Endodontic management of dens invaginatus Type IIIb: Case series

ABSTRACT

Dens invaginatus may be seen as a developmental malformation. It is characterized by an invagination of the enamel and dentin, creating a lumen inside the affected tooth, which may extend as deep as the apical foramen. Oehlers Type IIIb is considered the most challenging clinical conditions. The purpose of this study is to discuss the nonsurgical endodontic management of vital and necrotic dens invaginatus Type IIIb cases. Due to the complex anatomical consideration of dens invaginatus Type IIIb, endodontic treatment is extremely technique sensitive. A conservative approach was used in a vital case to treat the invaginated lumen only, to preserve the vitality of the pulp, and a more invasive approach was used in a necrotic case to debride the lumen and necrotic pulp for proper disinfection of the root canal system. Although different, all the approaches were successful. The clinical signs and symptoms were resolved. The vital case remains vital after 19 months, and the recall radiographs were able to show satisfactory periapical healing both in vital and necrotic cases. Due to the highly complex anatomy of dens invaginatus Type IIIb, the decision of preserving the pulp vitality may not be related only to pulpal diagnosis but also to the technical requirements of the treatment. Although very technically sensitive, it may be possible to treat the invaginated lumen exclusively, while preserving the vitality of the pulp. Necrotic cases may require a more aggressive approach to achieve a favorable prognosis.

Key words:

Dens in dente - dens invaginatus - endodontic treatment

• REFERENCES

• 1 Hülsmann M. Dens invaginatus: Aetiology, classification, prevalence, diagnosis, and treatment considerations. Int Endod J 1997; 30: 79-90
• 2 Grahnen H. Hereditary factors in relation to dental caries and congenitally missing teeth. In: Witkop CJ. editor. Genetics and Disorder. New York: McGraw-Hill; 1962: p. 194-204
• 3 Rushton MA. A collection of dilated composite odontomas. Br Dent J 1937; 63: 65-85
• 4 Kronfeld R. Dens in dente. J Dent Res 1934; 14: 49-66
• 5 Gustafson G, Sundberg S. Dens in dente. Br Dent J 1950; 88: 83-8
• 6 Hallett GE. Incidence, nature, and clinical significance of palatal invaginations in the maxillary incisor teeth. Proc R Soc Med 1953; 46: 491-9
• 7 Schulze C, Brand E. Dens invaginatus (dens in dente). I. ZWR 1972; 81: 569-73
• 8 Kirzioglu Z, Ceyhan D. The prevalence of anterior teeth with dens invaginatus in the western Mediterranean region of Turkey. Int Endod J 2009; 42: 727-34
• 9 Oehlers FA. Dens invaginatus (dilated composite odontome). I. Variations of the invagination process and associated anterior crown forms. Oral Surg Oral Med Oral Pathol 1957; 10: 1204-18
• 10 Bishop K, Alani A. Dens invaginatus. Part 2: Clinical, radiographic features and management options. Int Endod J 2008; 41: 1137-54
• 11 Beynon AD. Developing dens invaginatus (dens in dente). A quantitative microradiographic study and a reconsideration of the histogenesis of this condition. Br Dent J 1982; 153: 255-60
• 12 Omnell KA, Swanbsck G, Lindahl B. Dens invaginatus. II. A microradiographical, histological and micro X-ray diffraction study. Acta Odontol Scand 1960; 18: 303-30
• 13 Boyne PJ. Dens in dente: Report of three cases. J Am Dent Assoc 1952; 45: 208-9
• 14 Tsurumachi T. Endodontic treatment of an invaginated maxillary lateral incisor with a periradicular lesion and a healthy pulp. Int Endod J 2004; 37: 717-23
• 15 Zengin AZ, Sumer AP, Celenk P. Double dens invaginatus: Report of three cases. Eur J Dent 2009; 3: 67-70
• 16 Ozbas H, Subay R, Orduli M. Surgical retreatment of an invaginated maxillary central incisor following overfilled endodontic treatment: A case report. Eur J Dent 2010; 4: 324-8
• 17 Decurcio DA, Silva JA, Decurcio RA, Silva RG, Pécora JD. Influence of cone beam computed tomography on dens invaginatus treatment planning. Dent Press Endod 2011; 1: 87-93