Root canal treatment of type Ⅱ and ⅢA double dens invaginatus in maxillary lateral incisor: a case report / 华西口腔医学杂志

Dens invaginatus is a rare developmental anomaly of the teeth that is caused by the infolding of enamel organs or the penetration of their proliferations into dental papillae before calcification has occurred. The presence of double dens invaginatus is extremely rare. This paper describes the use of cone beam computed tomography in the evaluation of a maxillary lateral incisor with double dens invaginatus and periapical periodontitis. The tooth was treated through microscopic root canal therapy. The tooth was free of clinical symptoms, and the periradicular lesion narrowed during the follow-up period of 1 year.

Dens in dente Tipo III A: relato de caso / Dens invaginatus type III A: case report

Introdução: dens in dente é uma anomalia rara de desenvolvimento, caracterizada pela invaginação dos tecidos dentários, podendo variar de um ligeiro aumento da fosseta do cíngulo a um profundo sulco, que pode se estender até o ápice dentário. Objetivo: o objetivo do presente artigo foi relatar um caso clínico e descrever as peculiaridades dos achados clínicos e radiográficos de um dens in dente Tipo III A, com ênfase na descrição de sua morfologia completamente atípica, além das dificuldades que foram encontradas no diagnóstico e durante o tratamento endodôntico. Caso clínico: o paciente compareceu ao ambulatório de uma clínica de Endodontia com queixa de dor e leve edema. Ao exame clínico e radiográfico, observou-se imagem sugestiva de dens in dente no elemento #22, sendo, então, proposto tratamento endodôntico convencional, com estudo tomográfico. Resultados: após 1 ano e 6 meses de acompanhamento, o paciente encontrava-se assintomático. Notou-se reparo satisfatório, com formação óssea, apesar da sobre-extensão do cone. Conclusão: foi possível perceber a importância da tomografia computadorizada de feixe cônico como auxiliar no diagnóstico e planejamento da conduta frente a casos de dens in dente, principalmente por aumentar as chances de sucesso, evitando a perda precoce de elementos dentários (AU).

Introduction: Dens invaginatus is a rare dental anomalycharacterized by invagination of dental tissues, which maybe from a slight increase in the pit of the cingulum to a deep groove that may extend to the tooth apex. This report describes clinical and radiographic findings and the morphology of a completely atypical and unique anomaly, and discusses the difficulties in the diagnosis and endodontic treatment of the root canal of teeth with this complex anatomy. Clinical case: Patient seen in the outpatient clinic of the Endodontic Service with a complaint of pain and mild edema. Clinical and radiographic examinations were suggestive of invagination itooth #22, and conservative endodontic treatment and CT scans were indicated. Results: Patient was asymptomatic and had no functional disorders at 18 months of follow-up. Repair and new bone formation were satisfactory, despite cone overextension. Conclusion: Cone-beam CT seems to be an important method of diagnosis and treatment planning in cases of dens invaginatus, especially because it increases the chances of treatment success and prevents the early loss of teeth (AU).

Guided endodontics: a case report of maxillary lateral incisors with multiple dens invaginatus

Navigation of the main root canal and dealing with a dens invaginatus (DI) is a challenging task in clinical practice. Recently, the guided endodontics technique has become an alternative method for accessing root canals, surgical cavities, and calcified root canals without causing iatrogenic damage to tissue. In this case report, the use of the guided endodontics technique for two maxillary lateral incisors with multiple DIs is described. A 16-year-old female patient was referred with the chief complaint of pain and discoloured upper front teeth. Based on clinical and radiographic findings, a diagnosis of pulp necrosis and chronic periapical abscess associated with double DI (Oehler's type II) was established for the upper left lateral maxillary incisor (tooth #22). Root canal treatment and the sealing of double DI with mineral trioxide aggregate was planned for tooth #22. For tooth #12 (Oehler's type II), preventive sealing of the DI was planned. Minimally invasive access to the double DI and the main root canal of tooth #22, and to the DI of tooth #12, was achieved using the guided endodontics technique. This technique can be a valuable tool because it reduces chair-time and, more importantly, the risk of iatrogenic damage to the tooth structure.

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.

Endodontic-periodontal combined therapy for type Ⅲ dens invaginatus in maxillary lateral incisor: a case report / 华西口腔医学杂志

We report a clinical case of type Ⅲ dens invaginatus with endodontic-periodontal lesion in a maxillary lateral incisor. The palatal radicular anomaly predisposed the tooth to periodontal lesions. The caries along the palatal groove caused tooth pulp necrosis and periapical lesions. By means of microscopic root canal therapy, apical surgery, and guided periodontal tissue regeneration, the apical and periodontal infection were controlled, and the affected tooth was retained.

Apical barrier technology to treat chronic apical periodontitis caused by type Ⅱ dens invaginatus: a case report / 华西口腔医学杂志

Dens invaginatusis a rare malformation of the teeth, resulting in frequent pulp necrosis and chronic apical periodontitis. In this paper, the apical barrier technology was used to treat a case of chronic apical periodontitis caused by type Ⅱ dens invaginatus.

Dens invaginatus of right maxillary second molar: A case report and literature review / 吉林大学学报(医学版)

Objective: To explore the process of diagnosis and treatment of the patients with dens invaginatus of right maxillary second molar, to analyze the clinical features, the radiographic features and the pathological features of the dens invaginatus, and to make a reasonable treatment plan. Methods: The clinical data, imaging findings and pathological data of a patient with dens invagination were collected. The clinical diagnostic criteria and treatment methods of these cases were summarized with relevant literature review. Results: The patient, female, 28 years old, was diagnosed with a hole in the upper right posterior teeth for 6 months. The special examination results showed that the 17-toothed face was flat, the crown was huge, and the occlusal surface was seen in the sag and sputum; the medullary cavity was not reached. The radiograghic examination results showed that the enamel density image of the 17-toothed surface was sunken to the root, with a depth of about 7. 7 mm, diagnosed as dens invaginatus. At the time of initial treatment, the humus was removed and the sag received sedative treatment. The spontaneous pain still existed during the follow-up examination, and the problem of food embolism was not solved. Considering the poor recovery after treatment, the patient agreed to remove the tooth. The isolated tooth was observed by pathological grinding, and the enamel and dentin structures of the invaginatus were abnormal observed under microscope. Conclusion: The patients with dens invagination occurs in the molar area are rare; the type of disease and treatment plan should be determined by imaging examination during the process of diagnosis and treatment; it suggests that the patients with poor recovery after treatment should remove the teeth.

Multiple Dens Invaginatus - A case report and review of literature.

Dens invaginatus is a developmental variation of a tooth resulting from an alteration in the normal growth pattern of the dental papilla. It is clinically characterized by a palatine furrow that can be limited to the coronal pulp or may extend to the radicular apex. The commonly affected tooth is maxillary lateral incisor. The occurrence of multiple dens invaginatus is extremely rare. Although a clinical examination may reveal a deep pit or fissure on the lingual surfaces of maxillary anterior teeth, the radiographic examination is the choice for diagnosis of dens invaginatus. Familiarity with the radiographic appearance of this anomaly is essential for the dental practitioner. The purpose of this paper is to present a clinical case of multiple dens invaginatus involving maxillary anterior teeth which was diagnosed during routine radiographic evaluation.

Dental microscope aided treatment of dens invaginatus / 实用口腔医学杂志

Dens invaginatus is an unusual malformation.The difficulty in recognizing a tooth with dens invaginatus frequently results in the delayed diagnosis followed by unpromising treatment outcome because the abnormality cannot be seen until the tooth is involved with pulp necrosis even apical periodontitis.The application of CBCT scanning and dental microscope is playing a significantly important role in both diagnosis and treatment of dens invaginatus.This paper presents 2 cases with dens invaginatus which were well diagnosed and properly trea-ted,reviews the pathology and intends to get the principle ideas for the diagnosis and treatment of dens invaginatus.

Treatment of extensive cystic lesion in the maxilla associated with dens in dente / Tratamento de lesão cística extensa em maxila associada a dens in dente

Dens in dente is a dental development malformation that involves more commonly the upper lateral incisors. Infection of the canal of these teeth can cause the formation of chronic periapical lesions. The present study aimed to describe an integrated approach between the endodontic therapy and surgical intervention in an upper lateral incisor with dens in dente type II. A female patient, 14 years old, sought for dental care complaining of left palatal and paranasal bulging. Clinical, radiological and histopathological findings suggested periradicular cyst. First, marsupialization was performed to reduce the size of the lesion and to favor its enucleation, with less risk of injuring the tooth and vital structures. After diagnosis of pulp necrosis and in attempt to reduce the infection via canal, we used the reciprocating instrumentation associated with irrigation with sodium hypochlorite, intracanal medication based on calcium hydroxide and filled with a thermoplastic filling. After a year of marsupialization, fistulectomy and complete enucleation of the lesion were performed. Proservation was performed 1, 3, 6 and 12 months following marsupialization. Six months after enucleation, we observed the periradicular repair and remission of symptoms. The extensive apical lesion associated with dens in dente type II can be treated with a combination of surgical and endodontic therapy.

Dens in dente é uma malformação no desenvolvimento dentário que envolve mais comumente os incisivos laterais superiores. A infecção do canal destes dentes podem causar a formação de lesões periapicais crônicas. O objetivo deste trabalho é descrever uma abordagem integrada entre a terapia endodôntica e a intervenção cirúrgica em um incisivo lateral superior com dens in dente tipo II. Paciente de 14 anos, gênero feminino, procurou atendimento odontológico com queixa de abaulamento em região palatina e paranasal esquerda. Os achados clínico, radiográfico e histopatológico sugeriram cisto perirradicular. Marsupialização foi realizada inicialmente para reduzir o tamanho da lesão, favorecer a enucleação da mesma, com menor risco de injuriar o dente e as estruturas vitais. Diagnosticado necrose pulpar e na tentativa de combater a infecção via canal, empregou-se a instrumentação reciprocante associada a irrigação com hipoclorito de sódio, medicação intracanal a base de hidróxido de cálcio e finalizou-se com uma obturação termoplastificada. Após um ano do procedimento de marsupialização realizou-se a fistulectomia e a completa enucleação da lesão. A proservação foi realizada 1, 3, 6 e 12 meses posteriormente a marsupialização. Seis meses após a enucleação observou-se a reparação perirradicular e remissão dos sintomas. A extensa lesão perirradicular associada ao dens in dente tipo II pode ser solucionada com uma combinação entre a intervenção cirúrgica e endodôntica.

Rare Case of Multiple Compound Odontomas with Dens Invaginatus Associated with Impacted Primary and Unerupted Permanent Maxillary Central Incisor – A Case Report.

Aims: An Odontoma is usually found in the surrounding area of the unerupted permanent tooth bud and rarely adjacent to the primary central incisor. Histopathological examination of the Odontoma revealed presence of surface invagination similar to Dens invaginatus. Presentation of Case: A seven year-old healthy girl presented with an unerupted maxillary left primary central incisor along with swelling of labial gingiva in that region. No history of traumatic injury was recorded. Radiological examination revealed impacted primary maxillary left central incisor and three irregular masses of calcified tooth like tissues. Discussion: Odontomas are commonly occuring hamartomas associated with permanent dentition. Odontomas are rarely associated with Primary dentition. Multiple Odontomas leading to impaction of primary incisors is still rarer. This report presents a case of an impacted primary central incisor and unerupted permanent central incisor due to multiple odontomas, one of which was histologically diagnosed as multiple compound odontoma with Dens invaginatus. The Odontomas and impacted primary central were surgically removed to facilitate the eruption of permanent incisor. Conclusion: This report presents a unique and rare case of multiple Odontomas leading to impaction of primary tooth and unerupted permanent incisor. This report also proves Odontomas with deep surface invagination similar to Dens Invaginatus can be present.

Cone Beam Computed Tomography Aided Diagnosis of Double Dens Invaginatus in a Fused Supernumerary Tooth and Maxillary Central Incisor: A Case Report.

Dens invaginatus is a developmental malformation that causes changes in the internal anatomy of the tooth. Fusion and twinning are terms commonly used to describe the clinical presentation of double teeth. The presence of double dens invaginatus is extremely rare. Therefore understanding the complex morphology, type and extension of dens invaginatus are very essential. To establish the diagnostic hypothesis based on a periapical radiograph is a challenge for all different dentistry specialties. With cone-beam computed tomography (CBCT), the diagnostic dilemma is minimized because of the accurate visualization of the anatomy. The visualization of three-dimensional structures is very helpful in the diagnosis of these complex anatomic variations as it favors precise definition of the problem and treatment planning. With this case report, we would like to highlight how CBCT helped in the evaluation and treatment planning of Double dens invaginatus of a fused supernumerary tooth and maxillary central incisor, which could not be done using the intraoral periapical method.

Dens evaginatus and dens invaginatus in a double tooth: A rare case report.

The presence of dens invaginatus (DI) and dens evaginatus (DE) on same tooth is a rare phenomenon. However, when these dental anomalies occur on a double tooth, it becomes an extremely rare phenomenon. The authors report a rare case of DI and DE on fused permanent maxillary central incisor with supernumerary tooth in a 40‑year‑old male. The present article also focuses on the differentiating fusion from gemination and also reviews preventive and management strategies for tooth with complex dental anatomy.

One case report of type Ⅲ of dens in dente of maxillary bilateral incisors / 实用口腔医学杂志

Dens in dente is a rare malformation of teeth.This article reports one case of type Ⅲ dens in dente of maxillary bilateral incisors with acute periapical lesion.The case was treated successfully by apexification with Vitapex paste.

Treatment of maxillary lateral incisor with type Ⅲ dens invaginatus in a case / 实用口腔医学杂志

Dens invaginatus is a relatively rare tooth malformations,this paper reports a case of lateral incisor with typeⅢdens invaginatus with periradicular pathosis and without pulp involvement.The tooth was treated by root canal therapy and followed up for one year,the prog-nosis was good.

Dens Invaginatus in a Peg Lateral - An Unusual Presentation

Dens invaginatus is a developmental anomaly resulting from infolding of the surface of the tooth crown before calcification has occurred. While several mechanisms have been proposed for the cause of this phenomenon the exact etiology is not known. The malformation shows a broad spectrum of morphologic variations and frequently results in early pulp necrosis. The nature of the problem may increase the risk of pulp disease and complicate any root canal treatment. Dens invaginatus has been seen very commonly in maxillary lateral incisors; however, reported cases in peg laterals are few. A case is reported here of unusual presentation of dens invaginatus in a peg lateral. The problems associated with treatment of such teeth are discussed.

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

Dens invaginatus is a well-known malformation of teeth, which probably results from an invagination of enamel organ into dental papilla during tooth development. The endodontic treatment of invaginated teeth may be challenging due to difficulties in accessing the root canals and also due to complex variations of internal morphology. This article presents the endodontic management and follow-up in a rare case of right mandibular second premolar with Oehlers' type III dens invaginatus. The result of cold pulp testing was positive for this tooth but it was associated to a sinus tract and periapical lesion. Herein, it is described the root canal therapy of this tooth combined with periapical surgery, emphasizing the importance of proper diagnosis and planning by using cone beam computed tomography (CBCT). This case report presents the proper periapical healing 6 months after the combination of nonsurgical and surgical treatments. It also shows that CBCT is an important auxiliary examination to avoid errors in diagnosis and subsequent treatment of dental anomalies.

Dens invaginatus é uma malformação dentária já bem reconhecida, que provavelmente resulta de uma invaginação do órgão do esmalte para dentro da papila dentária durante o desenvolvimento do dente em questão. O tratamento endodôntico de dentes invaginados pode ser um desafio devido às dificuldades de acesso aos canais radiculares e também devido à complexidade da morfologia interna. Este artigo apresenta o manejo endodôntico e o acompanhamento de um caso raro de segundo pré-molar inferior direito com dens invaginatus Tipo III de Oehlers. O resultado do teste de sensibilidade pulpar ao frio foi positivo para este dente, mas o mesmo estava associado a uma fístula e lesão periapical. Relata-se o tratamento de canal deste dente associado à cirurgia periapical, enfatizando a importância de um correto diagnóstico e plano de tratamento, utilizando a tomografia computadorizada de feixe cônico (TCFC). Este relato de caso mostra reparo periapical adequado 6 meses após a combinação dos tratamentos não-cirúrgico e cirúrgico. Mostra também que a TCFC é um importante exame auxiliar para evitar erros no diagnóstico e posterior tratamento de anomalias dentárias.

A rare case of dilated invaginated odontome with talon cusp in a permanent maxillary central incisor diagnosed by cone beam computed tomography

It has been a challenge to establish the accurate diagnosis of developmental tooth anomalies based on periapical radiographs. Recently, three-dimensional imaging by cone beam computed tomography has provided useful information to investigate the complex anatomy of and establish the proper management for tooth anomalies. The most severe variant of dens invaginatus, known as dilated odontome, is a rare occurrence, and the cone beam computed tomographic findings of this anomaly have never been reported for an erupted permanent maxillary central incisor. The occurrence of talon cusp occurring along with dens invaginatus is also unusual. The aim of this report was to show the importance of cone beam computed tomography in contributing to the accurate diagnosis and evaluation of the complex anatomy of this rare anomaly.

Tratamento conservador de incisivos superiores em forma de pá e dens invaginatus: um estudo de caso / Conservative treatment of shovel-shaped upper incisors and dens invaginatus: a case study

The purpose of this paper was to describe the conservative treatment adopted in one nonsyndromic patient presenting with shovel-shaped upper incisors and dens invaginatus. A 13-yearold female patient sought treatment reporting pain in response to cold stimuli in the upper anterior teeth. Four upper incisors with shovel-shaped anatomical alterations in the palatal side of the crown were detected during intra-oral clinical examination; in addition, imaging exams revealed a type I dens invaginatus in tooth 22. There was no communication between the carious lesion and the pulp chamber, and a restorative treatment plan was developed. After 2 years of follow-up, the patient showed absence of pain, fistulas, swelling, or periodontal pockets. When faced with anomalous teeth, conservative procedures should be considered as a potential solution for restorative and endodontic treatment.

O objetivo desse trabalho foi descrever o tratamento conservador adotado em um paciente não sindrômico apresentando incisivos em forma de pá (shovel-shaped) e dens invaginatus. Paciente de 13 anos de idade, do sexo feminino, procurou tratamento com queixa de dor em resposta a estímulos frios nos dentes superiores anteriores. Quatro incisivos superiores com alterações anatômicas em forma de pá na face palatal da coroa foram detectados durante o exame clínico intraoral; além disso, exames de imagens revelaram a presença de dens invaginatus tipo I no dente 22. Não havia comunicação entre a cárie e a câmara pulpar, e um plano de tratamento restaurador foi desenvolvido. Após 2 anos de seguimento, a paciente demonstrava ausência de dor, fístulas, edema ou bolsas periodontais. Ao se deparar com anomalias dentárias, procedimentos conservadores devem ser considerados como uma potencial solução de tratamento restaurador e endodôntico.

Tratamento endodôntico convencional de dente invaginado com periodontite apical / Conventional endodontic treatment of a dens invaginatus with apical periodontitis

Dente invaginado é uma anomalia do desenvolvimento caracterizada por invaginação dos tecidos dentários que varia de ligeiro aumento da fosseta do cíngulo a um profundo sulco que pode se estender até o ápice dentário. O objetivo deste trabalho foi discutir um caso clínico de dente invaginado tipo II em incisivo lateral superior em que foi realizado o tratamento endodôntico convencional. Posterior ao acompanhamento de 11 anos e frente aos exames clínicos e imaginológicos observou-se tratamento endodôntico satisfatório e regressão da rarefação óssea. Baseado nisso, foi possível concluir que o tratamento endodôntico convencional é uma alternativa viável para tratamento de dente invaginado tipo II.

Dens invaginatus is a developmental anomaly characterized by invagination of the dental tissues ranging from slight rise of the pit to a depth of the cingulate sulcus and can be extended to the apical portion of the tooth. The aim of this study was to relate a case of dens invaginatus type II in upper lateral incisor in which a conventional treatment was realized. After eleven years-follow up and based on clinical and images exams, it was observed that the endodontic treatment was efficient and the bone rarefaction reduced. Based on this, it was possible to conclude that conventional endodontic treatment is a viable alternative for type II dens invaginatus.