The use of cone beam computed tomography in the management of dens invaginatus affecting a strategic tooth in a patient affected by hypodontia: a case report

Abstract

To report on the use of cone beam computed tomography (CBCT) in the diagnosis and management of dens invaginatus. Chronic apical periodontitis of an invaginated maxillary lateral incisor was diagnosed in a patient suffering from hypodontia and awaiting active orthodontic therapy. Loss of the tooth would have complicated orthodontic treatment. Conventional periapical radiographs provided insufficient information about the nature of the invagination and its relation to the root canal to formulate an appropriate plan for treating the tooth. A small volume CBCT scan of the tooth revealed that the invagination and the root canal were completely separate, non-communicating spaces and that the wall of the invagination acted as an obstruction to the effective chemomechanical debridement of the infected root canal. An innovative method of accessing the infected root canal, based on information from the CBCT images, was adapted to permit its instrumentation, disinfection and filling. • Teeth with dens invaginatus requiring endodontic treatment present diagnostic and technical challenges. • CBCT can provide essential information in the management of dens invaginatus.