Management of Type III Dens Invaginatus in a Mandibular Premolar: A Case Report

Retrospective Study of Intentional Replantation for Type Ⅲb Dens Invaginatus with Periapical Lesions

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.

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.

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.

Management of dens invaginatus in a maxillar lateral incisor with open apex and persistent sinus tract: A case report

Background/Aim: Dens invaginatus is a developmental anomaly of teeth. The endodontic treatment of these teeth may be difficult because of adversity in accessing the root canals and also complicated variations of internal structure. In this case, the report is presented the nonsurgical management and follow-up of a tooth with class II dens invaginatus with an open apex and sinus tract. Case Report: In the radiographic examination, there are two root canals; a primary (main) canal and an invaginated canal. The main canal wide-open at the portal of exit and associated with a large chronic periapical lesion extending to the apex of the maxillary left central incisor. An invaginated canal was not reaching the apex. In a clinical examination, a sinus tract was detected in the labial gingiva. After apexification with using MTA was applied, the endodontic treatment was completed. In 12 month recall, a gray discoloration was detected and internal bleaching with 35% hydrogen peroxide was applied. Finally, the tooth was restored using composite resin. 12 months follow-up radiographs revealed resolution of periapical radiolucency, trabecular bone formation, and closure of the root apex with the totally asymptomatic tooth. Conclusions: The case report shows that tooth with DI that has wide apex and sinus tract can be treated with non-surgical methods, such as immature tooth without anomalies.

Management of Oehler's Type III Dens Invaginatus Using Cone Beam Computed Tomography

Dens Invaginatus is a dental malformation that poses diagnostic difficulties in the clinical context. This anomaly may increase the risk of pulp disease and can potentially complicate endodontic procedure due to the aberrant root canal anatomy. Compared to conventional radiographs, three-dimensional images obtained with Cone Beam Computed Tomography (CBCT) are invaluable in the diagnosis of the extent of this anomaly and in the appropriate treatment planning. Oehler's classification (1957) for Dens Invaginatus (DI) into three types depending on the depth of the invagination has been used for treatment planning. Of the three types Type III DI is characterized by infolding of the enamel into the tooth up to the root apex and is considered as the most severe variant of DI and hence the most challenging to treat endodontically, due to the morphological complexities. This report describes a case of Oehler's Type III DI in a necrotic permanent maxillary lateral incisor in which CBCT images played a key role in diagnosis and treatment planning. The case was managed successfully by a combination of nonsurgical and surgical endodontic therapy with orthograde and retrograde thermoplastic gutta percha obturation.