Abstract
Dens invaginatus (DI) is a malformation of teeth probably resulting from an infolding of the dental papilla during tooth development. DI is classified as type I, II, and III by Oehlers depending on the severity of malformation. The maxillary lateral incisor is the most commonly affected tooth. Structural defects do exist in the depth of the invagination pits, and as a consequence, the early development of caries and the subsequent necrosis of the dental pulp, as well as abscess and cyst formation are clinical implications associated with DI. Occasionally, we can see more than one developmental anomaly occurring in a single tooth. In such cases it becomes important to identify the anomalies and initiate a proper treatment plan for good prognosis. In this paper, an unusual case of DI which clinically presented as a huge talons cusp affecting a mandibular lateral incisor tooth is described. This case report illustrates grinding of the talons cusp followed by nonsurgical endodontic management of dens invaginatus type II with an immature apex and periapical lesions, in which Mineral Trioxide Aggregate (MTA) shows a complete periapical healing with bone formation at the site of the lesions.
Highlights
Dens invaginatus (DI), commonly known as dens in dente, is a developmental anomaly resulting from invagination in the surface of a tooth crown before calcification has occurred
(1) type I—an enamel invagination within the crown and not extending beyond the CEJ, (2) type II—the enamel invagination into the root below the CEJ ending as a blind sac, (3) type III—the extension of enamel-lined invagination through the root to form an additional apical or lateral foramen; usually no direct communication with the pulp
As in our case the clinical appearance of talons cusp and periapical radiograph showed an invagination into pulp which extended into the root of the left mandibular lateral incisor which was categorized as Oehlers type II dens invaginatus
Summary
Dens invaginatus (DI), commonly known as dens in dente, is a developmental anomaly resulting from invagination in the surface of a tooth crown before calcification has occurred. The literature review showed only 10 cases involving 13 mandibular teeth with a majority in mandibular incisors among three cases involving four teeth [5] Synonyms for this malformation are dens in dente, invaginated odontome, dilated gestant odontome, dilated composite odontome, deep foramen caecum, tooth inclusion, dentoid in dente, gestant odontome, and dents telescopes— invagination is the common denominator of these lesions [6, 7]. Prophylactic grinding with root canal therapy using MTA apexification was done
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