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Wang J, Niu C, Zhang P, Ran S, Huang Z. Endodontic management considerations for Type III dens invaginatus based on anatomical characteristics: A case series. AUST ENDOD J 2024. [PMID: 38651624 DOI: 10.1111/aej.12847] [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: 08/20/2023] [Revised: 01/18/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
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.
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Affiliation(s)
- Jia Wang
- 1. Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chenguang Niu
- 1. Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Pengfei Zhang
- 1. Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shujun Ran
- 1. Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhengwei Huang
- 1. Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
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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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Nguyen KCT, Pachêco-Pereira C, Kaipatur NR, Cheung J, Major PW, Le LH. Comparison of ultrasound imaging and cone-beam computed tomography for examination of the alveolar bone level: A systematic review. PLoS One 2018; 13:e0200596. [PMID: 30281591 PMCID: PMC6169851 DOI: 10.1371/journal.pone.0200596] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 06/30/2018] [Indexed: 02/01/2023] Open
Abstract
Background and objective The current methods to image alveolar bone in humans include intraoral 2D radiography and cone-beam computed tomography (CBCT). However, these methods expose the subject to ionizing radiation. Therefore, ultrasound imaging has been investigated as an alternative technique, as it is both non-invasive and free from ionizing radiation. In order to assess the validity and reliability of ultrasonography in visualizing alveolar bone, a systematic review was conducted comparing ultrasound imaging to CBCT for examination of the alveolar bone level. Study design Seven databases were searched. Studies addressing examination of alveolar bone level via CBCT and ultrasound were selected. Risk of bias under Cochrane guidelines was used as a methodological quality assessment tool. Results All the four included studies were ex vivo studies that used porcine or human cadaver samples. The alveolar bone level was measured by the distance from the alveolar bone crest to certain landmarks such as cemento-enamel junction or gingival margin. The risk of bias was found as low. The mean difference between ultrasound and CBCT measurements ranged from 0.07 mm to 0.68 mm, equivalent to 1.6% - 8.8%. Conclusions There is currently preliminary evidence to support the use of ultrasonography as compared to CBCT for the examination of alveolar bone level. Further studies comparing ultrasound to gold standard methods would be necessary to help validate the accuracy of ultrasonography as a diagnostic technique in periodontal imaging.
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Affiliation(s)
- Kim-Cuong T. Nguyen
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Camila Pachêco-Pereira
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Comprehensive Dentistry, UT Health San Antonio, San Antonio, Texas, United States of America
| | - Neelambar R. Kaipatur
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail: (LHL); (NRK)
| | - June Cheung
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W. Major
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lawrence H. Le
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- * E-mail: (LHL); (NRK)
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Afkar M, Gholamshahi M, Mohammadi M. Nonsurgical Treatment of Type II Dens Invaginatus in a Maxillary Lateral Incisor Using Cone-Beam Computed Tomography. IRANIAN ENDODONTIC JOURNAL 2018; 13:132-134. [PMID: 29692849 PMCID: PMC5800455 DOI: 10.22037/iej.v13i1.19091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This is a clinical report of a case of Oehlers type II dens invagination in left maxillary lateral incisor. A 12-year-old female patient was referred to endodontic department of Islamic Azad University. She reported history of pain and swelling on left anterior maxilla. Due to the insufficient information from conventional radiography, cone-beam computed tomography (CBCT) was ordered. CBCT revealed apical lucency and two separate canals. Conventional root canal therapy was done using warm vertical technique for invaginated canal. One year follow-up radiographies showed periapical repair and absence of symptoms.
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Affiliation(s)
- Mohsen Afkar
- Department of Endodontics, Dental Branch of Tehran, Islamic Azad University, Tehran, Iran
| | - Mahboubeh Gholamshahi
- Department of Endodontics, Dental Branch of Tehran, Islamic Azad University, Tehran, Iran
| | - Mehdi Mohammadi
- Dentistry Student, Dental Branch of Tehran, Islamic Azad University, Tehran, Iran
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Goel S, Nawal RR, Talwar S. Management of Dens Invaginatus Type II Associated with Immature Apex and Large Periradicular Lesion Using Platelet-rich Fibrin and Biodentine. J Endod 2017; 43:1750-1755. [PMID: 28712634 DOI: 10.1016/j.joen.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 02/07/2023]
Abstract
Dens invaginatus (DI) poses peculiar challenges in endodontic treatment of teeth because of distortion of pulpal space. A case of Oehlers type II DI with open apex and large periapical lesion is reported. The case was managed using cone-beam computed tomography (CBCT), operating microscope, platelet-rich fibrin (PRF), and Biodentine. A 15-year-old male patient presented with palatal swelling. Pulp sensibility testing of right maxillary lateral incisor was negative. Intraoral periapical digital radiograph revealed an Oehlers type II DI with open apex and periapical radiolucency. A CBCT scan was performed to study the anatomy, determine the true extent of the periapical lesion, and form a treatment plan. A diagnosis of Oehlers type II DI with pulp necrosis and acute periapical abscess was made. Two-visit endodontic treatment was performed. In the first visit, the invaginated central mass was removed under operating microscope, chemo-mechanical preparation was done, and double antibiotic paste dressing was placed. In the second visit, the canal was sealed with apical matrices of PRF and Biodentine as filling material. The patient was asymptomatic and radiographs revealed continued healing of the osseous defect at follow-up visits. A CBCT scan at 30 months showed complete continuity of periodontal ligament space, healing of labial and palatal cortical plates, and formation of intercortical bone. The advances in endodontic armamentarium and technology, like CBCT and operating microscope, have made successful treatment of challenging cases possible. PRF and Biodentine as apical matrices and filling material, respectively, proved to be effective in the present case.
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Affiliation(s)
- Shruti Goel
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, Delhi, India
| | - Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, Delhi, India.
| | - Sangeeta Talwar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, Delhi, India
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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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Kato A, Ziegler A, Utsumi M, Ohno K, Takeichi T. Three-dimensional imaging of internal tooth structures: Applications in dental education. J Oral Biosci 2016. [DOI: 10.1016/j.job.2016.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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A Rare Case of Type III Dens Invaginatus in a Mandibular Second Premolar and Its Nonsurgical Endodontic Management by Using Cone-beam Computed Tomography: A Case Report. J Endod 2016; 42:669-72. [DOI: 10.1016/j.joen.2016.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/04/2016] [Indexed: 12/18/2022]
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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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Kato A, Ziegler A, Higuchi N, Nakata K, Nakamura H, Ohno N. Aetiology, incidence and morphology of the C-shaped root canal system and its impact on clinical endodontics. Int Endod J 2014; 47:1012-33. [PMID: 24483229 PMCID: PMC4258081 DOI: 10.1111/iej.12256] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/27/2014] [Indexed: 01/15/2023]
Abstract
The C-shaped root canal constitutes an unusual root morphology that can be found primarily in mandibular second permanent molars. Due to the complexity of their structure, C-shaped root canal systems may complicate endodontic interventions. A thorough understanding of root canal morphology is therefore imperative for proper diagnosis and successful treatment. This review aims to summarize current knowledge regarding C-shaped roots and root canals, from basic morphology to advanced endodontic procedures. To this end, a systematic search was conducted using the MEDLINE, BIOSIS, Cochrane Library, EMBASE, Google Scholar, Web of Science, PLoS and BioMed Central databases, and many rarely cited articles were included. Furthermore, four interactive 3D models of extracted teeth are introduced that will allow for a better understanding of the complex C-shaped root canal morphology. In addition, the present publication includes an embedded best-practice video showing an exemplary root canal procedure on a tooth with a pronounced C-shaped root canal. The survey of this unusual structure concludes with a number of suggestions concerning future research efforts.
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Affiliation(s)
- A Kato
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University, Aichi, Japan
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Use of cone-beam computed tomography in diagnosis of an otherwise undetected periapical lesion in an anomalous tooth. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0130-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mishra S, Mishra L, Sahoo SR. A Type III Dens Invaginatus with Unusual Helical CT and Histologic Findings: A Case Report. J Clin Diagn Res 2013; 6:1606-9. [PMID: 23285474 DOI: 10.7860/jcdr/2012/4347.2577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 10/01/2012] [Indexed: 12/27/2022]
Abstract
Dens Invaginatus (DI) is a rare developmental anomaly which affects the tooth, which shows an infolding of enamel and dentine which extends into the pulp chamber and sometimes into the root. The aim of this case report was to describe its radiographic findings, to emphasize the bizarre morphology and the difficulties which are encountered in the diagnosis by using conventional radiographic techniques and the importance of computed tomography as a valuable diagnostic aid. Dens Invaginatus is clinically significant due to the possibility of an early pulpal involvement and the chronic periapical lesions are often associated with this anomaly without any clinical symptoms. Difficulties are encountered during the endodontic treatment, owing to the complex root canal anatomy; therefore, a proper radiologic evaluation by using different imaging modalities, is essential for its successful treatment.
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Affiliation(s)
- Satyaranjan Mishra
- Lecturer, Department of Oral Medicine & Radiology, Institute of Dental Sciences, Siksha 'O' Anusandhan University , Bhubaneswar, Odisha, India
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Pradeep K, Charlie M, Kuttappa MA, Rao PK. Conservative Management of Type III Dens in Dente Using Cone Beam Computed Tomography. J Clin Imaging Sci 2012; 2:51. [PMID: 23029634 PMCID: PMC3440932 DOI: 10.4103/2156-7514.100372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 04/30/2012] [Indexed: 11/24/2022] Open
Abstract
Dens in dente, also known as dens invaginatus, dilated composite odontoma, or deep foramen caecum, is a developmental malformation that usually affects maxillary incisor teeth, particularly lateral incisors. It may occur in teeth anywhere within the jaws, other locations are comparatively rare. It can occur within both the crown and the root, although crown invaginations are more common. The use of cone beam computed tomography (CBCT) is very helpful in endodontic diagnosis of complex anatomic variations. In this case we demonstrate the use of CBCT in the evaluation and endodontic management of a Type III dens in dente (Oehler's Type III).
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Affiliation(s)
- K Pradeep
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, India
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Narayana P, Hartwell GR, Wallace R, Nair UP. Endodontic clinical management of a dens invaginatus case by using a unique treatment approach: a case report. J Endod 2012; 38:1145-8. [PMID: 22794224 DOI: 10.1016/j.joen.2012.04.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/16/2012] [Accepted: 04/27/2012] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Dens invaginatus is a developmental anomaly that poses treatment challenges when nonsurgical root canal therapy is deemed necessary. Teeth with complex root canal morphology often require a comprehensive treatment approach to effectively clean, shape, and disinfect the pulp canal space before obturation. Endodontic clinical management of a tooth with dens invaginatus might include using cone-beam computed tomography (CBCT) to aid in the diagnosis and treatment-planning phase and use of the surgical operating microscope in performing the clinical phase of treatment. A novel approach could include using the revascularization technique as the final treatment step in the management of a dens invaginatus case in which the root apex has not completed formation. METHODS This case report will provide both an overview of the feasibility of using CBCT scans in diagnosis and treatment planning and a step-by-step clinical technique, by using surgical operating microscope and the revascularization technique, in the successful endodontic management of a complex dens invaginatus case. CONCLUSIONS Five-month and 12-month follow-up clinical and radiographic findings will provide a candid view of inherent advantages and challenges of this technique.
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Affiliation(s)
- Pushpak Narayana
- Department of Endodontics, University of Medicine and Dentistry of New Jersey, 110 Bergen St., Newark, NJ 07101, USA.
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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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