Surgical treatment of a lateroradicular lesion on an invaginated lateral incisor (dens in dente)

Non-surgical management of dens invaginatus type IIIB in maxillary lateral incisor with three root canals and 6-year follow-up: A case report and review of literature

BACKGROUND

The presence of dens invaginatus (DI) complicates treatment of any tooth, from diagnosis to access cavity and biomechanical preparation and obturation. Reports of successful non-surgical management of DI type IIIB in maxillary lateral incisor are rare. Here, we report such a case, with three root canals and a long follow-up.

CASE SUMMARY

A 13-year-old female patient presented with mild pain in the maxillary right lateral incisor (#7) for 10-15 d. On examination, the tooth was slightly rotated, with slight tenderness on percussion and grade I mobility but with no caries, pockets or restorations and non-vital pulp (via vitality tests). Radiographic examination revealed unusual configuration of the tooth’s root canals, with an enamel-lined invagination extending to the apex, suggesting the possibility of DI Oehler’s type IIIB and a periapical radiolucency. Widening the access cavity lingually revealed one distinct buccal orifice and two distinct palatal orifices; under higher magnification of a dental operating microscope (DOM), the mesio-palatal and disto-palatal orifices were observed as connected by a C-shaped groove. The root canals were prepared with hand K-files following a step-back technique, and obturated using a combination technique of lateral condensation and vertical compaction. At the 6-year follow-up, the patient was asymptomatic, and the periapical radiography displayed significant healing around the apical end of the root.

CONCLUSION

Proper knowledge of unusual root canal anatomy is required in treating DI. Conventional methods of root canal treatment can successfully resolve such complex cases, facilitated by DOM and cone-beam computed tomography.

Radicular Dens in Dente: Review of the Literature with Report of a Rare Case in a Child

Introduction:

Dens invaginatus is an extremely rare developmental disturbance that can occur in primary, permanent, or supernumerary teeth due to invagination of the enamel organ into the dental papilla during tooth development. The clinical recognition of the radicular variant of dens in the dente is challenging as it is mostly asymptomatic with a normal-appearing clinical crown and is incidentally discovered in radiographs.

Case presentation:

This report describes a case of the radicular variant of dens in dente that involved the mandibular lateral incisor in an 8-year-old child. The affected tooth was symptomatic and was extracted as a part of treatment.

Conclusion:

Although the present case required extraction since it was associated with periapical infection, in other cases, treatment may be rendered with appropriate restorative/endodontic procedures with a keen intent to avoid sacrificing the involved tooth as has been reported earlier and reviewed herein.

Dens Invaginatus of the Mandibular First Molars in a Dog

A 6-year-old dog was presented for draining tracts associated with both mandibular first molar teeth. Radiographs of the affected teeth showed periapical bone lysis. Surgical tooth extractions were performed and the tooth segments were submitted for histopathologic examination. Microscopic evaluation of the teeth showed in folding of the enamel and dentin consistent with a diagnosis of dens invaginatus. Examination performed 13-months following the extraction procedures indicated uncomplicated healing at the extraction sites and no other visible evidence of endodontic disease.

Complex treatment of dens invaginatus type III in maxillary lateral incisor

The complex anatomy and diagnosis of dens invaginatus make endodontic treatment of such teeth difficult. This case describes combined nonsurgical and surgical treatment of a maxillary lateral incisor with a normally shaped canal and a dens invaginatus type III with a lateroradicular lesion. The root canal was treated conventionally with gutta-percha and a zinc oxide-eugenol sealer. The root was surgically exposed and the canal of the dens invaginatus was cleaned, instrumented and obturated with gutta-percha and a zinc oxide-eugenol sealer. At follow-up 3 years 6 months later, the tooth was asymptomatic and radiographically showed repair of the lesion in the region of the dens invaginatus.