Preservation of Pulp Vitality in Type IIIA Dens Invaginatus with an Extensive Peri-invagination Lesion: a case Report with 5-year Follow-up.

Dens invaginatus may be associated with peri-invagination lesions and vital pulp concurrently. This case report examines the successful preservation of vital pulp and minimally invasive treatment of invagination for Oehlers type IIIA dens invaginatus with an extensive peri-invagination lesion. A healthy 19-year-old man presented with occasional swelling of the left maxillary anterior region. Pulp vitality tests revealed vital and healthy tooth pulp. CBCT indicated Oehlers type IIIA dens invaginatus with an invagination parallel to the pulp cavity. The diagnosis was type IIIA dens invaginatus with a peri-invagination lesion. The treatment plans involved preservation of the vital pulp and minimally invasive treatment of the invagination. A 5-year follow-up revealed that both healing of the peri-invagination lesion and preservation of the vital pulp had been successful. Pulp vitality can be preserved in type IIIA dens invaginatus associated with a peri-invagination lesion through minimally invasive treatment of the invagination.

Radiologic evaluation of associated symptoms and fractal analysis of unilateral dens invaginatus cases.

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.

Application of personalized templates in minimally invasive management of coronal dens invaginatus: a report of two cases.

BACKGROUND: Treating the coronal dens invaginatus (CDI) with pulp infection commonly involves the removal of invagination, which increases the risk of perforation and fracture, and compromises the tooth structure. Minimally invasive endodontic management of CDI is highly recommended. This report describes two cases of type II CDI with the application of personalized templates. CASE PRESENTATION: Two cases of type II CDI, affecting the main root canal in a maxillary canine and a lateral incisor, were diagnosed. A guided endodontics (GE) approach was applied. Cone-beam computed tomography and intraoral scans were imported and aligned in a virtual planning software to design debridement routes and templates. The MICRO principle (which involves the aspects of Mechanical (M) debridement, Irrigation (I), Access cavities (C), Rectilinear routes (R), and Obstruction (O)) was proposed for designing optimal debridement routes for future applications. The templates were innovatively personalized and designed to preserve the tooth structure maximally while effectively debriding the root canal. Root canal treatment with supplementary disinfection was then performed. The follow-up of the two patients revealed favorable clinical and radiographic outcomes. CONCLUSIONS: The GE approach could be a feasible method for preserving healthy dental structure while effectively debriding the root canal, thereby achieving successful and minimally invasive endodontic treatment for CDI.

Photodynamic Therapy in a Lateral Maxillary Incisor with Dens in Dente Type â ¡ and Primary Endodontic Lesion: Case Report.

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.

Endodontic management considerations for Type III dens invaginatus based on anatomical characteristics: A case series.

Dens invaginatus (DI) is a developmental anomaly of the teeth characterised by the in-folding of the enamel into the dentin. Oehlers' Type III DI is the most serious form, in which the inherently invaginated channels communicate with periodontal and dental pulp tissue, increasing the risk of bacterial contamination. However, varying and complex anatomical features make diagnosis and treatment challenging. Conventional endodontic therapies promote healing by avoiding unnecessary interventions (e.g., surgical or other invasive treatments). Radiographic examination can reveal the structural details of such malformations. We obtained multiple procedural details for treating Type III DI based on radiographic analyses from our clinical experience. In addition, we introduce a new classification strategy for the management of Type III DI that is more applicable to treatment needs. This study aimed to discuss the anatomical features and current treatment considerations of Type III DI.

A Novel Diagnostic and Treatment Approach to an Unusual Case of Dens Invaginatus in a Mandibular Lateral Incisor Using CBCT and 3D Printing Technology.

BACKGROUND: This case report demonstrates the use of three-dimensional (3D) models produced from a cone beam computed tomographic (CBCT) volume to develop a treatment strategy for a rare type of dens invaginatus (DI) in a mandibular incisor. METHODS: A patient with DI Type IIIa presented for endodontic treatment. Following CBCT evaluation, the complex morphologic nature of the invagination required additional diagnostic tools for treatment planning. The fabrication of 3D models provided clarity regarding the treatment strategy. Treatment involved intracanal medication with calcium hydroxide Ca(OH)2, nonsurgical root canal therapy (NS-RCT) of the main canal, and endodontic surgery for the DI anomaly using mineral trioxide aggregate (MTA), bone graft, and platelet-rich fibrin (PRF) membrane. RESULTS: The use of 3D models provided an invaluable guide for proper treatment. Complicating factors were diagnosed and planned for accordingly. CONCLUSIONS: It is difficult to appreciate the anatomical complexity, the extent, and the nature of the invagination of rare Type III DI morphology. CBCT imaging and 3D models played a critical role in the pre-treatment planning to ensure a predictable outcome. A 3D model is recommended as a diagnostic tool in treating complex cases where the DI morphology is wide, oblique, or the foraminal opening is irregular.

Treatment opinions for dens invaginatus: A case series.

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.

Non-surgical and guided-bone-regeneration surgical management of Type-3b dens invaginatus with an apico-marginal defect: A case report.

BACKGROUND: Dens invaginatus (DI), an unusual developmental anomaly is a challenge for the operating dentist with regard to its diagnosis and treatment. This case report presents the successful management of a Type-3b DI in a permanent maxillary lateral incisor associated with a large radicular cyst and communicating apico-marginal defect (Von Arx type IIb). METHODS AND RESULTS: A 19-year-old female patient reported pain and palatal swelling. During the clinical examination, tooth #12 exhibited tenderness to percussion, and presented a deep periodontal pocket depth (PPD) of 12 mm, along with grade I mobility. Radiographic examination revealed a large peri-radicular radiolucency with atypical tooth morphology. Cone beam computed tomography clarified the complicated root canal anatomy to be Type-3b DI associated with an apico-marginal defect. The case was managed successfully by non-surgical endodontic therapy followed by surgical intervention utilizing a guided bone regenerative (GBR) approach. Eighteen-month follow-up showed an asymptomatic and functional tooth with a significant reduction in pocket depth. The periapical radiographs showed continued healing of the osseous defect. CONCLUSIONS: The successful healing outcome of a challenging case, characterized by a complex DI morphology, a large peri-radicular lesion, a through-and-through defect, and a combined endodontic-periodontal apico-marginal defect was achieved through accurate diagnosis, treatment planning, and execution using contemporary endodontic and periodontal treatment techniques. The application of GBR techniques during the surgical phase of treatment may have contributed to the improved regenerative healing outcome in this case, which was initially considered prognostically questionable. KEY POINTS: Why is this case new information? Type-3b DI exhibits a complex root canal structure, each case displaying unique characteristics, necessitating a case-specific treatment plan. In this case report the Type-3b DI morphology was associated with a large peri-radicular, through and through defect and combined endodontic periodontal apico-marginal defect. The treatment approach involved incorporating guided bone regenerative (GBR) principles during the surgical phase. This case report contributes to the existing evidence on the diagnosis and successful management of Type-3b DI with a concurrent apico-marginal defect. What are the keys to successful management of this case? The successful management of a prognostically challenging case was achieved through a closely integrated multidisciplinary coordination between the endodontist and periodontist. Utilization of contemporary techniques and tools contributed to the successful management The use of three-dimensional radiological examination through cone beam computed tomography enabled a precise preoperative assessment, facilitating the formulation of a treatment plan for managing both the Type-3b DI morphology and the associated peri-radicular lesion. Employing GBR techniques in peri-radicular surgery may have assisted in the healing of through-and-through periapical defects with concurrent apico-marginal defects (Von Arx type IIb). What are the primary limitations to the success of this case? A complex root canal anatomy associated with Type-3b DI morphology A large peri-radicular through and through defect with concurrent apico-marginal defect. Difficulty in weekly and long-term follow-up of the patient.

Multiple Developmental Dental Anomalies in a Nonsyndromic Patient: A Rare Case Report.

The present case report illustrates a rare occurrence of multiple dental anomalies in a healthy 12-year-old patient including anomalies of shape and number of teeth. The developmental dental anomalies noticed in the present case scenario are dens invaginatus, taurodontism, radix entomolaris, supernumerary teeth, and pulp stones seen in multiple teeth. It is not rare to notice these anomalies individually, but their combination is rare in a single, non-syndromic patient. This report also signifies the importance of thorough extra-intra-oral and radiographic examinations of patients with dental anomalies.

Treatment of Peri-Invagination Lesion and Vitality Preservation in Type III Dens Invaginatus in Bilateral Immature Maxillary Lateral Incisors: A Case Report.

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.

Endodontic management of type IIIb dens invaginatus in central incisor: A case report.

We described a type IIIb dens invaginatus, its root canal treatment, and results on 3- and 12-month visits. Despite its significant challenges, proper endodontic therapy in such cases can cause positive prognosis and successful outcome.

Successful nonsurgical treatment of type II dens invaginatus with 5 root canals using a self-adjusting file: a case report.

The present report describes the endodontic treatment of an Oehlers type II dens invaginatus in a maxillary lateral incisor with 5 root canals, an extremely rare condition. Apical periodontitis and related symptoms were noted. Cone-beam computed tomography was used to aid the diagnosis, reveal tooth morphology, and assist in canal location. The pulp chamber was carefully accessed, and the root canals were explored under magnification. All root canals were prepared with an R25 Reciproc Blue system and sodium hypochlorite (NaOCl) irrigation. After initial preparation, a self-adjusting file (SAF) with NaOCl and ethylenediaminetetraacetic acid was used to complement the disinfection. Additionally, calcium hydroxide medication was applied. Vertical compaction was used to fill the canals with a calcium silicate-based endodontic sealer and gutta-percha. After 12 months, the patient exhibited healing of the periapical region, absence of symptoms, and normal dental function. In conclusion, this nonsurgical treatment protocol was successful in promoting the cure of apical periodontitis. Both complementary disinfection with an SAF and use of calcium hydroxide medication should be considered when choosing the best treatment approach for dens invaginatus with very complex anatomy.

Long-term follow-up of single-visit pulp revascularisation for the dens evaginatus and dens invaginatus: Cases report.

This article documents cases of single-visit pulp revascularisation for dens evaginatus and dens invaginatus, without using intracranial medicaments or antibiotics, aiming to provide a potentially applicable protocol for pulp revascularisation procedure in a single-visit. Two patients with chief complaints of pain and swelling visited a dental hospital. Radiographs revealed that the causative teeth had an open apex and periapical radiolucency, and the teeth were diagnosed as pulp necrosis and acute apical abscess or symptomatic apical periodontitis. For both cases, single-visit revascularisation was completed without intracanal medicaments or antibiotics. The patients were periodically recalled to evaluate periapical healing after treatment. The apical lesion healed, and the root dentin thickening was observed. The single-visit pulp revascularisation procedure without using specific intracanal medicaments can produce clinically favourable results for these dental anomalies.

Root Canal Treatment of Oehlers Type III Dens Invaginatus in Maxillary Lateral Incisor and Remote Sinus Tract Using Dental Surgical Microscope and Cone-Beam Computed Tomography.

Dens invaginatus is a morphological abnormality of the tooth that results from a developmental anomaly during tooth formation, in which part of the enamel and dentin of the crown invaginates into the pulp cavity. This report describes a case of a maxillary lateral incisor with apical periodontitis apparently caused by Oehlers Type III dens invaginatus. The patient was a 69-year-old man who visited our clinic complaining of discomfort in the maxillary right lateral incisor. Cone-beam computed tomography (CBCT) revealed dens invaginatus of the maxillary lateral incisor and a sinus tract in the maxillary central incisor region, which was derived from apical periodontitis of the maxillary lateral incisor. The dens invaginatus was accompanied by a complex root canal morphology. Treatment, which was performed using a dental surgical microscope, had a favorable outcome. The patient remains in good condition at 1 year postoperatively.

Root canal treatment of type â ¡ and â ¢A double dens invaginatus in maxillary lateral incisor: a case report.

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.

Root Maturation of an Immature Dens Invaginatus Despite Unsuccessful Revitalization Procedure: A Case Report and Recommendations for Educational Purposes.

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.

A Successful Non-surgical Management of a Type II Dens Invaginatus with Antimicrobial Photodynamic Therapy: A Case Report.

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.

Rare variant of dens invaginatus with accessory root and labial talon cusp in maxillary lateral incisor-Case report.

Dens invaginatus (DI) often causes dysmorphic changes in both the crown and root. This case report presents a complicated type 3a DI in a maxillary lateral incisor with labial talon cusp and root bifurcation. Although lingual talon cusp is common in maxillary lateral incisor, labial talon cusp is rare. An auxiliary palatal root in maxillary lateral incisor is also unusual. No such case involving all three variations has been described in the literature. The DI was classified as type B4 according to Schulze and Brand, as it involved division of pulp and root. DI was managed by orthograde MTA, radisectomy and periodontal regeneration was done for the palatal root. Labial talon associated with DI and can lead to early periodontal/pulpal involvement. Type 3 DI can affect the root with marked dilatation and division. Additional palatal root should be carefully detected in type 3a DI and managed with the aid of CBCT.

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.

Non-surgical management of dens invaginatus type IIIB in maxillary lateral incisor with three root canals and 6-year follow-up: A case report and review of literature.

BACKGROUND: The presence of dens invaginatus (DI) complicates treatment of any tooth, from diagnosis to access cavity and biomechanical preparation and obturation. Reports of successful non-surgical management of DI type IIIB in maxillary lateral incisor are rare. Here, we report such a case, with three root canals and a long follow-up. CASE SUMMARY: A 13-year-old female patient presented with mild pain in the maxillary right lateral incisor (#7) for 10-15 d. On examination, the tooth was slightly rotated, with slight tenderness on percussion and grade I mobility but with no caries, pockets or restorations and non-vital pulp (via vitality tests). Radiographic examination revealed unusual configuration of the tooth's root canals, with an enamel-lined invagination extending to the apex, suggesting the possibility of DI Oehler's type IIIB and a periapical radiolucency. Widening the access cavity lingually revealed one distinct buccal orifice and two distinct palatal orifices; under higher magnification of a dental operating microscope (DOM), the mesio-palatal and disto-palatal orifices were observed as connected by a C-shaped groove. The root canals were prepared with hand K-files following a step-back technique, and obturated using a combination technique of lateral condensation and vertical compaction. At the 6-year follow-up, the patient was asymptomatic, and the periapical radiography displayed significant healing around the apical end of the root. CONCLUSION: Proper knowledge of unusual root canal anatomy is required in treating DI. Conventional methods of root canal treatment can successfully resolve such complex cases, facilitated by DOM and cone-beam computed tomography.