Bilateral dens invaginatus in the mandibular premolars - Diagnosis and treatment

Multiple dens invaginatus in Wilson's disease: A case report

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.

[Dens invaginatus or dilated odontoma, a definition controversy.]

The invaginate tooth (IT) is an alteration in the development of the dental organ, which occurs as a consequence of invagination of the internal epithelium of the enamel organ. IT is also known as "dens in dente", among other denominations, and presents a series of clinical, histological and imaging characteristics. The most extreme variant of IT has a very complex configuration, and the magnitude of the intussusception has led to it also being called dilated odontoma, being a term that generates confusion in some professionals.While the term odontoma has been reported as a synonym for both IT as well as a new variant of odontomas, there is a difference betweene the two types: one is a developmental anomaly and the other is a growth with a hamartomatous appearance. However, the literature continues to use both terms to define IT, and thus, it is important to know the origin and be aware that the controversy is based on historical and customary references.

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.

Endo-restorative Management of a Type II Dens Invaginatus in Mandibular Premolar Associated with a Large Cyst

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.