Management of Dens Invaginatus Type I and Open Apex: Report of Three Cases

Abstract

Introduction Dens invaginatus is a critical condition for endodontic treatment once it frequently presents a complex internal anatomy and might be associated with incomplete root and apical development. Methods Three cases of dens invaginatus with open apex in maxillary lateral incisors are presented. In the first case, apexification with calcium hydroxide pastes was performed. In the second case, initial treatment was carried out, but the patient missed follow-up appointments for 15 months. In the third case, periradicular surgery was done as a result of the persistence of exudates and incomplete root canal development after conservative endodontic treatment. Oehlers' type I dens invaginatus was also present in the opposite maxillary lateral incisor in 2 patients, but no treatment was required. Results At subsequent follow-up, the periradicular region was completely healed, and postoperative radiographs revealed good bone healing in all patients. Patient #2 had an increase in root length, and after 38 months the apical third was completely calcified. Conclusions A careful clinical and radiographic examination should be conducted to identify dens invaginatus associated with incomplete root development and open apexes. Adequate periradicular healing was observed after the infection, and the anatomical features in the root canal system were accessed. Because a long period is required to determine the clinical outcome, patient compliance must be encouraged.