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Amiri M, Mirzaie A. Photodynamic Therapy in a Lateral Maxillary Incisor with Dens in Dente Type Ⅱ and Primary Endodontic Lesion: Case Report. IRANIAN ENDODONTIC JOURNAL 2024; 19:130-133. [PMID: 38577008 PMCID: PMC10988645 DOI: 10.22037/iej.v19i2.43487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/02/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
Endodontic treatment in dens invaginatus anomaly is associated with challenges in all stages. This case report outlines the therapy provided for tooth #10 with occasional pain. In examinations, tenderness to percussion and touch and non-response to sensibility tests were observed, and pulp necrosis and symptomatic periapical periodontitis were diagnosed. Radiographic evaluation showed a structural anomaly related to the dens invaginatus and the associated periapical lesion. Cone-beam computed tomography confirmed the presence of DI type II. Endodontic treatment combined with photodynamic therapy and active irrigation using a dental operating microscope was successful and radiographic examinations showed periapical healing along with bone formation in 6-month and 1-year follow-ups.
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Affiliation(s)
- Maryam Amiri
- Endodontics Department. School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran;
| | - Arezoo Mirzaie
- Department of Endodontics, School Of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nasrabadi N, Naseri M, Khosraviani F, Nematollahi Z. A Successful Non-surgical Management of a Type II Dens Invaginatus with Antimicrobial Photodynamic Therapy: A Case Report. IRANIAN ENDODONTIC JOURNAL 2023; 18:59-62. [PMID: 36751410 PMCID: PMC9900150 DOI: 10.22037/iej.v18i1.38789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 02/09/2023]
Abstract
Endodontic therapy of dens invaginatus (DI) anomalies is challenging due to difficult access, inadequate cleaning and shaping, and incomplete disinfection of its complicated root canal system. The present case report describes the treatment of tooth #10 with tooth discomfort, intermittent pus discharge, and localized swelling. Sinus tract, mobility, and probing grade 1 were observed. The tooth was tender on palpation and percussion with negative responses to pulp sensibility tests. Radiographic assessments revealed an atypical structure of pulpal anatomy, probably dens invaginatus, associated with a large periapical lesion and severe root curvature. Cone-beam computed tomography confirmed the presence of DI type II. Finally, the diagnosis of pulp necrosis with chronic apical abscess of tooth #10 was made. Combining antimicrobial photodynamic therapy as an adjunctive treatment with different irrigation techniques were effective in nonsurgical endodontic management of the complicated DI type II in a maxillary lateral incisor with a large periradicular lesion and severe root curvature. Six-month and one-year recall radiographic images revealed asymptomatic tooth and progressive osseous healing.
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Affiliation(s)
- Navid Nasrabadi
- Department of Endodontics, School of Dentistry, Birjand University of Medical Sciences, Birjand, Iran;
| | - Mandana Naseri
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | - Farshad Khosraviani
- University of California Los Angeles, School of Dentistry, Los Angeles, USA; ,Corresponding author: Farshad Khosraviani, 714 Tiverton Drive, Los Angeles, CA, 90024. E-mail:
| | - Zahra Nematollahi
- Dental Research Center, Research Institute of Dental Science, Shahid Beheshti University of Medical Science, Tehran, Iran, and Crani -Maxillofacial Research Center, Azad University, Dental Branch, Tehran, Iran
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Zargar N, Ashraf H, Asnaashari M, Soltaninejad F, Amiri M. Treatment of Peri-Invagination Lesion and Vitality Preservation in Type III Dens Invaginatus in Bilateral Immature Maxillary Lateral Incisors: A Case Report. IRANIAN ENDODONTIC JOURNAL 2023; 18:186-191. [PMID: 37431525 PMCID: PMC10329757 DOI: 10.22037/iej.v18i3.42102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023]
Abstract
The superior lateral incisors are primarily affected by the developmental deformity known as dens invaginatus (DI). Oehler's type III DI has the highest complexity rendering a root canal treatment (RCT) an arduous challenge for this type, so early diagnosis and treatment before pulp involvement are important. This report presents two maxillary lateral incisors with type IIIb DI, the left one being associated with a periapical lesion and the right one with normal pulp. A nine-year-old boy was referred to our clinic complaining of mobility of the maxillary left lateral incisor (LLI) associated with gumboil throughout the previous two months. Periapical radiolucency was visible on radiographs, as well as an invagination that crosses the apical foramen from the pulp chamber in both maxillary lateral incisors. The pulp of the main canal of LLI was vital and pseudo canals were necrotized and associated with chronic apical abscess. Based on the condition of the main pulp of maxillary lateral incisors, two separate treatments were carried out. RCT was done only for the pseudo canals in the LLI, while the main root canal was preserved. The right maxillary lateral incisor (RLI) had vital pulp with normal periapical tissue So the invagination was sealed as the tooth was erupting. During the one-year follow-up period, the development of the root in LLI with a thick root wall and closed apex was observed in the periapical radiograph but pseudo canals became infected and the tooth became symptomatic, therefore retreatment for pseudo canals was carried out. The RLI root was developed and the tooth was clinically asymptomatic, so it didn't need further treatment. Maintaining pulp vitality is crucial for type III Dens invaginated young permanent teeth since it could support root formation and improve long-term prognosis, and in cases with pulp involvement, non-surgical RCT is clinically predictable.
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Affiliation(s)
- Nazanin Zargar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | - Hengameh Ashraf
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | - Mohammad Asnaashari
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | - Fatemeh Soltaninejad
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | - Maryam Amiri
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
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Moazami F, Sobhnamayan F, Malekzadeh P, Naseri M. Nonsurgical Treatment of Unusual Dens Invaginatus with MTA Based Filler in Immature Maxillary Lateral Incisor: A Case Report. IRANIAN ENDODONTIC JOURNAL 2021; 16:60-64. [PMID: 36704412 PMCID: PMC9709883 DOI: 10.22037/iej.v16i1.30581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/24/2020] [Accepted: 11/06/2020] [Indexed: 01/28/2023]
Abstract
Dens invaginatus (DI) is a dental anomaly associated with complex internal anatomy. Our article discusses an unusual maxillary lateral incisor with two DI. The treatment was planned and performed using cone-beam computed tomographic (CBCT) imaging. During clinical and radiographic evaluations, tooth #7 was diagnosed with DI and pulp necrosis with asymptomatic apical abscess. Periapical radiographs of the tooth showed 2 roots and complex internal anatomy. CBCT evaluation revealed tooth #7 had 2 separate cul-de-sacs (that separate the main canal into four portions). Root canal treatment was completed in 2 visits. The tooth was obturated with EndoSeal MTA. At the 6-month re-evaluation, the patient remained asymptomatic and his tooth had remained functional. Clinical and radiographic examination showed tooth #7 had no sensitivity to percussion or palpation, probe depths within normal limits (#3 mm), no mobility and continued improvement of periapical lesion, despite the commencement of orthodontic Rx 3months previous. Radiographic assessment at the one-year follow up showed significant osseous healing of the preoperative lesion even after the orthodontic forces.
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Affiliation(s)
- Fariborz Moazami
- Department of Endodontics, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshte Sobhnamayan
- Department of Endodontics, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author: Fereshte Sobhnamayan, Department of Endodontics, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parastoo Malekzadeh
- Department of Endodontics, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadhasan Naseri
- Department of Endodontics, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran
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Oliveira Fonseca F, Canal Vasconcellos B, Martins Costa M, Ribeiro Sobrinho AP, Fonseca Tavares WL. Combined Endodontic and Surgical Therapy for Resolution of Type III Dens Invaginatus. IRANIAN ENDODONTIC JOURNAL 2020; 15:117-123. [PMID: 36704442 PMCID: PMC9709837 DOI: 10.22037/iej.v15i2.26882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/03/2020] [Accepted: 03/18/2020] [Indexed: 01/28/2023]
Abstract
Dens invaginatus is an abnormal dental developmental, probably resulting of the invagination of mineralized tissues from the tooth crown surface before its calcification. The teeth that are most affected by this abnormality are the maxillary lateral incisors. This dental developmental anomaly has various types and the rarest is type III which has the worst prognosis, because of its complex anatomy. Conventional root canal therapy may not sufficiently resolve the case itself and in some circumstances the surgical intervention is also necessary. This report addresses a complex combined endodontic treatment of a type III dens invaginatus in a maxillary lateral incisor in an 18 years-old female patient, with an extensive periapical lesion affecting the buccal and palatine cortical bone, diagnosed by cone-beam computed tomography (CBCT). The case was conducted with the combination of endodontic and surgical treatment, under the use of the surgical operating microscope. The association of CBCT, visual magnification, XP-endo Finisher, bioceramic sealer, MTA Repair HP and bone graft were important to ensure predictable success.
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Affiliation(s)
- Francielen Oliveira Fonseca
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil,Corresponding author: Francielen Oliveira Fonseca, Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Avenida Antônio Carlos 6627. Belo Horizonte, Minas Gerais, Brazil. E-mail:
| | - Betânia Canal Vasconcellos
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marcela Martins Costa
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, 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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Saberi E, Bijari S, Farahi F. Endodontic Treatment of a Maxillary Lateral Incisor with Two Canals: A Case Report. IRANIAN ENDODONTIC JOURNAL 2018; 13:406-408. [PMID: 30083216 PMCID: PMC6064021 DOI: 10.22037/iej.v13i3.20986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Variations in the number of roots and canals have been extensively reported in endodontic literature. One rare variation is presence of two separate root canals in maxillary lateral incisors. This study reports a maxillary lateral incisor with two canals. Although rare, knowledge about this anatomical variation can help in successful endodontic treatment of such teeth.
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Affiliation(s)
- Eshaghali Saberi
- Department of Endodontics, Oral and Dental Diseases Research Center, Dental School, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Shima Bijari
- Department of Endodontics, Oral and Dental Diseases Research Center, Dental School, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Forough Farahi
- Department of Endodontics, Oral and Dental Diseases Research Center, Dental School, Zahedan University of Medical Sciences, Zahedan, Iran
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