 teeth) identified in panoramic radiographs taken for diagnostic purposes between January 2018 and December 2023 at our Department of Oral and Maxillofacial Radiology were included in the study. Data were analysed using IBM SPSS V23. The Chi-square test was used for comparing categorical variables between groups. The relationship between the FD values calculated around the apexes of the teeth with unilateral dens invaginatus and the contralateral teeth was analyzed by paired t test. A significance level of p < 0.050 was adopted.

RESULTS

The mean age of the cases was calculated as 28.1 (8-63) years. 66 (48.5%) of the cases were female, and 70 (51.1%) were male. The lateral incisor was the most affected tooth among these cases. Bilateral cases were observed in 34 patients. Type 2 was detected in 93 patients, Type 1 in 35 patients, and Type 3 dens invagination in 8 patients. Dens invaginatus cases were observed in 134 maxillary and 2 mandibular teeth. Periapical lesions were seen in 22 of these cases.

CONCLUSIONS

Dens invaginatus cases are a congenital anomaly encountered at any age. Early diagnosis is crucial to prevent the loss of pulp vitality due to these invaginations. It should be noted that these invaginations can affect both jaws. However, due to the prevalence of occurrence in the maxillary anterior teeth and asymptomatic nonvitality, particular attention should be paid to evaluating this region.

Endodontic management considerations for Type III dens invaginatus based on anatomical characteristics: A case series

Dens invaginatus (DI) is a developmental anomaly of the teeth characterised by the in-folding of the enamel into the dentin. Oehlers' Type III DI is the most serious form, in which the inherently invaginated channels communicate with periodontal and dental pulp tissue, increasing the risk of bacterial contamination. However, varying and complex anatomical features make diagnosis and treatment challenging. Conventional endodontic therapies promote healing by avoiding unnecessary interventions (e.g., surgical or other invasive treatments). Radiographic examination can reveal the structural details of such malformations. We obtained multiple procedural details for treating Type III DI based on radiographic analyses from our clinical experience. In addition, we introduce a new classification strategy for the management of Type III DI that is more applicable to treatment needs. This study aimed to discuss the anatomical features and current treatment considerations of Type III DI.

Application of personalized templates in minimally invasive management of coronal dens invaginatus: a report of two cases

BACKGROUND

Treating the coronal dens invaginatus (CDI) with pulp infection commonly involves the removal of invagination, which increases the risk of perforation and fracture, and compromises the tooth structure. Minimally invasive endodontic management of CDI is highly recommended. This report describes two cases of type II CDI with the application of personalized templates.

CASE PRESENTATION

Two cases of type II CDI, affecting the main root canal in a maxillary canine and a lateral incisor, were diagnosed. A guided endodontics (GE) approach was applied. Cone-beam computed tomography and intraoral scans were imported and aligned in a virtual planning software to design debridement routes and templates. The MICRO principle (which involves the aspects of Mechanical (M) debridement, Irrigation (I), Access cavities (C), Rectilinear routes (R), and Obstruction (O)) was proposed for designing optimal debridement routes for future applications. The templates were innovatively personalized and designed to preserve the tooth structure maximally while effectively debriding the root canal. Root canal treatment with supplementary disinfection was then performed. The follow-up of the two patients revealed favorable clinical and radiographic outcomes.

CONCLUSIONS

The GE approach could be a feasible method for preserving healthy dental structure while effectively debriding the root canal, thereby achieving successful and minimally invasive endodontic treatment for CDI.

Non-surgical and guided-bone-regeneration surgical management of Type-3b dens invaginatus with an apico-marginal defect: A case report

BACKGROUND

Dens invaginatus (DI), an unusual developmental anomaly is a challenge for the operating dentist with regard to its diagnosis and treatment. This case report presents the successful management of a Type-3b DI in a permanent maxillary lateral incisor associated with a large radicular cyst and communicating apico-marginal defect (Von Arx type IIb).

METHODS AND RESULTS

A 19-year-old female patient reported pain and palatal swelling. During the clinical examination, tooth #12 exhibited tenderness to percussion, and presented a deep periodontal pocket depth (PPD) of 12 mm, along with grade I mobility. Radiographic examination revealed a large peri-radicular radiolucency with atypical tooth morphology. Cone beam computed tomography clarified the complicated root canal anatomy to be Type-3b DI associated with an apico-marginal defect. The case was managed successfully by non-surgical endodontic therapy followed by surgical intervention utilizing a guided bone regenerative (GBR) approach. Eighteen-month follow-up showed an asymptomatic and functional tooth with a significant reduction in pocket depth. The periapical radiographs showed continued healing of the osseous defect.

CONCLUSIONS

The successful healing outcome of a challenging case, characterized by a complex DI morphology, a large peri-radicular lesion, a through-and-through defect, and a combined endodontic-periodontal apico-marginal defect was achieved through accurate diagnosis, treatment planning, and execution using contemporary endodontic and periodontal treatment techniques. The application of GBR techniques during the surgical phase of treatment may have contributed to the improved regenerative healing outcome in this case, which was initially considered prognostically questionable.

KEY POINTS

Why is this case new information? Type-3b DI exhibits a complex root canal structure, each case displaying unique characteristics, necessitating a case-specific treatment plan. In this case report the Type-3b DI morphology was associated with a large peri-radicular, through and through defect and combined endodontic periodontal apico-marginal defect. The treatment approach involved incorporating guided bone regenerative (GBR) principles during the surgical phase. This case report contributes to the existing evidence on the diagnosis and successful management of Type-3b DI with a concurrent apico-marginal defect. What are the keys to successful management of this case? The successful management of a prognostically challenging case was achieved through a closely integrated multidisciplinary coordination between the endodontist and periodontist. Utilization of contemporary techniques and tools contributed to the successful management The use of three-dimensional radiological examination through cone beam computed tomography enabled a precise preoperative assessment, facilitating the formulation of a treatment plan for managing both the Type-3b DI morphology and the associated peri-radicular lesion. Employing GBR techniques in peri-radicular surgery may have assisted in the healing of through-and-through periapical defects with concurrent apico-marginal defects (Von Arx type IIb). What are the primary limitations to the success of this case? A complex root canal anatomy associated with Type-3b DI morphology A large peri-radicular through and through defect with concurrent apico-marginal defect. Difficulty in weekly and long-term follow-up of the patient.

Prevalence and morphological analysis of dens invaginatus in anterior teeth using cone beam computed tomography: A systematic review and meta-analysis

OBJECTIVES

To evaluate the prevalence and morphological characteristics of DI using CBCT.

METHODS

A literature search was performed in PubMed, Embase, Scopus, and Web of Science. Inclusion criteria were randomized clinical trials, cross-sectional studies, and prospective and retrospective cohort studies evaluating the morphological characteristics of DI in anterior teeth using CBCT. Three reviewer authors independently screened the studies, applied the eligibility criteria, assessed the risk of bias, and extracted until September (2022). The risk of bias was evaluated using the Joanna Briggs Institute criteria. Meta-analyses of proportions were used for estimate the prevalence DI according to factors at participant and tooth levels.

RESULTS

Six studies were included in the meta-analysis. Among 7373 individuals, a prevalence of 7.45 % of DI was observed (n = 258; τ2 = 0.0096; CI of 4.51-11.3; p < 0.05), with no significant influence of sex. Regarding laterality, unilateral DI showed higher mean prevalence (4.30 %; CI of 2.03-7.33). Among the 382 anterior teeth with DI (0.72 %), the most affected tooth was the upper lateral incisor (5.12 %; n = 329; CI of 2.35-8.86; p < 0.001), type I was the most prevalent (0.59 %; CI of 0.24-1.08) and the presence of open apex and periradicular pathology ranged from 4.3 % to 22.72 % and 3.5-77.92 %, respectively.

CONCLUSIONS

The prevalence of individuals with dens invaginatus was 7.45 %, the most affect tooth was the upper lateral incisor with a prevalence of 5.12 % unilaterally and type I was the most prevalent morphology.

Successful nonsurgical treatment of type II dens invaginatus with 5 root canals using a self-adjusting file: a case report

The present report describes the endodontic treatment of an Oehlers type II dens invaginatus in a maxillary lateral incisor with 5 root canals, an extremely rare condition. Apical periodontitis and related symptoms were noted. Cone-beam computed tomography was used to aid the diagnosis, reveal tooth morphology, and assist in canal location. The pulp chamber was carefully accessed, and the root canals were explored under magnification. All root canals were prepared with an R25 Reciproc Blue system and sodium hypochlorite (NaOCl) irrigation. After initial preparation, a self-adjusting file (SAF) with NaOCl and ethylenediaminetetraacetic acid was used to complement the disinfection. Additionally, calcium hydroxide medication was applied. Vertical compaction was used to fill the canals with a calcium silicate-based endodontic sealer and gutta-percha. After 12 months, the patient exhibited healing of the periapical region, absence of symptoms, and normal dental function. In conclusion, this nonsurgical treatment protocol was successful in promoting the cure of apical periodontitis. Both complementary disinfection with an SAF and use of calcium hydroxide medication should be considered when choosing the best treatment approach for dens invaginatus with very complex anatomy.

Prevalence, classification and dental treatment requirements of dens invaginatus by cone-beam computed tomography

Background

This study aimed the evaluation of the prevalence, characteristics, types of dens invaginatus (DI) and co-observed dental anomalies to understand dental treatment requirements in anterior teeth that are susceptible to developmental anomalies by using cone-beam computed tomography (CBCT).

Methods

In this retrospective study, the anterior teeth of 958 patients were evaluated by using CBCT for the presence of DI. The demographic features, types of DI and treatment requirements were also recorded. The association between sex and the presence of DI was evaluated using chi-squared test.

Results

Seventy-three DI anomalies were detected in the anterior teeth of 49 patients (18 females, 31 males). The frequency of DI was 5.11% and the most frequently involved teeth were lateral (57.53%). Forty-six teeth were classified as Type I (63.01%), 24 as Type II (32.87%), and three as Type III (4.10%). Apical pathosis was found to be 20.54% in all DIs detected and accounted for all Type III and one-third of Type II.

Conclusions

CBCT imaging can be effective in the detection of dental anomalies such as DI and planning for root canal therapy and surgical treatments. Prophylactic interventions might be possible to prevent apical pathosis with the data obtained from CBCT images.

Prevalence of dens invaginatus and its association with periapical lesions in a Western Indian population-a study using cone-beam computed tomography

OBJECTIVES

This study aimed to assess the prevalence of dens invaginatus (DI) and its association with periapical lesions (PLs) in a Western Indian population by means of cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

CBCT volumes of 5201 subjects were evaluated. Associations among gender, tooth type, DI type (Oehler's classification), and presence of PL were investigated. PL was codified using Estrela's Cone Beam Computed Tomography Periapical Index (CBCTPAI). Chi-square tests and descriptive statistics were used at p = 0.05.

RESULTS

Overall, 7048 CBCTs were assessed, containing 19,798 maxillary and mandibular anteriors, of which 77 maxillary teeth demonstrated DI (0.39% of all anteriors). Of all 5201 subjects, 57 had DI (1.1%). Bilateral DI was more common in females than in males (p = 0.046). DI type distribution was as follows: type I (22.1%), type II (61.03%), type IIIa (10.4%), and type IIIb (6.5%), which was significantly different (p < 0.001). Maxillary lateral incisors were the most associated with PL (p < 0.001). Type I was frequently associated with CBCTPAI scores 1 and 2 (absence of PL), whereas types II, IIIa, and IIIb were associated with CBCTPAI scores 3, 4, and 5 (presence of PL).

CONCLUSIONS

A prevalence of 1.1% identifies DI as a common developmental tooth anomaly in a Western Indian subpopulation. The percentage of maxillary anteriors affected by DI and associated PLs should be considered before diagnosis and treatment planning.

CLINICAL RELEVANCE

Knowledge about the prevalence of DI and its subtypes, and their association with/without periapical pathosis may aid clinicians in treatment planning and execution to improve patient outcomes.

Assessment of dens invaginatus and its characteristics in maxillary anterior teeth using cone-beam computed tomography

This cone-beam computed tomographic (CBCT) study aimed to evaluate the prevalence of dens invaginatus (DI) and its characteristics in maxillary anterior teeth in a Saudi population. A total of 505 CBCT scans were evaluated, including a total of 2790 maxillary anterior teeth. The patients' demographic data, including age and sex, were recorded. The presence of DI and the related characteristics including bilateral occurrence; DI type according to Oehlers classification; and presence of periapical radiolucency, open apex, and/or nearby impacted teeth were analyzed. The associations between DI and the other factors were analyzed using the chi-square and fisher exact tests. DI was detected in 7.3% of the patients and 1.6% of the teeth examined. Most of the DI-affected teeth were maxillary lateral incisors (76.1%), followed by mesiodens (19.6%) and maxillary central incisors (4.3%), while no DI was observed in the maxillary canines. Bilateral DI was found in 24.3% of the affected patients. Oehlers type I DI was the most frequent (80%). Periapical radiolucencies, open apices, and nearby impacted teeth were observed in 10.9%, 4.3%, and 30% of the invaginated teeth, respectively. DI was significantly associated with tooth type (P < 0.0001) but not with sex (P > 0.05). Although most of the DI cases are limited to the crown, CBCT imaging is essential for DI evaluation and management.

Successful Pulp-Preserving Treatment for Peri-invagination Periodontitis of Double Dens Invaginatus With Oehlers Type IIIA and IIIB: A Case Report

Dens invaginatus (DI), which often occurs in the maxillary lateral incisor, is an important issue in endodontics because the treatment complexity increases depending on the degree of invagination and the vitality or nonvitality of the pulp. An 11-year-old female patient with a sinus tract in the gingiva of the maxillary lateral incisors showed peri-invagination periodontitis and double DI on radiography. Cone-beam computed tomographic imaging was used to examine the structure in the root canal in detail, and Oehlers type IIIA and IIIB DI was found. It was also shown that the patient's bone defect was caused by type IIIA. Because a healthy reaction was observed in the pulp test, the final diagnosis was peri-invagination periodontitis associated with type IIIA of the double DI with vital pulp. We expected the lesion to heal by treating only the type IIIA invaginated pseudo-root canal while preserving the healthy pulp. The invaginated root canal was cleaned under a microscope using ultrasonic instruments and nickel-titanium files to minimize irritation to the pulp. Because the lesion shrinkage was confirmed by cone-beam computed tomographic imaging taken 3 months after the start of treatment, vertical compaction of the warm gutta-percha technique was performed. At the 6-month postoperative recall, the pulp was normal, and the lesions were further improved. Treatment of the main root canal of double DI is complicated. However, proper diagnosis and careful cleaning of the invaginated root canal are essential for healing while preserving the pulp.

Multiple dens invaginatus in Wilson's disease: A case report

Wilson's disease (WD) is a rare autosomal recessive genetic disease that affects copper metabolism. Anomalies can be seen in the dento-maxillofacial structures of WD patients. Dens invaginatus (DI) is an uncommon tooth anomaly, and its incidence in decidious and permanent molars is even lower. This case report primarily explored the multiple DI of a patient with WD. A 9-year-old boy was admitted to our clinic with complaints of pain and swelling in the right lower molar area. It was learnt that the patient was diagnosed with WD after he was born. Fistula, submandibular lymphadenopathy and diffuse swelling were detected. Using cone-beam computed tomography (CBCT), multiple DIs were observed in bilateral bimaxillary four first molars and deciduous molars. When the patient's systemic condition was considered, extraction was planned under oral antibiotic therapy and was performed. During the 6-month follow-up, uneventful healing was observed.

Laser Doppler for Accurate Diagnosis of Oehler’s Type III Dens Invaginatus: A Case Report

In vital pulp therapy, pulp testing aids in the differential diagnosis and influences the treatment plan. Different from previous doppler flowmetry studies that only recorded waves and data, we report the first time, the use of a laser doppler blood flow monitor and imager with a colored image to present pulp vitality information in the dental field. We report here a case of Oehlers type IIIa dens invaginatus of the right upper lateral incisor in a 31-year-old girl, with the opening of the invagination near CDJ and a peri-invagination lesion sized 8 × 9 mm2. Cone beam computed tomography was used to verify specific spatial and stereoscopic data. After removing the source of infection, mineral trioxide aggregate was selected to fill the invagination. Laser doppler was scheduled for further assessment. After three years of regular follow-up, the patient’s clinical condition improved, the peri-invagination lesion healed, and the laser doppler and electric pulp test both showed a positive reaction. Laser doppler has successfully improved the diagnostic accuracy Thus, unnecessary interventions can be avoided while reducing the treatment time by preserving the vitality. However, further work is needed to resolve the limitations of laser doppler.

Investigation of dens invaginatus in a Chinese subpopulation using Cone-beam computed tomography

OBJECTIVE

This study assesses the prevalence and characteristics of dens invaginatus (DI) in a sample of Chinese population by using cone-beam computed tomography (CBCT) images.

METHODOLOGY

A retrospective study was conducted by using the CBCT images of 1,004 patients. The whole dentition was evaluated for the presence and characteristics of DI. Periapical pathosis status and bilateral feature of affected teeth were also examined.

RESULTS

Dens invaginatus was observed in 85 of 1,004 subjects, with a prevalence of 8.47% and a tooth prevalence of 0.494%. Males presented a higher prevalence of DI than females (p = .011). Type I DI was the most commonly observed type of dens invaginatus, followed by type II and type III. The structure form of different types of DI was various. Overall 2.48% of the patients with type I DI, 5.88% of the patients with type II DI, 100% of the patients with type III DI had apical pathosis. Bilateral DI was found in 63.53% of the affected patients.

CONCLUSIONS

This study indicates that DI was not rare, and clinicians should be aware of its existence. CBCT examination can provide an accurate representation of dental anatomy and should be incorporated into early diagnosis and treatment planning for teeth with DI.

Prevalence of dens invaginatus in young Israeli population and its association with clinical morphological features of maxillary incisors

Dens invaginatus is an anomaly mostly observed in maxillary incisors. This study aimed to assess the prevalence of dens invaginatus in maxillary incisors in young Israeli population and to study its potential association with clinical coronal morphological features. Data was collected from periapical radiographs and clinical photographs of patients from Orthodontics Department between 2006 and 2018. Radiographic characteristics were evaluated and compared to clinical coronal morphological features. Statistical analysis was performed using the Pearson chi-square test with statistical significance set at p < 0.05. The sample included 1621 maxillary incisors from 547 patients. Dens invaginatus was observed in 422 (26%) of these teeth. Maxillary lateral incisors were more affected than central incisors. In 103 patients dens invaginatus was unilateral, while in all other cases it was bilateral. Unique clinical morphological characteristics were observed in 88% of the teeth that exhibited radiographic evidence of dens invaginatus. Dens invaginatus Type I was most frequently observed, accounting for 90% of the teeth. A significant association between clinical coronal morphological features and dens invaginatus was detected. Dens invaginatus is common in maxillary incisors of the study population. Several clinical morphological features may predict the presence of dens invaginatus.

CBCT in orthodontics: a systematic review on justification of CBCT in a paediatric population prior to orthodontic treatment

BACKGROUND

Taking into account radiation doses, safety, and protection, we highlighted the features in which cone-beam computed tomography (CBCT) can offer an advantage compared to the conventional two-dimensional imaging in paediatric dentistry before orthodontic treatment.

OBJECTIVE

The aim of this article was to conduct a systematic review to assess the diagnostic efficacy of CBCT in the paediatric population at a pre-orthodontic phase.

SEARCH METHODS

MEDLINE via PubMed was searched to identify all peer-reviewed articles potentially relevant to the review until 1 July 2018. Relevant publications were selected by two reviewers independently.

SELECTION CRITERIA

The literature selection for this systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was based on predetermined inclusion criteria.

DATA COLLECTION AND ANALYSIS

Data were collected on overall study characteristics and examination characteristics of the selected studies. Methodological quality of the selected studies was evaluated. Original studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Thereafter, levels of evidence were obtained according to Grading of Recommendations Assessment, Development and Evaluation criteria.

RESULTS

As a result of the QUADAS assessment, a total of 37 articles were included in the protocol. Following a proper protocol, CBCT was regarded as a reliable tool for assessment and management of impacted canine and root fracture. It provided a better evaluation of normal and pathological condylar shape and volume. CBCT was a superior choice for pre-surgical diagnostic applications in cleft lip and/or palate over a medical computed tomography based on its lower radiation exposure, shorter investigation time, and low purchase costs.

CONCLUSIONS

CBCT is justified only in those cases where conventional radiography fails to provide a correct diagnosis of pathology. Therefore, it cannot be regarded as a standard method of diagnosis. CBCT imaging may also be justified when it positively affects treatment options or provides treatment optimization.

REGISTRATION

None.

CONFLICT OF INTEREST

None to declare.

Dental Age, Agenesis, and Morphology in Patients With Operated Single-Suture Craniosynostoses

OBJECTIVE

The aim of this study was to evaluate the dental age, agenesis, and morphology of children with surgically operated single-suture craniosynostoses from orthopantomographs.

DESIGN

A single-centered cross-sectional observational archival study.

PATIENTS

A sample of 196 Finnish patients with single-suture craniosynostosis without additional birth defects or syndromes (excluding Muenke syndrome) was included in this study.

MAIN OUTCOME MEASURES

Dental age was assessed using the method developed by Demirjian et al. and modified by Nyström et al. for the Finnish population. Methods described by Tulensalo et al. and Oehlers et al. were used to study taurodontism and dens invaginatus, respectively.

RESULTS

The study sample of 149 patients was divided into 3 groups: patients with sagittal synostosis (n = 103), coronal synostosis (n = 25), and metopic synostosis (n = 21). Orthopantomographs taken on average at ages 8.20 to 8.33 were used. The dental ages in different groups were on average 0.37, 0.60, and 0.66 years ahead of normative values, for sagittal, coronal, and metopic groups, respectively. Tooth agenesis, taurodontism, and invaginated teeth were found in all groups with invaginations having a high prevalence. Peg-shaped upper lateral incisors and one geminated lower lateral incisor were also found.

CONCLUSIONS

These descriptive data may help improve dental care in patients with single-suture craniosynostosis.

Mandibular Carnassial Tooth Malformations in 6 Dogs-Micro-Computed Tomography and Histology Findings

Objective: To document the clinical, radiographic, and histological characteristics of mandibular first molar teeth with developmental abnormalities previously attributed to dens invaginatus and enamel pearls in dogs. Materials and Methods: Affected mandibular first molar teeth from dogs were evaluated grossly and via intraoral radiography. Endodontically and/or periodontally compromised teeth were extracted and subjected to some combination of micro-computed tomography, histopathology, and immunohistochemistry with anti-amelogenin antibody. Results: Six dogs with developmental abnormalities of mandibular first molar teeth were identified, representing 11 affected teeth. The condition was bilateral in 5 dogs, while in 1 dog, only one mandibular first molar tooth was present. Patient weight ranged from 1.7 to 6 kg (median = 4.09 kg). On intraoral radiographs, root convergence or parallelism was noted in 6 of 11 teeth, and root dilaceration was noted in 3 of 11 teeth. Eight teeth required extraction due to periapical lucencies or periodontitis. On micro-CT, the abnormal teeth were characterized by the presence of abnormal, heterogenous hard tissue with beam attenuation characteristics midway between that of enamel and dentin. Enamel fissures were identified in 4 of 8 teeth, while ectopic radicular enamel was identified in 2 of 8 teeth. The abnormal tissue was traversed by channels measuring 20-40 μm in diameter. Channels communicated with the enamel fissures in 2/8 teeth, the furcation in 2/8 teeth and the pulp in 4/8 teeth. The abnormal tissue was frequently surrounded by disorganized dentin. Histologic features of enamel and dentin were absent from the abnormal tissue and immunohistochemistry to detect amelogenin in the abnormal tissue was negative in all samples. Conclusion: The dental abnormalities described here correspond to a previously unrecognized developmental abnormality involving the mandibular first molar teeth in dogs. The developmental origin of the abnormal tissue could not be ascertained, and further investigations are required to determine the mode of formation, origin of the abnormal tissue, and factors associated with development. These developmental abnormalities more closely resemble molar-incisor malformation, rather than dens invaginatus or enamel pearls as described in humans. The authors propose that affected mandibular first molar teeth simply be referred to as having carnassial tooth malformations.

A case report of multiple bilateral dens invaginatus in maxillary anteriors

The present report presents a case of dens invaginatus (DI) in a patient with 4 maxillary incisors. A 24-year-old female complained of swelling of the maxillary left anterior region and discoloration of the maxillary left anterior tooth. The maxillary left lateral incisor (tooth #22) showed pulp necrosis and a chronic apical abscess, and a periapical X-ray demonstrated DI on bilateral maxillary central and lateral incisors. All teeth responded to a vitality test, except tooth #22. The anatomic form of tooth #22 was similar to that of tooth #12, and both teeth had lingual pits. In addition, panoramic and periapical X-rays demonstrated root canal calcification, such as pulp stones, in the maxillary canines, first and second premolars, and the mandibular incisors, canines, and first premolars bilaterally. The patient underwent root canal treatment of tooth #22 and non-vital tooth bleaching. After a temporary filling material was removed, the invaginated mass was removed using ultrasonic tips under an operating microscope. The working length was established, and the root canal was enlarged up to #50 apical size and obturated with gutta-percha and AH 26 sealer using the continuous wave of condensation technique. Finally, non-vital bleaching was performed, and the access cavity was filled with composite resin.

Guided endodontics: a case report of maxillary lateral incisors with multiple dens invaginatus

Navigation of the main root canal and dealing with a dens invaginatus (DI) is a challenging task in clinical practice. Recently, the guided endodontics technique has become an alternative method for accessing root canals, surgical cavities, and calcified root canals without causing iatrogenic damage to tissue. In this case report, the use of the guided endodontics technique for two maxillary lateral incisors with multiple DIs is described. A 16-year-old female patient was referred with the chief complaint of pain and discoloured upper front teeth. Based on clinical and radiographic findings, a diagnosis of pulp necrosis and chronic periapical abscess associated with double DI (Oehler's type II) was established for the upper left lateral maxillary incisor (tooth #22). Root canal treatment and the sealing of double DI with mineral trioxide aggregate was planned for tooth #22. For tooth #12 (Oehler's type II), preventive sealing of the DI was planned. Minimally invasive access to the double DI and the main root canal of tooth #22, and to the DI of tooth #12, was achieved using the guided endodontics technique. This technique can be a valuable tool because it reduces chair-time and, more importantly, the risk of iatrogenic damage to the tooth structure.

Successful management of a case of true radicular dens invaginatus using platelet-rich fibrin and guided tissue regeneration

A radicular variant of dens invaginatus (DI) is a rare form of dens invaginatus which develops in the root of the tooth after the crown development is completed. This report involves successful management of a case with guided tissue regeneration and describes the cone beam computed tomography (CBCT) characteristics of true radicular DI. A 20-year-old woman reported with recurrent swelling and pus discharge associated with her maxillary left central incisor (#21). Cone beam computed tomography (CBCT) of the region revealed #21 had an invagination in the mesial aspect of the coronal third of the root with a para radicular low-density region perforating both the cortices. A diagnosis of true radicular variant of DI was made by exclusion. The case was managed with Biodentine^® , platelet-rich fibrin and freeze-dried demineralised bone graft. A 2-year review showed that the tooth was functional with normal periodontal parameters and normal response to electric pulp sensibility test.

Conservative pulp treatment for Oehlers type III dens invaginatus: A case report

BACKGROUND

Diverse presentations of dens invaginatus (DI) and root canal treatment with an immature open apex often pose challenges to dentists. Adequate treatment planning for DI is the main reason for successful approach, i.e., we should consider the shape and depth of the concave folding, the condition of the original pulp, and the growth stage of the root formation.

CASE SUMMARY

A 9-year-old girl complained of severe pain of the right maxillary incisor (tooth 12) when chewing for two weeks. Following clinical and radiographic examinations, Oehlers type III DI of tooth 12, with an immature open apical foramen and a symptomatic periapical pathosis, was diagnosed. Cone-beam computed tomography verified the specific spatial and stereoscopic data regarding the communication between the main root canal and pseudo root canal of the involved tooth. After removing the source of infection, a mineral trioxide aggregate was selected to fill and seal the pseudo root canal; additionally, pulp capping of the main canal was performed through the interconnections between the root canals in the middle segment to preserve pulp vitality and enable continual root formation and eventual root apex closure.

CONCLUSION

We propose to conduct main root canal pulp capping for DI with communication between the main and pseudo root canals.

Successful treatment of dens invaginatus type 3 with infected invagination, vital pulp, and cystic lession: A case report

All efforts should be aimed to safe permanent tooth for adolescents. Presented rare case confirms a possibility to save a tooth with Oehlers Type 3 anomaly with peri-invaginated periodontitis and to preserve vitality of the tooth pulp, even when surgical cyst removal is performed.

Orthodontic treatment of a patient with maxillary lateral incisors with dens invaginatus: 6-year follow-up

INTRODUCTION

Dens invaginatus is an anomaly of dental development in which calcified tissues, such as enamel and dentin, are invaginated into the pulp cavity. This morphologic alteration is more frequent in maxillary permanent lateral incisors and makes them more susceptible to carious lesions and pulp alterations.

METHODS

This case report describes a patient with maxillary lateral incisors affected by dens invaginatus. The maxillary right lateral incisor had already undergone endodontic treatment, and the maxillary left one had a periapical lesion. Additionally, the patient had a Class II Division 1 malocclusion, with anterior open bite, posterior crossbite, and an impacted mandibular left second molar.

RESULTS

The orthodontic treatment involved extraction of the maxillary lateral incisors and 2 mandibular premolars, resulting in proper overjet and overbite with good arch coordination and occlusal stability.

CONCLUSIONS

Treatment results were stable, as evaluated in a 6-year posttreatment follow-up.

Cone-beam CT in paediatric dentistry: DIMITRA project position statement

DIMITRA (dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks) is a European multicenter and multidisciplinary project focused on optimizing cone-beam CT exposures for children and adolescents. With increasing use of cone-beam CT for dentomaxillofacial diagnostics, concern arises regarding radiation risks associated with this imaging modality, especially for children. Research evidence concerning cone-beam CT indications in children remains limited, while reports mention inconsistent recommendations for dose reduction. Furthermore, there is no paper using the combined and integrated information on the required indication-oriented image quality and the related patient dose levels. In this paper, therefore, the authors initiate an integrated approach based on current evidence regarding image quality and dose, together with the expertise of DIMITRA's members searching for a state of the art. The aim of this DIMITRA position statement is to provide indication-oriented and patient-specific recommendations regarding the main cone-beam CT applications in the pediatric field. The authors will review this position statement document when results regarding multidisciplinary approaches evolve, in a period of 5 years or earlier.

Endodontic management of double dens invaginatus in maxillary central incisor

This case report deals with the successful endodontic treatment of double dens invaginatus in maxillary left central incisor. Dens invaginatus is a rare developmental anomaly that is challenging to diagnose and treat. A patient reported with unesthetic appearance and previously attempted endodontic treatment of tooth #21. Cone beam computed tomography revealed the presence of a complex invagination communicating with the periodontium. A combination of techniques enhanced the debridement of the complex invagination. Obturation was performed using warm vertical compaction. The patient was asymptomatic during the follow-up period of 12 months.

Non-Surgical Endodontic Management of Type II Dens Invaginatus with Closed and Open Apex

Dens invaginatus (DI) is a developmental anomaly that poses a significant challenge to the clinician if endodontic treatment is required. The type II (as per Oehlers) form exhibits complex internal anatomy and is frequently associated with incomplete root and apex formation. The purpose of this study is to present two cases of type II DI in the maxillary lateral incisors. In the first case, non-surgical endodontic therapy was performed utilizing calcium hydroxide as an intracanal dressing, showing significant periapical healing of the apical radiolucent area at the six month follow-up. In the second case, the development of the root and apex were affected by pulp necrosis, and the revascularization procedure was performed. Complete resolution of the pre-existing apical radiolucency, apical closure, thickening of the root canal walls, and increase in root length, after 32 months was observed. Early detection of teeth with DI type II and proper exploration of their internal anatomy are key factors for their successful management. As demonstrated in this report, conservative non-surgical endodontic treatment should be the first line of treatment for these cases. The use of revascularization protocols in teeth that develop pulp necrosis and exhibit early stage of root development could be a better alternative than traditional apexification techniques.

Cone-beam computed tomography for assessment of dens invaginatus in the Polish population

Objectives

There are many developmental variations in the permanent dentition. Dens invaginatus can be recognized on many dental X-rays of affected patients, but not every image allows for assessment of the type of malformation. The aim of the present study was to assess the presence of dens invaginatus with radiological features using cone-beam computed tomography (CBCT).

Methods

CBCT images of 33 patients were evaluated. Age, sex, side, lateralization, occurrence in a particular group of teeth, type of invagination, differentiation, and the consequences of these factors were analyzed.

Results

Forty-one teeth with dens invaginatus met the inclusion criteria for this evaluation. Females were affected more frequently than males (57.6 vs. 42.4%, respectively). The patients’ age ranged from 7 to 40 years, and the occurrence of dens invaginatus peaked from age 9 to 13 years. In total, 92.7% of affected teeth were present in the maxilla, more often unilaterally (75.8%) than bilaterally (24.2%). The most frequent tooth with dens invaginatus was the maxillary lateral incisor (53.7% of affected teeth). Almost two-thirds (63.4%) of affected teeth were found on the left side and 36.6% were found on the right. The tooth anatomy was distorted within the crown and root. Dens invaginatus sometimes affected other surrounding teeth and reduced their esthetics.

Conclusions

The obtained data indicate that CBCT examination is an essential tool in assessing dens invaginatus and can guide dental practitioners in treating patients who exhibit characteristic features of this disorder. CBCT allows the clinician to distinguish the type of anomaly.

Double Dens Invaginatus with Multiple Canals in a Maxillary Central Incisor: Retreatment and Managing Complications

Dens invaginatus is a developmental anomaly that often presents a perplexing challenge to the endodontist. It involves the maxillary central incisor less commonly than the maxillary lateral incisor. Double dens invaginatus is even rarer. Herein a unique case of dens invaginatus in a maxillary central incisor is presented. The tooth had an inadequate previous root canal treatment. On retreatment, multiple canals and double dens invaginatus were found. The invaginations were Oehlers type 3b and type 2. The complex morphology was diagnosed and confirmed with cone-beam computed tomography imaging and managed with a combined surgical and orthograde approach. Four canals and a blind sac along with an open apex were found. There were many intercommunications between the canals. During the treatment, a complication of a separated instrument occurred, which was managed successfully. The 1-year follow-up shows successful outcome of the treatment. Dens invaginatus may be more complicated than it seems. It needs meticulous treatment by a specialist. Failure or a delay in referring the case to a specialty setting may further increase the complications. With the advancements in equipment and materials, it is possible to save even severe cases of dens invaginatus.

A comparison of the use of cone-beam computed tomography and panoramic radiography in the assessment of pre-eruptive intracoronal resorption

OBJECTIVE

This study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PIR) using cone beam computed tomography (CBCT) and panoramic radiography and to compare the findings of these imaging techniques.

METHODS

This retrospective study consisted of 733 patients who had at least one unerupted tooth and had undergoneimaging with both three-dimensional (3D) CBCT and two-dimensional (2D) panoramic radiography. In all the images, the number of teeth with intracoronal resorption, affected tooth type and number, and size and location of the PIR defects were recorded. The McNemar test was used to compare the prevalence of PIR in the CBCT and panoramic images.

RESULTS

Fewer PIR defects were detected in the panoramic images (3.1% of the patients) than in the CBCT images (9.5% of the patients) (p< .001). According to the CBCT images, the distribution of PIR defects was as follows: third molars (59.5%), canine teeth (11.4%), second molars and premolars (7.6% for both), supernumerary teeth (5.1%), second molars (3.8%), central incisors (2.5%), and first premolar and primary second molar teeth (1.5% for both). According to the scoring classification system for PIR defects, PIR 1 defects were the most common (65.8%), followed by PIR 3 (24.1%) and PIR 2 (10.1%). Of these defects, 69.6% were located in the central aspect of the crown. Ectopically positioned teeth showing intracoronal resorption accounted for 51.9% of the cases of PIR.

CONCLUSIONS

CBCT detected more cases of PIR than panoramic radiography. The mandibular third permanent molar was the most commonly affected tooth.