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Kaya S, Koc A. Radiologic evaluation of associated symptoms and fractal analysis of unilateral dens invaginatus cases. Oral Radiol 2024:10.1007/s11282-024-00756-4. [PMID: 38748387 DOI: 10.1007/s11282-024-00756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/27/2024] [Indexed: 07/07/2024]
Abstract
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.
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Affiliation(s)
- Sema Kaya
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Van Yuzuncu Yil University, Van, Turkey.
| | - Alaettin Koc
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Van Yuzuncu Yil University, Van, Turkey
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Wei C, Wang D, Shen L, Lu P, Meng Z, Zhou R. Treatment opinions for dens invaginatus: A case series. Exp Ther Med 2024; 27:138. [PMID: 38476914 PMCID: PMC10928843 DOI: 10.3892/etm.2024.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
Dens invaginatus (DI) is a rare congenital dental malformation characterized by enamel or cementum folded into dentine. Such teeth are susceptible to caries, pulp infection or necrosis and periradicular lesion. The complex anatomy of this disease results in difficult treatment and a high rate of therapeutic failure. Therapeutic options, such as debriding and filling invagination, root canal treatment (RCT) and intentional replantation, vary according to the morphology and infection of the involved tooth. The present study reports five cases of DI with chronic apical periodontitis. The treatment strategies and procedures, including RCT, removing the invagination, intentional replantation and surgical treatment, are discussed according to the classification and the condition of pulp and periapical tissue. The study also reports the prognosis: All patients were followed up for ≥12 months and all teeth demonstrated periapical healing and clinical asymptomatic. In summary, appropriate treatment is based on accurate analysis of the anatomical variation in different types of DI and intentional replantation is a reliable and viable treatment to preserve the tooth.
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Affiliation(s)
- Chengshi Wei
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Dong Wang
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Lili Shen
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Ping Lu
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Zhen Meng
- Biomedical Laboratory, Medical School of Liaocheng University, Liaocheng, Shandong 252000, P.R. China
| | - Rongjing Zhou
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
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Root Maturation of an Immature Dens Invaginatus Despite Unsuccessful Revitalization Procedure: A Case Report and Recommendations for Educational Purposes. Dent J (Basel) 2023; 11:dj11020047. [PMID: 36826192 PMCID: PMC9955176 DOI: 10.3390/dj11020047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The clinical management of teeth with complex dens invaginatus (DI) malformations and apical periodontitis may be challenging due to the lack of routine. The aim of this case report is to describe the endodontic treatment of an immature tooth with DI and to discuss strategies for preclinical training for teeth with such malformations. CASE REPORT A 9-year-old male presented with an immature maxillary incisor with DI (Oehlers Type II) and apical periodontitis which was diagnosed by cone beam computed tomography (CBCT). Revitalization was initially attempted but then abandoned after failure to generate a stable blood clot. Nevertheless, considerable increase in both root length and thickness could be detected after medication with calcium hydroxide followed by root canal filling with MTA as an apical plug. CONCLUSIONS The endodontic management of teeth with DI requires thorough treatment planning. In immature teeth, under certain conditions, root maturation may occur even with conventional apexification procedures. From an educational perspective, different strategies including CBCT and 3D-printed transparent tooth models for visualization of the complex internal morphology and redesigned 3D-printed replica with various degrees of difficulty for endodontic training, can be used to overcome the challenges associated with endodontic treatment of such teeth.
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Hegde V, Mujawar A, Shanmugasundaram S, Sidhu P, Narasimhan S, Setzer FC, Nagendrababu V. Prevalence of dens invaginatus and its association with periapical lesions in a Western Indian population-a study using cone-beam computed tomography. Clin Oral Investig 2022; 26:5875-5883. [PMID: 35648236 DOI: 10.1007/s00784-022-04545-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/11/2022] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Vivek Hegde
- Department of Conservative Dentistry and Endodontics, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, India.
| | - Asiya Mujawar
- Department of Conservative Dentistry and Endodontics, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Srilatha Shanmugasundaram
- Department of Conservative Dentistry and Endodontics, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Preena Sidhu
- Division of Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | | | - Frank C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.
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Memis S, Bas Z. Multiple dens invaginatus in Wilson's disease: A case report. AUST ENDOD J 2021; 47:679-683. [PMID: 33905151 DOI: 10.1111/aej.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/13/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Sadi Memis
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - Zubeyir Bas
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Borkar S, Dhupar A, Parab M. Endo-restorative Management of a Type II Dens Invaginatus in Mandibular Premolar Associated with a Large Cyst. Contemp Clin Dent 2017; 8:158-160. [PMID: 28566871 PMCID: PMC5426152 DOI: 10.4103/ccd.ccd_1123_16] [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] [Indexed: 11/07/2022] Open
Abstract
We present the management of a case of Type II dens invaginatus in a mandibular premolar with a large invagination in the coronal third of the root on mesial aspect of the crown in proximity of cementoenamel junction significantly compromising the strength of the crown structure. We describe in detail the various measures taken to assess the internal tooth structure destruction and enhance the fracture resistance of the involved premolar. The case has a long-term follow-up of 36 months showing clinical and radiographic signs of healing. We highlight use of a simple “foil coated fiber postblocker technique” for root reinforcement in the first premolar. Successful management of teeth with dens invaginatus can be effectively done using with careful treatment planning and selection of reinforcing adhesive restorative materials.
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Affiliation(s)
- Swati Borkar
- Department of Conservative Dentistry, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Anita Dhupar
- Department of Oral Pathology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Manjita Parab
- Department of Prosthodontics, Goa Dental College and Hospital, Bambolim, Goa, 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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Ahmed HMA, Hashem AA. Accessory roots and root canals in human anterior teeth: a review and clinical considerations. Int Endod J 2015; 49:724-36. [DOI: 10.1111/iej.12508] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/09/2015] [Indexed: 01/14/2023]
Affiliation(s)
- H. M. A. Ahmed
- Department of Conservative Dentistry; School of Dental Sciences; Universiti Sains Malaysia; Kelantan Malaysia
| | - A. A. Hashem
- Department of Endodontics; Faculty of Dentistry; Ain Shams University; Cairo Egypt
- Department of Endodontics; Faculty of Dentistry; Future University; Cairo Egypt
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Wall A, Ng S, Djemal S. The value of cone beam CT in assessing and managing a dilated odontome of a maxillary canine. DENTAL UPDATE 2015; 42:126-8. [PMID: 26058225 DOI: 10.12968/denu.2015.42.2.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A case of an unusual anomaly in a maxillary canine is described. A deep enamel invagination resulted in pulpal necrosis, longstanding infection and development of an associated radicular cyst. Diagnostic X-ray imaging was invaluable in demonstrating the complex root anatomy of the dilated odontome. In particular, a cone beam CT scan helped in the formulation of an appropriate treatment plan. Clinical Relevance: Three-dimensional imaging using cone beam CT was valuable in this case to demonstrate the complicated anatomy of a rare dental anomaly, and to help plan treatment.
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Capar ID, Ertas H, Arslan H, Tarim Ertas E. 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. J Endod 2015; 41:473-8. [PMID: 25595467 DOI: 10.1016/j.joen.2014.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This study assessed the presence, characteristics, and type of dens invaginatus (DI) by using cone-beam computed tomography (CBCT) and panoramic images rendered from CBCT images. In addition, the findings of the imaging techniques were compared. METHODS We evaluated 300 CBCT images to determine the type of DI, the presence of an impacted tooth near the DI, and the presence of apical pathosis. The McNemar test was used to compare the prevalence of DI according to CBCT and panoramic images rendered from CBCT images. RESULTS The presence of DI was lower on panoramic images rendered from CBCT images (3% of the patients) compared with on CBCT images (10.7% of the patients) (P < .001). According to the CBCT images, the distribution of teeth with DI was as follows: maxillary lateral incisors (75%), maxillary central incisors (6.8%), mandibular premolars (4.6%), mesiodens (9%), maxillary canines (2.3%), and mandibular canines (2.3%). Type I DI was the most commonly observed type of invaginatus (65.9%), followed by type II (29.5%) and type III (4.6%). All patients with type III DI and 25% of the patients with type II DI had apical pathosis at the time of referral, but periapical lesions were not observed in teeth with type I DI. In total, 13.6% of DI cases had impacted teeth. CONCLUSIONS CBCT can be recommended as an effective diagnostic device for identifying DI because it provides an accurate representation of the external and internal dental anatomy.
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Affiliation(s)
- Ismail Davut Capar
- Faculty of Dentistry, Department of Endodontics, İzmir Katip Çelebi University, İzmir, Turkey.
| | - Huseyin Ertas
- Faculty of Dentistry, Department of Endodontics, İzmir Katip Çelebi University, İzmir, Turkey
| | - Hakan Arslan
- Faculty of Dentistry, Department of Endodontics, Atatürk University, Erzurum, Turkey
| | - Elif Tarim Ertas
- Faculty of Dentistry, Department of Oral Diagnosis and Radiology, İzmir Katip Çelebi University, İzmir, Turkey
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Akers HF, Henderson CM, Foley MA. Diagnosis and management of a maxillary lateral incisor exhibiting dens invaginatus and dens evaginatus. AUST ENDOD J 2014; 40:32-8. [PMID: 24456015 DOI: 10.1111/aej.12056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This case report, involving an indigenous Australian, presents the diagnosis and non-surgical endodontic management of a 22 with developmental abnormalities. They include a dens evaginatus and a dens invaginatus that extends to an apical burst in a second truncated root. Cone-beam computed tomography and endodontic microscopy were not available to the clinician. This case report focuses on ambiguities appearing in the literature relating to classification and terminology associated with the abovementioned developmental anomalies. It also demonstrates the need to methodically collect and cautiously interpret available information before initiating endodontic intervention. Axial inclination, distance perception, internal demarcation and spatial awareness, together with an understanding of dental anatomy, embryology and histology and associated physiology and pathology, allowed the clinician to accurately predict the point, the angle and the depth of coronal access. Sensibility of the dentino-pulpal complex was maintained. Critical thinking, experience, innovation, problem-solving and established principles can compensate for inaccessible technologies.
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Affiliation(s)
- Harry Francis Akers
- Brisbane Dental Hospital, Queensland Health, Brisbane, Queensland, Australia
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Endodontic Treatment of Type II Dens Invaginatus in a Maxillary Lateral Incisor: A Case Report. Case Rep Dent 2012; 2012:153503. [PMID: 23213576 PMCID: PMC3507043 DOI: 10.1155/2012/153503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 10/27/2012] [Indexed: 11/17/2022] Open
Abstract
Dens invaginatus is a developmental anomaly that results in an enamel-lined cavity intruding into the crown or root before the mineralization phase. It typically affects permanent maxillary lateral incisors, central incisors, and premolars. This paper describes the root canal treatment of Oehlers' type II dens invaginatus in maxillary left lateral incisors. A 16-year-old boy presented to the Faculty of Dentistry, University of Kocaeli, to receive his dental treatments. During the caries removal, the pulp was exposed then anendodontic treatment was initiated. Two canals, one of which represented the invagination, were instrumented, irrigated, and then obturated with a lateral condensation technique.
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