Dens Invaginatus Research Articles

Endodontic Management of a Maxillary Lateral Incisor with 4 Root Canals and a Dens Invaginatus Tract

Dens invaginatus (DI) is associated with complex internal anatomy. This article represents a maxillary lateral incisor with 5 root canals including DI. The treatment was planned and performed using cone-beam computed tomographic (CBCT) imaging. After clinical and radiographic evaluations, tooth #7 was diagnosed with DI and pulp necrosis with symptomatic apical periodontitis. Periapical radiographs of the tooth showed 2 roots and complex internal anatomy. CBCT evaluation revealed tooth #7 had 5 separate canals (4 root canals and 1 DI canal extending through the root to the periodontal ligament), communication between DI and the root canal system, and severe and multiple curvatures of the palatal canals. Root canal treatment was completed in 2 visits. Modified access openings were required to safely treat the dilacerated palatal canals. At the 6-month re-evaluation, the patient reported he had remained asymptomatic and his tooth had remained functional since the treatment was completed. Clinical examination showed tooth #7 had no sensitivity to percussion or palpation, probe depths within normal limits (≤3 mm), and no mobility. Radiographic assessment of the tooth showed significant osseous healing of the preoperative lesion. Three-dimensional imaging is a valuable tool for endodontic management of teeth with complex internal anatomy. Three-dimensional imaging is recommended for evaluating and treatment planning cases with DI.

MAKSİLLER 2.MOLAR DİŞTE İZLENEN DENS INVAJİNATUS: OLGU SUNUMU

Dens invaginatus (DI), also known as “dens in dente”, “dilated composite odontome” or “gestant odontoma”, is an enamel lined developmental malformation that occurs through an invagination of the dental papilla during the soft tissue stage of tooth development. This malformation may be seen in decidious and permanent dentition. Dens in dente commonly occur in the maxillary lateral incisor. Treatment has ranged from conservative approach to surgical tecniques. The diagnosis of Dens invaginatus is important for preventing complications such as caries, periodontal problems, pulp necrosis, periapical lesions. Success of treatment may vary depending on type of dens invaginatus. Dens invaginatus in the maxillary second molar is considerably a rare case. This article reports a case of Oehlers Type III dens invaginatus in the maxillary second molar

A Retrospective Comparative Study of Cone-beam Computed Tomography versus Rendered Panoramic Images in Identifying the Presence, Types, and Characteristics of Dens Invaginatus in a Turkish Population

IntroductionThis study assessed the presence, characteristics, and type of dens invaginatus (DI) by using cone-beam computed tomography (CBCT) and panoramic images rendered from CBCT images. In addition, the findings of the imaging techniques were compared. MethodsWe evaluated 300 CBCT images to determine the type of DI, the presence of an impacted tooth near the DI, and the presence of apical pathosis. The McNemar test was used to compare the prevalence of DI according to CBCT and panoramic images rendered from CBCT images. ResultsThe presence of DI was lower on panoramic images rendered from CBCT images (3% of the patients) compared with on CBCT images (10.7% of the patients) (P < .001). According to the CBCT images, the distribution of teeth with DI was as follows: maxillary lateral incisors (75%), maxillary central incisors (6.8%), mandibular premolars (4.6%), mesiodens (9%), maxillary canines (2.3%), and mandibular canines (2.3%). Type I DI was the most commonly observed type of invaginatus (65.9%), followed by type II (29.5%) and type III (4.6%). All patients with type III DI and 25% of the patients with type II DI had apical pathosis at the time of referral, but periapical lesions were not observed in teeth with type I DI. In total, 13.6% of DI cases had impacted teeth. ConclusionsCBCT can be recommended as an effective diagnostic device for identifying DI because it provides an accurate representation of the external and internal dental anatomy.

Schulze and Brand type a-IV dens invaginatus with radicular cyst: A rare case report

Though a clinical examination may reveal a deep fissure or pit on the surface of an anterior tooth, radiographic examination is a more accurate approach to diagnose an invagination. Dens invaginatus is one of the common dental deformities, but the defect involving the root and its association with radicular cyst is still very uncommon. The objective of this case presentation is to report a case of radicular dens in dente, which is a rare dental anomaly. This case report shows that dens invaginatus with an open apex and a radicular cyst can be treated successfully using currently available materials.

Bilateral double dens invaginatus in multituberculated maxillary central incisors with impacted supernumerary teeth: A rare case

Dens Invaginatus (DI) is a rare developmental malformation of teeth, resulting from an infolding of dental papilla. The increased risk of pulpal pathologies associated with DI makes it clinical relevant. Only few cases have been reported where double DI was found associated with supernumerary teeth. Diagnosis of DI with the conventional radiographs is not easy, so advanced imaging modalities are must. This paper highlights a rare case of bilateral double DI in multituberculated maxillary central incisors with impacted supernumerary teeth with its clinical and imaging features.

An Overview of Dens Invaginatus with Report of 2 Cases

Dens invaginatus occurs as a result of invagination of the enamel organ. These cases may present difficulties with respect to its diagnosis and treatment because of canal morphology. It frequently leads to caries, pulpal, and periodontal involvement with necrosis and loss of attachment. The knowledge of classification and anatomical variations of teeth with dens invaginatus are of utmost importance for correct treatment. This paper presents two cases of dens invaginatus and its treatment depending on the patient symptoms either by prophylactic sealing or root canal treatment.

Resorption in the maxillary incisor with dens invaginatus

The management of root resorption is a challenge to the endodontist. It occurs in cases with chronic pulpal inflammation or due to trauma. Internal resorption, a rare phenomenon, has been a quandary from the standpoints of both its diagnosis and treatment. It is mostly asymptomatic and discovered by chance on routine radiographic examination or by a classic sign, the pink tooth. Early diagnosis, removal of the cause, proper treatment of the resorbed root are mandatory for successful treatment outcome. External tooth resorption usually follows trauma to the periodontal ligament. It is often confused with internal resorption. A combination of both external and internal resorptions can also occur on the same tooth, making the management more complex. Dens invaginatus is a developmental malformation of the teeth that most commonly affects the permanent maxillary lateral incisor. The clinical importance of dens invaginatus results from the risk of pulpal disease. The presence of dens invaginatus with internal resorption is extremely rare. This paper is an attempt to summarize the knowledge on internal root resorption and present cases, which were successfully managed by different treatment modalities.

Bilateral supplemental maxillary incisors with both dens invaginatus and dens evaginatus in a non syndromic patient: a rare case report.

A 13-year-old boy was reported with complaint of unaesthetic look due to crowding of teeth. Family and medical history was non contributory. Intra oral examination revealed presence of multiple supernumerary anterior teeth resulting into crowding [Table/Fig-1,Table/Fig-2]. Clinical and radiographic (occlusal and orthopentamograph) [Table/Fig-3,Table/Fig-4] examination confirmed the presence of erupted bilateral three supernumerary (supplemental) teeth resembling one central and two lateral incisors teeth in maxilla in non syndromic patient. Radiographically left central incisor presented with both dens invaginatus and dens evaginatus which is uncommon anomaly [Table/Fig-5]. Clinically all supplemental and permanent incisors were visible in the oral cavity. Two supplemental lateral incisors were palatally placed and supplemental central incisor was rotated. Treatment was planned to extract all supplemental teeth followed by orthodontic correction of spacing and diastema. Upon surgical extraction of supplemental teeth, supplemental lateral incisor showed enamel projection at cemento-enamel junction (CEJ) on proximal side for about 2.5 mm, which is uncommon [Table/Fig-6]. The patient didn’t turned up on follow up for the management of chief complaint

Dens evaginatus and dens invaginatus in a double tooth: A rare case report

The presence of dens invaginatus (DI) and dens evaginatus (DE) on same tooth is a rare phenomenon. However, when these dental anomalies occur on a double tooth, it becomes an extremely rare phenomenon. The authors report a rare case of DI and DE on fused permanent maxillary central incisor with supernumerary tooth in a 40-year-old male. The present article also focuses on the differentiating fusion from gemination and also reviews preventive and management strategies for tooth with complex dental anatomy.

Management of type II dens invaginatus and peg laterals with spacing of maxillary anteriors

A case of peg-shaped lateral with dens invaginatus (DI) and midline diastema affecting maxillary incisors in a 32-year old female patient is discussed. This clinical report describes the endodontic management of DI in tooth #12, esthetic correction of peg laterals and diastema with all ceramic restorations. Satisfactory results were achieved esthetically following treatment and gave the patient a new confident smile.

Treatment of Dens Invagination in a Maxillary Lateral Incisor: A Case Report.

Dens invagination is a developmental anomaly requiring specific treatment approaches. Oehler's Type III dens in dente, extends into the root and perforates at the apical area or lateral surface of the root. In this case endodontic treatment of the invaginated tooth was carried out through the central lumen of the invagination with calcium hydroxide without manipulation of the main pulp canal, thereby leaving the tooth vital. The 18-month follow-up examinations were indicative of treatment success; the periapical lesion resolved completely and the tooth remained vital. Conclusion:Information about the three dimensional anatomy of the teeth especially those with an abnormality is necessary for a successful treatment.

Bilateral dens invaginatus in the mandibular premolars - Diagnosis and treatment

Dens invaginatus (DI) is a developmental anomaly that results from an infolding of the dental papilla during tooth development and simulates the appearance of a tooth within another tooth. It shows a wide spectrum of variations in morphology and usually affects the maxillary lateral incisors. This study presents an unusual case of an Oehlers’ Type I DI involving the bilateral mandibular first and second premolars, which presented as an incidental radiographic finding in the first premolars and was associated with a periapical lesion in the second premolars which was successfully treated using nonsurgical endodontics.

Maxillary sinusitis as a complication of infected dens invaginatus in maxillary lateral incisor: A case report

Introduction: Maxillary sinusitis can have various origins, including odontogenic origin. Case Report: We describe a case of maxillary sinusitis in a 25-year-old female patient who experienced pain and swelling in the right maxillary region as a complication of infected maxillary lateral incisor. Clinical and radiographic examinations revealed dens invaginatus (DI; Oehler's type III) associated with apical pathosis in the maxillary right lateral incisor, with a large periapical lesion involving the adjacent four teeth. Nonsurgical root canal treatment using calcium hydroxide medicament was carried out for all five teeth, which resulted in gradual diminution of sinusitis, and the patient remained asymptomatic. Discussion: This paper emphasizes the following: (i) the challenges posed by DI for root canal treatment because of its anatomical complexity; (ii) a nonsurgical approach in the management of a large periapical lesion, using calcium hydroxide medicament; and (iii) the interdisciplinary management of conditions of common clinical concern for medical and dental practitioners, for successful outcome.

Dens Invaginatus with a Radicular cyst-A Case report

Ens invaginatus is a developmental malformation of teeth. It is a dental anomaly resulting from invagination of the enamel organ into the dental papilla, during odontogenesis. Affected teeth show a deep infolding of enamel and dentine starting from the foramen caecum or even the tip of the cusps and which may extend deep into the root. Teeth most affected are maxillary lateral incisors. The affected teeth radiographically shows an in folding of enamel and dentine which may extend deep into the pulp cavity and into the root and sometimes even reach the root apex. The malformation shows a broad spectrum of morphologic variations and frequently results in early pulp necrosis. The radiographic examination is the most realistic way to diagnose the invagination. Root canal therapy may present severe problems because of complex anatomy of teeth.

Non-Surgical Endodontic Treatment of Type III Dens Invaginatus in Maxillary Canine: A Case Report

Non-Surgical Endodontic Treatment of Type III Dens Invaginatus in Maxillary Canine: A Case Report

Radicular dens invaginatus associated with radicular cyst in maxillary third molar – Rare case report

Dens invaginatus is a developmental tooth anomaly showing broad spectrum of morphological variations. Most extreme form of the invagination results in a bulbous expansion of the affected crown and/or root has been termed as dilated odontome. Radicular dens invaginatus is a rare dental anomaly formed by infolding of Hertwig's epithelial root sheath and in few forms invagination is lined by enamel. Various techniques of treatment including conservative treatment, nonsurgical root canal treatment, and endodontic surgery usually are unsuccessful because of their complex morphology and are associated with periapical lesions. We report a case of radicular dens in dente with dilated root and was associated with radicular cyst in the right maxillary third molar in a patient aged 38 years. Histological examination showed a dilated bulbous root with enamel formation within root invagination and the associated radicular cyst was lined by pseudostratified ciliated columnar epithelium.

What can cause the pulps of immature, permanent teeth with open apices to become necrotic and what treatment options are available for these teeth.

Pulp necrosis of immature permanent teeth represents a significant challenge for clinical management as root development ceases and open apices remain. The aetiology of pulp necrosis in immature permanent teeth can include caries, trauma or the presence of the dental anomalies, dens invaginatus and dens evaginatus. Endodontic treatment is complicated by the resultant thin dentinal root walls and the lack of apical closure. The long-term prognosis is compromised by increased risk of cervical root fracture and reduced crown to root ratio. Currently there is a paradigm shift in the management of such cases from traditional apexification procedures towards regenerative endodontic procedures. Regenerative endodontics can promote continued root development and apical closure, which does not occur with calcium hydroxide or mineral trioxide aggregate apexification. As supporting evidence grows and clear treatment guidelines are developed for regenerative endodontics, it is likely to become the gold standard for management of such teeth.

Endodontic management of bilateral type II dens invaginatus

Root canal treatment of invaginated teeth is frequently challenging because of problems associated with gaining access to the root canals and with variations of canal morphology associated with this type of malformation. This article reports on the conservative endodontic management of bilateral upper central incisors diagnosed with infected dens invaginatus (Oehlers type II) and associated irreversible pulpitis with concomitant oligodontia. The use of contemporary endodontic techniques in the diagnosis, treatment planning and management of the case are highlighted.

A Variant Form of Dens Invaginatus in Permanent Maxillary Canine

Dens Invaginatus (DI) is a rare developmental anomaly, which presents as an infolding of enamel and dentine extending into the pulp chamber and sometimes into the root. The aim of this case report was to describe its radiographic findings, to emphasize the inexplicable morphology. Considering the likelihood of an early pulpal involvement and the chronic periapical lesions often associated with this anomaly without any clinical symptoms, dens invaginatus is clinically significant. Difficulties are encountered during the endodontic treatment, owing to the complex root canal anatomy. Therefore, a proper diagnosis and evaluation of the anomaly is essential to save the involved tooth.

Successful Nonsurgical Endodontic Outcome of a Severely Affected Permanent Maxillary Canine with Dens Invaginatus Oehlers Type 3

IntroductionThe morphogenic complexities of dens invaginatus (DI) Oehlers type 3 in maxillary canines offer significant endodontic challenges. MethodsA case report is provided of a 14-year-old female patient who presented with an anomalous-looking permanent maxillary canine associated with a sinus tract. Pulp testing revealed a normal response on the distal aspect of the tooth, whereas the mesial segment tested nonresponsive. A radiolucent lesion was seen on the mesiolateral radicular area adjacent to the severely distended pulp chamber. A gutta-percha point inserted into the sinus tract traced to this same region. The diagnosis was normal pulp coincident with DI Oehlers type 3 with pulp necrosis and chronic apical abscess. ResultsDespite a concerted effort to limit the root canal therapy to only the necrotic canal, its proximity to the normal canal obviated this possibility, entailing endodontic treatment of the entire root canal system. The necrotic pulp space was subjected to sustained irrigation with 5.25% sodium hypochlorite and then completed with 17% ethylenediaminetetraacetic acid. A bolus of gutta-percha was used to create an apical barrier, and then the remainder of the enlarged pulp space was obturated with injectable thermoplasticized gutta-percha. At a 4.5-year recall, there was no clinical and radiographic evidence of infection. ConclusionsEndodontic success was accomplished with meticulous efforts of disinfection. Thermoplasticized gutta-percha can offer utility for obturation of anatomically complicated pulp spaces. The use of the dental operating microscope is an invaluable aid for discernment of the intricacies of teeth affected with DI type 3 variant and can enhance clinical outcomes.