Treatment of peri-invagination lesion and vitality preservation in an immature type III dens invaginatus: a case report

Ju-Kyung Lee,Hyeon-Cheol Kim,Jae Joon Hwang

doi:10.1186/s12903-020-1008-x

Abstract

BackgroundTo report a case of type III dens invaginatus associated with peri-invagination periodontitis in an immature permanent mandibular central incisor with open apex, in which only the invagination area was treated and vitality was preserved.Case presentationA 9-year-old boy was referred complaining of pain in the mandibular left central incisor. After radiographic examination, an invagination into the pulp chamber of the tooth associated with periapical radiolucency was detected. Endodontic access was performed and the orifice was identified under a dental operating microscope. The invagination area was chemo-mechanically cleaned. After 1 week, the invagination was obturated with mineral trioxide aggregate. During the 2-year follow up period, the tooth was asymptomatic. Radiographic examination revealed significant progression of periapical healing and root development in the main root canal of the tooth.ConclusionNon-surgical root canal treatment of the invagination may preserve pulp vitality, and continuous root development of the tooth.

Highlights

To report a case of type III dens invaginatus associated with peri-invagination periodontitis in an immature permanent mandibular central incisor with open apex, in which only the invagination area was treated and vitality was preserved.Case presentation: A 9-year-old boy was referred complaining of pain in the mandibular left central incisor
Dens invaginatus (DI) is a developmental anomaly, which results in the deepening or invagination of the enamel organ into the dental papilla before the calcification of dental tissues [1,2,3]
The complex anatomical structures are subdivided into Type III A and Type III B according to the characteristics of communications with the periodontal tissue

Summary

Background

Dens invaginatus (DI) is a developmental anomaly, which results in the deepening or invagination of the enamel organ into the dental papilla before the calcification of dental tissues [1,2,3]. Type III A is defined as an invagination extends through the root and communicates laterally with the periodontal ligament space through a pseudo-foramen. Type III B invagination extends through the root and communicates with the periodontal ligament at the apical foramen. Neither it has a communication with the pulp [11]. It was postulated that the pain of the tooth might be associated with an infection of the invagination communicated with the periodontal ligament space in isolation to the root canal, which developed the periapical lesion related with the DI, while the pulp remained in vital. At the 2-year follow-up, main root development of the tooth was evident with the evidence of apex closure (Fig. 4f)

Discussion and conclusions

14. AAE and AAOMR Joint Position Statement