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LaLonde L, Askar M, Paurazas S. A Novel Diagnostic and Treatment Approach to an Unusual Case of Dens Invaginatus in a Mandibular Lateral Incisor Using CBCT and 3D Printing Technology. Dent J (Basel) 2024; 12:107. [PMID: 38668019 PMCID: PMC11048744 DOI: 10.3390/dj12040107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND This case report demonstrates the use of three-dimensional (3D) models produced from a cone beam computed tomographic (CBCT) volume to develop a treatment strategy for a rare type of dens invaginatus (DI) in a mandibular incisor. METHODS A patient with DI Type IIIa presented for endodontic treatment. Following CBCT evaluation, the complex morphologic nature of the invagination required additional diagnostic tools for treatment planning. The fabrication of 3D models provided clarity regarding the treatment strategy. Treatment involved intracanal medication with calcium hydroxide Ca(OH)2, nonsurgical root canal therapy (NS-RCT) of the main canal, and endodontic surgery for the DI anomaly using mineral trioxide aggregate (MTA), bone graft, and platelet-rich fibrin (PRF) membrane. RESULTS The use of 3D models provided an invaluable guide for proper treatment. Complicating factors were diagnosed and planned for accordingly. CONCLUSIONS It is difficult to appreciate the anatomical complexity, the extent, and the nature of the invagination of rare Type III DI morphology. CBCT imaging and 3D models played a critical role in the pre-treatment planning to ensure a predictable outcome. A 3D model is recommended as a diagnostic tool in treating complex cases where the DI morphology is wide, oblique, or the foraminal opening is irregular.
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Affiliation(s)
| | | | - Susan Paurazas
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (L.L.); (M.A.)
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2
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CBCT Evaluation and Conservative Management of a Large Periapical Lesion Associated with Dens Invaginatus Type II. Case Rep Dent 2022; 2022:1529835. [PMID: 35198249 PMCID: PMC8860537 DOI: 10.1155/2022/1529835] [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: 07/27/2021] [Revised: 12/04/2021] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
This case report illustrated the conservative management of an invaginated type II tooth with a large periapical lesion. This dental malformation is characterized by the complexity of root canal anatomy, which when associated with a periapical lesion complicates the performance of conventional endodontic treatment, hence resulting to the difficulty of obtaining the optimal disinfection of the root canal system, which is an essential element for the success of any endodontic treatment. In the present case report, clinical and radiographic examinations were supplemented by CBCT examination to identify the root canal configuration and the extension of the periapical lesion. Conservative orthograde endodontic treatment was performed by combining mechanical and chemical action. Additionally, active nonsurgical decompression was performed and the follow-up visits revealed a favorable outcome.
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Zhang J, Wang Y, Xu L, Wu Z, Tu Y. Treatment of type III dens invaginatus in bilateral immature mandibular central incisors: a case report. BMC Oral Health 2022; 22:28. [PMID: 35120475 PMCID: PMC8815253 DOI: 10.1186/s12903-022-02059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/25/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Dens invaginatus (DI) is a developmental anomaly, Oehlers Type III DI is the most complex type and early diagnosis and treatment is complicated and challenging. This report presents a rare case of a type IIIb DI associated with a periapical lesion in bilateral immature permanent mandibular central incisors. CASE PRESENTATION An eight-year-old boy referred to our clinic manifesting with pain along with swelling in the mandibular incisors for the past one month. Radiographic examination showed periapical radiolucency exhibiting a scantly defined border, as well as an invagination which had a central invaginated canal extending from the pulp chamber throughout the apical foramen in both mandibular central incisors. We performed two different treatment procedures on the basis of the condition of the main pulp of the mandibular central incisors. in which only the invagination root canal was treated in the right mandibular central incisor, while the invagination and main root canals were treated in the left mandibular central incisor. During the 18-month follow-up period, the teeth were clinically asymptomatic. Imaging examinations indicated complete healing of the periapical lesion and revealed that the wall of the root canal was thickened and the open apex was closed. CONCLUSION For young permanent teeth with type III Dens invaginatus, it is particularly important to keep pulp vitality, which could maintain root development and allow a good long-term prognosis.
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Affiliation(s)
- Jie Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Yuan Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Lei Xu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Zhifang Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China.
| | - Yan Tu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China.
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Retrospective Study of Intentional Replantation for Type Ⅲb Dens Invaginatus with Periapical Lesions. J Endod 2022; 48:329-336. [PMID: 34999093 DOI: 10.1016/j.joen.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In recent years intentional replantation (IR) has received more attention for its high tooth survival rate and wide range of indications. Type Ⅲb dens invaginatus (DI) is one of the most serious types of tooth malformation and is very challenging to treat. When root-end surgery is not feasible, IR may be considered as an alternative to extraction. However, there is little information available on the use of IR for type Ⅲb DI. Therefore, this study investigated the treatment outcomes and clinical procedures used for treatment of type IIIb DI with IR. METHODS IR was performed to treat 10 patients with type Ⅲb DI with periapical lesions. Each tooth was examined clinically and radiologically. IR was selected by these patients as their treatment plan after treatment procedures were discussed. An experienced endodontist and an experienced surgeon performed all treatments using the same protocol and surgical technique. Postoperative assessments were comprised of clinical and radiographic examinations, tooth survival and functional status. RESULTS The follow-up period ranged from 4 to 39 months. After IR, eight teeth were functioning properly with no clinical and radiological signs of pathology. The other two teeth had complications after IR comprising recurrence of periapical radiolucency and sinus tract formation in one patient, and development of a mucosal fenestration in another. Both of these patients received additional surgery and showed marked improvements. CONCLUSION Our study evaluated the most clinical data to date and showed that IR may be a reliable alternative for type IIIb DI with a periapical lesion.
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Berlin-Broner Y, Levin L. Retrospective evaluation of endodontic case reports published in the International Endodontic Journal and the Journal of Endodontics for their compliance with the PRICE 2020 guidelines. Int Endod J 2020; 54:210-219. [PMID: 32961626 DOI: 10.1111/iej.13415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/15/2020] [Indexed: 01/25/2023]
Abstract
AIM To evaluate, retrospectively, the quality of previously published case reports in Endodontics according to the PRICE 2020 guidelines. METHODOLOGY An electronic literature search was conducted in PubMed database on 12 March 2020, to identify case reports published during the last five years in the International Endodontic Journal and the Journal of Endodontics. For each of the included case reports, information regarding fulfilment of each of the items of the PRICE 2020 guidelines was extracted as '0' (not present in the manuscript), '1' (present in the manuscript) and 'NA' (not applicable) and translated into a score (percentage of items fulfilled). Additionally, the percentage of papers fulfilling each item was calculated. RESULTS Overall, 70 endodontic case reports were identified. The scores of the papers ranged between 56.41% and 79.55%, with a mean score of 70.26 ± 4.36% (SD). The percentage of papers fulfilling each item of the applicable PRICE 2020 items ranged widely, between 0% and 100%. The median of the percentage of all the items (n = 47) was 97.01% and mean 73.33 ± 36.28% (SD). The lowest scores were recorded for specific items in the following domains: 'Case Report Information'-Items 6c, 6g-i, 'Patient Perspective'-Item 8a and 'Quality of Images'-Items 12c-d. CONCLUSIONS Several areas with low reporting rates were identified in case reports published over the last 5 years in Endodontics. Authors should be encouraged to follow the PRICE 2020 guidelines in order to increase the quality and improve reproducibility of their case reports.
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Affiliation(s)
- Y Berlin-Broner
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - L Levin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Nagendrababu V, Chong BS, McCabe P, Shah PK, Priya E, Jayaraman J, Pulikkotil SJ, Dummer PMH. PRICE 2020 guidelines for reporting case reports in Endodontics: explanation and elaboration. Int Endod J 2020; 53:922-947. [PMID: 32221975 DOI: 10.1111/iej.13300] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 12/17/2022]
Abstract
Case reports play a key role in showcasing new, unusual or rare disease(s), and the impact of newer therapeutic approaches or interventions. The Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines are being introduced exclusively for Endodontics by adapting and integrating the CAse REport (CARE) guidelines and Clinical and Laboratory Images in Publications principles. The PRICE 2020 guidelines have been developed to help authors improve the completeness, accuracy and transparency of case reports in Endodontics and thus enhance the standard of manuscripts submitted for publication. The aim of this document is to provide a comprehensive explanation for each item in the PRICE 2020 checklist along with examples from the literature that demonstrate compliance with these guidelines. This information will highlight the importance of each item and provide practical examples to help authors understand the necessity of providing comprehensive information when preparing case reports. A link to this PRICE 2020 explanation and elaboration document is available on the Preferred Reporting Items for study Designs in Endodontology website at http://www.pride-endodonticguidelines.org.
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Affiliation(s)
- V Nagendrababu
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - B S Chong
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - P McCabe
- Oranhill Dental Suite, Galway, Ireland
| | - P K Shah
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - E Priya
- Division of Community and Children Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - J Jayaraman
- Department of Developmental Dentistry, University of Texas Health School of Dentistry, San Antonio, TX, USA
| | - S J Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Lee JK, Hwang JJ, Kim HC. Treatment of peri-invagination lesion and vitality preservation in an immature type III dens invaginatus: a case report. BMC Oral Health 2020; 20:29. [PMID: 32000767 PMCID: PMC6993444 DOI: 10.1186/s12903-020-1008-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report a case of type III dens invaginatus associated with peri-invagination periodontitis in an immature permanent mandibular central incisor with open apex, in which only the invagination area was treated and vitality was preserved. CASE PRESENTATION A 9-year-old boy was referred complaining of pain in the mandibular left central incisor. After radiographic examination, an invagination into the pulp chamber of the tooth associated with periapical radiolucency was detected. Endodontic access was performed and the orifice was identified under a dental operating microscope. The invagination area was chemo-mechanically cleaned. After 1 week, the invagination was obturated with mineral trioxide aggregate. During the 2-year follow up period, the tooth was asymptomatic. Radiographic examination revealed significant progression of periapical healing and root development in the main root canal of the tooth. CONCLUSION Non-surgical root canal treatment of the invagination may preserve pulp vitality, and continuous root development of the tooth.
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Affiliation(s)
- Ju-Kyung Lee
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Geumo-ro 20, Mulgeum, Yangsan, Gyeongnam, 50612, Korea
| | - Jae Joon Hwang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Geumo-ro 20, Mulgeum, Yangsan, Gyeongnam, 50612, Korea.
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Abu Hasna A, Ungaro DMDT, de Melo AAP, Yui KCK, da Silva EG, Martinho FC, Gomes APM. Nonsurgical endodontic management of dens invaginatus: a report of two cases. F1000Res 2019; 8:2039. [PMID: 31885864 PMCID: PMC6915815 DOI: 10.12688/f1000research.21188.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 12/15/2022] Open
Abstract
Dens invaginatus is a malformation affecting mainly the superior lateral incisors. It is defined as an infolding of the crown hard tissues, including the enamel and dentin, and can extend up to the root apex. Root canal treatment of this abnormality is considered difficult due to the complex anatomy presented by these teeth. This case series presents nonsurgical endodontic treatment in two cases of dens invaginatus (type II and III) in maxillary lateral incisors. This nonsurgical or conventional endodontic treatment results in healing of the periapical lesions associated with both cases, with no need for extra intervention e.g. surgical or invasive management. The manual instrumentation associated with sodium hypochlorite and calcium hydroxide were able to completely heal the lesions. Radiographic exams were carried out to control and asses the healing. Nonsurgical treatment was successful in both cases with adequate repair after a 6-year follow-up with radiographic and tomographic assessments.
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Affiliation(s)
- Amjad Abu Hasna
- Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, 12245000, Brazil
| | - Daniela Maria de Toledo Ungaro
- Department of Science and Technology Applied to Dentistry, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, 12245000, Brazil
| | - Allana Agnes Pereira de Melo
- Department of Science and Technology Applied to Dentistry, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, 12245000, Brazil
| | - Karen Cristina Kazue Yui
- Department of Restorative Dentistry, Operative Dentistry Division, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, 12245000, Brazil
| | - Eduardo Galera da Silva
- Department of Science and Technology Applied to Dentistry, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, 12245000, Brazil
| | - Frederico Canato Martinho
- Department of Endodontics, Prosthodontics and Operative Dentistry, School of Dentistry, University of Maryland, Baltimore, Baltimore, USA
| | - Ana Paula Martins Gomes
- Department of Science and Technology Applied to Dentistry, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, 12245000, Brazil
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Chung SH, Hwang YJ, You SY, Hwang YH, Oh S. A case report of multiple bilateral dens invaginatus in maxillary anteriors. Restor Dent Endod 2019; 44:e39. [PMID: 31799167 PMCID: PMC6875537 DOI: 10.5395/rde.2019.44.e39] [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: 07/16/2019] [Revised: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Shin Hye Chung
- Dental Research Institute and Department of Dental Biomaterials, School of Dentistry, Seoul National University, Seoul, Korea
| | - You-Jeong Hwang
- Department of Dentistry, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | | | - Young-Hye Hwang
- Department of Endodontic Dentistry, Seoul Dental Hospital for the Disabled, Seoul, Korea
| | - Soram Oh
- Department of Conservative Dentistry, Kyung Hee University Dental Hospital, Seoul, Korea
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Zhang F, Zhang YW, Jiang XQ, Chen HT, Sun L. [Endodontic-periodontal combined therapy for type Ⅲ dens invaginatus in maxillary lateral incisor: a case report]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:453-456. [PMID: 31512844 DOI: 10.7518/hxkq.2019.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report a clinical case of type Ⅲ dens invaginatus with endodontic-periodontal lesion in a maxillary lateral incisor. The palatal radicular anomaly predisposed the tooth to periodontal lesions. The caries along the palatal groove caused tooth pulp necrosis and periapical lesions. By means of microscopic root canal therapy, apical surgery, and guided periodontal tissue regeneration, the apical and periodontal infection were controlled, and the affected tooth was retained.
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Affiliation(s)
- Feng Zhang
- Stomatology Health Care Center, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, China
| | - Yi-Wen Zhang
- Stomatology Health Care Center, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, China
| | - Xiao-Qiong Jiang
- Stomatology Health Care Center, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, China
| | - Hao-Ting Chen
- Stomatology Health Care Center, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, China
| | - Lei Sun
- Stomatology Health Care Center, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, China
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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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12
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Rodrigues EA, Belladonna FG, De-Deus G, Silva EJNL. Endodontic management of type II dens invaginatus with open apex and large periradicular lesion using the XP-endo Finisher: A case report. J Clin Exp Dent 2018; 10:e1040-e1044. [PMID: 30386511 PMCID: PMC6203901 DOI: 10.4317/jced.55031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/21/2018] [Indexed: 02/03/2023] Open
Abstract
Dens invaginatus (DI) represents an endodontic challenge because of its complex root canal morphology. This case report presents the clinical management of a 22-year-old woman with type II DI in right maxillary lateral incisor with a painful swelling. Pulp testing revealed no response with the tooth. Type II DI with open apex and large periradicular lesion was seen on radiograph. The treatment was planned by using cone-beam computed tomography (CBCT) imaging. Canal treatment was completed in two appointments with the aid of a dental operating microscope. In the first appointment, the internal anatomy was modified using an ultrasonic tip, and chemo-mechanical preparation was performed using the XP-endo Finisher instrument and NaOCl; calcium hydroxide intracanal dressing was used for one month. In the second appointment, an apical plug of mineral trioxide aggregate (MTA) Repair HP was performed and the remaining pulp space was then filled with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. At the fourteen-month reevaluation, the patient was asymptomatic, the tooth had remained functional, and radiographic and CBCT assessment showed significant osseous healing of the lesion. Successful non-surgical management of the present type II DI was achieved in the present case. The association of CBCT, dental operating microscope, XP-endo Finisher, NaOCl and MTA Repair HP were important for ensuring a predictable outcome.
Key words:Cone beam computed tomography, dens invaginatus, MTA apexification, XP-endo Finisher.
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Affiliation(s)
- Evaldo-Almeida Rodrigues
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil. Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Felipe-Gonçalves Belladonna
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil. Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil. Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Emmanuel-João-Nogueira-Leal Silva
- Department of Endodontics, Grande Rio University, Duque de Caxias, Rio de Janeiro, Brazil.,Department of Endodontics, Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
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