Endodontic management of type II dens invaginatus with open apex and large periradicular lesion using the XP-endo Finisher: A case report

Ea Rodrigues,G De-Deus,Ejnl Silva,Fg Belladonna

doi:10.4317/jced.55031

Abstract

Dens invaginatus (DI) represents an endodontic challenge because of its complex root canal morphology. This case report presents the clinical management of a 22-year-old woman with type II DI in right maxillary lateral incisor with a painful swelling. Pulp testing revealed no response with the tooth. Type II DI with open apex and large periradicular lesion was seen on radiograph. The treatment was planned by using cone-beam computed tomography (CBCT) imaging. Canal treatment was completed in two appointments with the aid of a dental operating microscope. In the first appointment, the internal anatomy was modified using an ultrasonic tip, and chemo-mechanical preparation was performed using the XP-endo Finisher instrument and NaOCl; calcium hydroxide intracanal dressing was used for one month. In the second appointment, an apical plug of mineral trioxide aggregate (MTA) Repair HP was performed and the remaining pulp space was then filled with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. At the fourteen-month reevaluation, the patient was asymptomatic, the tooth had remained functional, and radiographic and CBCT assessment showed significant osseous healing of the lesion. Successful non-surgical management of the present type II DI was achieved in the present case. The association of CBCT, dental operating microscope, XP-endo Finisher, NaOCl and MTA Repair HP were important for ensuring a predictable outcome. Key words:Cone beam computed tomography, dens invaginatus, MTA apexification, XP-endo Finisher.

Highlights

Dens invaginatus (DI) is a developmental abnormality resulting from the invagination of enamel organ into the dental papilla, which begins at the crown and sometimes extends into the root before the occurrence of calcification [1]
In the present case report, the XP-endo Finisher instrument was used during chemo-mechanical preparation
Endodontic management of a permanent tooth with open apex, pulp necrosis, and periapical lesion consists on apexification or revascularization

Summary

Introduction

Dens invaginatus (DI) is a developmental abnormality resulting from the invagination of enamel organ into the dental papilla, which begins at the crown and sometimes extends into the root before the occurrence of calcification [1]. Cases of DI teeth presenting pulp necrosis and immature apex represent a problem, as instruments with great diameter are not able to touch the root canal walls compromising debridement and disinfection; biofilm can remain in untouched areas of the irregularities of the root canals [6]. This case report describes the clinical management of a nonsurgical endodontic treatment performed with the XP-endo Finisher instrument in a maxillary lateral incisor presenting type II DI.

Results

Conclusion