Regenerative endodontic treatment of an infected immature dens invaginatus with the aid of cone-beam computed tomography.

Işıl Kaya-Büyükbayram,Emre Aytugar,Seda Aydemir,Şerife Özalp

doi:10.1155/2014/403045

Işıl Kaya-Büyükbayram, Emre Aytugar + Show 2 more

Open Access

https://doi.org/10.1155/2014/403045

Copy DOI

Abstract

Dens invaginatus is a developmental anomaly that results in an enamel-lined cavity intruding into the crown or root before the mineralization phase. This report presents regenerative endodontic treatment of a necrotic immature tooth with Oehler's type III dens invaginatus of a nine-year-old female patient. A diagnosis of dens invaginatus (Oehler's type III) and a large periapical lesion was established with the aid of cone-beam computed tomography (CBCT). In the presented case contrary to the classic revascularization protocol, mechanical instrumentation was performed which apparently did not interfere with the regeneration process. After mechanical instrumentation of the invaginated canal by manual K-files, the invaginated canal space was disinfected by triple antibiotic paste followed by blood clot induction from the periapical tissues and the placement of mineral trioxide aggregate. At one-year follow-up, the tooth remained clinically asymptomatic. Radiographic examination revealed complete healing of the periapical lesion. At the 20-month follow-up, the radiographic examination also showed that the open apex was closed and the walls of the root canal were thickened.

Highlights

Known more commonly as “dens in dente,” is an unusual developmental anomaly resulting in a deepening or invagination of the enamel organ into the dental papilla before the mineralization phase
The vital pulp tissue in the invaginated canal had been removed during instrumentation; the main root canal was not exposed, the tooth had a negative response to vitality testing postoperatively, and the periapical lesion resolved
The treatment of an immature permanent tooth with periapical pathosis is a challenge in paediatric dentistry, especially in the case of dens invaginatus

Summary

Introduction

Known more commonly as “dens in dente,” is an unusual developmental anomaly resulting in a deepening or invagination of the enamel organ into the dental papilla before the mineralization phase. This treatment, unlike the apexification and artificial barrier technique, allows for the continuation of root development [7] This approach is based on the occurrence of osteo/odontoprogenitor stem cells in the apical papilla that are resistant to the infection and necrosis caused by proximity to periodontal blood supply [8]. With this treatment, the objective is to create an appropriate environment inside the root canal space, including the absence of bacteria and necrotic pulp tissue and the presence of a scaffold and a tight coronal seal. The purpose of this report is to present a clinical case in which regenerative endodontic treatment was applied as a conservative method to successfully treat a maxillary lateral incisor with type III dens invaginatus and a large periapical lesion

Case Presentation

Discussion