Oehlers Type Research Articles

Successful non-surgical endodontic management of type III dens invaginatus by using cone-beam computed tomography: a case report

Dens invaginatus (DI) is a rare malformation of a tooth caused by the invagination of tooth crown before biological mineralization occurs. In DI type III invagination extends beyond the cementum-enamel junction, with the second foramen extending into the periapical tissues or into the periapical area. DI type III may pose real challenges for the clinician, especially when endodontic treatment is required. Objective: The present case report describes the successful non-surgical endodontic management of a tooth with DI type III with the aid of cone-beam computed tomography (CBCT). Case report: A 20-year-old male patient was referred for endodontic evaluation and treatment of the left maxillary lateral incisor (tooth #22), which presented a darker and unusual crown shape. Periapical radiography and CBCT scans revealed the presence of a type III DI, and a larger periapical lesion associated with external root resorption and discontinuous buccal cortical plate Results: The diagnosis of Oehlers type III DI with asymptomatic apical periodontitis was established, and non-surgical endodontic treatment was initiated. After 5 months, a decrease in the periapical lesion and arrest of external resorption was detected. The root canals were then filled, and the tooth restored. At the 3-years follow-up, clinical and imaging assessments revealed successful outcome of the treatment. Conclusion: CBCT is an inestimable tool for non-surgical endodontic management of teeth with complex internal anatomy, such as DI type III with associated large periapical lesion.

Root Maturation of an Immature Dens Invaginatus Despite Unsuccessful Revitalization Procedure: A Case Report and Recommendations for Educational Purposes

The clinical management of teeth with complex dens invaginatus (DI) malformations and apical periodontitis may be challenging due to the lack of routine. The aim of this case report is to describe the endodontic treatment of an immature tooth with DI and to discuss strategies for preclinical training for teeth with such malformations. A 9-year-old male presented with an immature maxillary incisor with DI (Oehlers Type II) and apical periodontitis which was diagnosed by cone beam computed tomography (CBCT). Revitalization was initially attempted but then abandoned after failure to generate a stable blood clot. Nevertheless, considerable increase in both root length and thickness could be detected after medication with calcium hydroxide followed by root canal filling with MTA as an apical plug. The endodontic management of teeth with DI requires thorough treatment planning. In immature teeth, under certain conditions, root maturation may occur even with conventional apexification procedures. From an educational perspective, different strategies including CBCT and 3D-printed transparent tooth models for visualization of the complex internal morphology and redesigned 3D-printed replica with various degrees of difficulty for endodontic training, can be used to overcome the challenges associated with endodontic treatment of such teeth.

Type III dens in dente (dens invaginatus) as a reason for endodontic treatment failure - case report

Introduction. Dens invaginatus is an infrequent developmental anomaly of teeth with an unknown etiology. The prevalence rate ranges from 0.25% to 10%. The most affected teeth are lateral maxillary incisors. Various classifications have been proposed to categorize the different types of dens in dente. However, the Oehlers classification, named after the dentist who first described it, is the most commonly used for this malformation. This classification has three primary types and was introduced in 1957. Case Report. A 17-yearold female patient appeared at the Dentistry Clinic of Vojvodina, Novi Sad with a lateral maxillary incisor exhibiting dens invaginatus (Oehlers type IIIA). The pulp was necrotic, accompanied by a large periradicular lesion. The patient had previously been prescribed penicillin antibiotics, and we initiated endodontic therapy. The patient returned for the scheduled check-up appointment with swelling in the area of the canine fossa above the upper left lateral incisor. In consultation with an oral surgeon, the tooth was extracted with purulent content. Four days after the extraction, the patient received a resin bonded bridge. Conclusion. The clinical significance and importance of dens in dente lie primarily in its potential to manifest with various symptomatic indications and its association with the occurrence and development of dental caries. It is crucial for clinicians and dental professionals to remain highly attentive, vigilant, and alert to the potential presence of dens in dente. This involves considering and acknowledging the wide array of diverse presentations and manifestations that this anomaly can exhibit.

Treatment of type III dens invaginatus in bilateral immature mandibular central incisors: a case report

BackgroundDens invaginatus (DI) is a developmental anomaly, Oehlers Type III DI is the most complex type and early diagnosis and treatment is complicated and challenging. This report presents a rare case of a type IIIb DI associated with a periapical lesion in bilateral immature permanent mandibular central incisors.Case presentationAn eight-year-old boy referred to our clinic manifesting with pain along with swelling in the mandibular incisors for the past one month. Radiographic examination showed periapical radiolucency exhibiting a scantly defined border, as well as an invagination which had a central invaginated canal extending from the pulp chamber throughout the apical foramen in both mandibular central incisors. We performed two different treatment procedures on the basis of the condition of the main pulp of the mandibular central incisors. in which only the invagination root canal was treated in the right mandibular central incisor, while the invagination and main root canals were treated in the left mandibular central incisor. During the 18-month follow-up period, the teeth were clinically asymptomatic. Imaging examinations indicated complete healing of the periapical lesion and revealed that the wall of the root canal was thickened and the open apex was closed.ConclusionFor young permanent teeth with type III Dens invaginatus, it is particularly important to keep pulp vitality, which could maintain root development and allow a good long-term prognosis.

A Case Report: Successful Treatment for Maxillary Left Lateral Incisor with Dens Invaginatus Oehler Type Ⅲ

A Case Report: Successful Treatment for Maxillary Left Lateral Incisor with Dens Invaginatus Oehler Type Ⅲ

Retreatment of a maxillary lateral incisor with type II dens invaginatus: One-year follow-up

Dens invaginatus is a developmental dental anomaly that occurs when the enamel organ is folded into the dental papilla prior to calcification of dental tissues. Endodontic treatment of the teeth with dens invaginatus can be challenging and due to atypical and complex anatomy. This case report presents non-surgical endodontic treatment of maxillary lateral incisor with Oehlers Type II Dens Invaginatus. The anamnesis revealed that the maxillary left lateral incisor had root canal treatment in the past; however the symptoms remained. Radiographic and clinical examination revealed an inadequately filled accessory canal and a necrotic unfilled main canal surrounded by a large periapical lesion. Subsequently, endodontic treatment of the main and retreatment of the accessory canal was completed. One year of clinical and radiographical follow-up demonstrated an asymptomatic tooth with a healing periapical lesion. Keywords: Dens in Dente; Incisor; Invaginatus, Retreatment

REPETITIVE REGENERATIVE ENDODONTIC PROTOCOL TREATMENT FOR MATURE TEETH WITH DENS INVAGINATUS AND SEVERE PERFORATED INTERNAL ROOT RESORPTION: A CASE REPORT WITH 24-MONTH FOLLOW-UP

The association of internal root resorption (IRR) with dens invaginatus is an extremely rare finding, and its incidence may be underestimated, adding to the difficulty of endodontic treatment. A 9-year-old boy was admitted with complaints of swelling and pain. Radiological examination revealed closed apex Oehlers type II dens invaginatus and severe IRR, as well as apical third of two lateral root perforation and lesion. Calcium hydroxide applied in the regenerative endodontic protocol (REP) as intracanal medicament. Differently, bleeding was achieved by irritating the lateral perforation area. However, the tooth showed spontaneous pain and sensitivity to percussion after 2 months. The same REP was performed, but a triple antibiotic paste was used as the intracanal medicament. After 2 years, the tooth was asymptomatic, and radiographic examination revealed the decrease was cared on the previous resorption sites, and one of the openings on the lateral root surface had closed.

Successful Pulp-Preserving Treatment for Peri-invagination Periodontitis of Double Dens Invaginatus With Oehlers Type IIIA and IIIB: A Case Report

Dens invaginatus (DI), which often occurs in the maxillary lateral incisor, is an important issue in endodontics because the treatment complexity increases depending on the degree of invagination and the vitality or nonvitality of the pulp. An 11-year-old female patient with a sinus tract in the gingiva of the maxillary lateral incisors showed peri-invagination periodontitis and double DI on radiography. Cone-beam computed tomographic imaging was used to examine the structure in the root canal in detail, and Oehlers type IIIA and IIIB DI was found. It was also shown that the patient’s bone defect was caused by type IIIA. Because a healthy reaction was observed in the pulp test, the final diagnosis was peri-invagination periodontitis associated with type IIIA of the double DI with vital pulp. We expected the lesion to heal by treating only the type IIIA invaginated pseudo–root canal while preserving the healthy pulp. The invaginated root canal was cleaned under a microscope using ultrasonic instruments and nickel-titanium files to minimize irritation to the pulp. Because the lesion shrinkage was confirmed by cone-beam computed tomographic imaging taken 3 months after the start of treatment, vertical compaction of the warm gutta-percha technique was performed. At the 6-month postoperative recall, the pulp was normal, and the lesions were further improved. Treatment of the main root canal of double DI is complicated. However, proper diagnosis and careful cleaning of the invaginated root canal are essential for healing while preserving the pulp.

Laser Doppler for Accurate Diagnosis of Oehler’s Type III Dens Invaginatus: A Case Report

In vital pulp therapy, pulp testing aids in the differential diagnosis and influences the treatment plan. Different from previous doppler flowmetry studies that only recorded waves and data, we report the first time, the use of a laser doppler blood flow monitor and imager with a colored image to present pulp vitality information in the dental field. We report here a case of Oehlers type IIIa dens invaginatus of the right upper lateral incisor in a 31-year-old girl, with the opening of the invagination near CDJ and a peri-invagination lesion sized 8 × 9 mm2. Cone beam computed tomography was used to verify specific spatial and stereoscopic data. After removing the source of infection, mineral trioxide aggregate was selected to fill the invagination. Laser doppler was scheduled for further assessment. After three years of regular follow-up, the patient’s clinical condition improved, the peri-invagination lesion healed, and the laser doppler and electric pulp test both showed a positive reaction. Laser doppler has successfully improved the diagnostic accuracy Thus, unnecessary interventions can be avoided while reducing the treatment time by preserving the vitality. However, further work is needed to resolve the limitations of laser doppler.

Endodontic management of type IIIB dens invaginatus: An unusual case report

Dens invaginatus (DI) is an unusual anomaly of teeth, presumably resulting from an infolding of the dental papilla during tooth development. The root canal treatment of such teeth is arduous because of problems associated with gaining access to the root canals and with variations of canal morphology associated with this type of malformation. The present case describes the effective endodontic treatment of an Oehlers Type IIIB DI in a mandibular right central incisor associated with periapical lesion. It likewise demonstrates that spiral computed tomography scan is a significant auxiliary aid to avoid errors in diagnosis and treatment of the dental anomaly.

Endodontic treatment for Oehlers type 3 dens invaginatus with a curved root canal

Endodontic treatment for Oehlers type 3 dens invaginatus with a curved root canal

Management of Dens Invaginatus Type II Associated with Immature Apex and Large Periradicular Lesion Using Platelet-rich Fibrin and Biodentine

Dens invaginatus (DI) poses peculiar challenges in endodontic treatment of teeth because of distortion of pulpal space. A case of Oehlers type II DI with open apex and large periapical lesion is reported. The case was managed using cone-beam computed tomography (CBCT), operating microscope, platelet-rich fibrin (PRF), and Biodentine. A 15-year-old male patient presented with palatal swelling. Pulp sensibility testing of right maxillary lateral incisor was negative. Intraoral periapical digital radiograph revealed an Oehlers type II DI with open apex and periapical radiolucency. A CBCT scan was performed to study the anatomy, determine the true extent of the periapical lesion, and form a treatment plan. A diagnosis of Oehlers type II DI with pulp necrosis and acute periapical abscess was made. Two-visit endodontic treatment was performed. In the first visit, the invaginated central mass was removed under operating microscope, chemo-mechanical preparation was done, and double antibiotic paste dressing was placed. In the second visit, the canal was sealed with apical matrices of PRF and Biodentine as filling material. The patient was asymptomatic and radiographs revealed continued healing of the osseous defect at follow-up visits. A CBCT scan at 30 months showed complete continuity of periodontal ligament space, healing of labial and palatal cortical plates, and formation of intercortical bone. The advances in endodontic armamentarium and technology, like CBCT and operating microscope, have made successful treatment of challenging cases possible. PRF and Biodentine as apical matrices and filling material, respectively, proved to be effective in the present case.

Delayed Root Development by Displaced Mineral Trioxide Aggregate after Regenerative Endodontics: A Case Report

IntroductionThis case report presents the treatment of a 16-year-old boy with a maxillary lateral incisor (tooth #10) presenting with Oehlers type II dens invaginatus and diagnosed with previously initiated therapy and asymptomatic apical periodontitis. MethodsA regenerative endodontic procedure (REP) was performed for the tooth but complicated by apically displaced mineral trioxide aggregate (MTA). Clinical and radiographic examination was undertaken yearly, and a cone-beam computed tomography scan was taken to investigate further the formation of hard tissues within the root canal. Subsequently, tooth #10 was re-accessed and then root-filled with MTA. ResultsThere was complete periapical healing, thickening of the dentinal root walls, and completed apex formation 3 years after REP. Hard tissue formation was noted within the root canal, on the root canal wall, and the root apex through clinical and radiographic examination. Less hard tissue formation was noted on the labial root canal wall where the displaced MTA was located, which was identified on the cone-beam computed tomography scan. ConclusionsThis report demonstrates that REP can potentially provide excellent treatment outcomes for structurally compromised teeth. REP should be considered as a first-line treatment before proceeding with a root filling when root development is incomplete, but attention to technical detail is essential.

A Rare Case of Type III Dens Invaginatus in a Mandibular Second Premolar and Its Nonsurgical Endodontic Management by Using Cone-beam Computed Tomography: A Case Report

Invaginated teeth present technical difficulties in clinical management because of their abnormal anatomic configuration. Endodontic clinical management of type III dens invaginatus can be greatly enhanced by newer techniques and materials such as cone-beam computed tomography (CBCT), mineral trioxide aggregate, and platelet-rich fibrin. This case report presents a 13-year-old male patient with type III dens invaginatus (DI) in left mandibular second premolar with history of recurrent swelling. Pulp testing revealed no response with the tooth. Dens invaginatus type III with an immature apex and periapical lesion was seen on radiograph. The case was diagnosed as Oehlers type III DI with pulp necrosis and chronic apical abscess. The treatment was planned and performed by using CBCT imaging. CBCT was performed to see the canal anatomy and to know the size of periapical lesion. Root canal treatment was completed in 2 visits. Calcium hydroxide dressing was placed in the first visit. In the second visit MTA was used for apexification in the main canal, and warm vertical compaction technique with gutta-percha was used in the invaginated canal. At the 2-year reevaluation, the patient was asymptomatic, and his tooth had remained functional since the treatment was completed. 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.

Management of Oehlers Type II Dens in Dente with Open Apex and Alveolar Bone Defect.

A 22-year-old male patient was referred to Department of Conser-vative Dentistry and Endodontics with a chief complain of pus discharge in upper left teeth region. Clinical examination showed oedema, sinus opening and pus discharge in relation to maxillary left central incisor, which did not respond to thermal tests (heat and cold) but responded positively to palpation and percussion [Table/Fig-1a,b]. On radiographic examination the upper left central incisor showed a bulbous root associated with open apex and periapical radiolucent area. It clearly showed that there was a tooth within a tooth extending nearly up to the root apex [Table/Fig-1c]. A clinical diagnosis of dens in dente Type II with open apex was made. The treatment options were discussed with the patient and informed consent was obtained. The treatment plan consisted of removal of dens in dente followed by root canal treatment, periapical surgery, retrograde filling of root with MTA and bone graft for regeneration of lost periodontal tissue. With rubber dam isolation the dens in dente was carefully separated and removed with help of a diamond bur and ultrasonic tips [Table/Fig-1d-f]. The canal was instrumented circumferentially and enlarged. Chlorhexidine was used as an irrigant as use of sodium hypochlorite carried the risk of extrusion into the periapical region through the open apex. Calcium hydroxide-iodoform paste (Metapex) was used as intra-canal medicament and the canal was obturated with gutta-percha cones after seven days when the patient was asymptomatic. Rest of canal was laterally condensed using accessory cones, and the access cavity was sealed with non-eugenol temporary cement (Cavit, 3M ESPE). After this under local anaesthesia, a mucoperiosteal flap was reflected and severe osseous destruction was observed on facial surface of tooth #21 [Table/Fig-2a]. After thorough debridement of the periapical osseous defect, a canal template was placed inside the canal and the defect was repaired with Resin Modified Glass Ionomer Cement [Table/Fig-2b]. Apex was sealed with MTA (ProRoot MTA, Dentsply) and the large osseous defect was filled with hydroxyapatite bone graft (G-bone, Surgiwear) covering the defect surface [Table/Fig-2c]. Flap was repositioned and sutured with 3-0 silk non-resorbable interrupted sutures [Table/Fig-2d]. Written post-operative instructions were given, antibiotics and analgesics were prescribed for one week. Patient was monitored on weekly schedule post-operatively, to ensure good oral hygiene. Sutures were removed after 10 days and tooth was restored with fiber post and nano-hybrid composite (Coltene Whaledent) [Table/Fig-3a-3e]. Oral hygiene instructions were reinforced, and patient was kept on maintenance for 3 months to re-evaluate this area. At subsequent follow-up examinations tooth was asymptomatic and post-operative radiograph after one year revealed complete healing in peri-radicular region [Table/Fig-3f,g].

Management of ‘labial’ type of dens invaginatus: A rare case report

Dens invaginatus is a developmental anomaly resulting in an infolding of the enamel organ into the dental papilla prior to calcification of the dental tissues. The invagination predisposes the tooth for the development of dental caries. Conventional radiographs do not provide detailed information concerning the three-dimensional image, which would help the clinician in making a confirmatory diagnosis and planning the treatment before undertaking the actual treatment. This report describes a case where Oehlers type II dens invaginatus was diagnosed with the help of spiral computed tomography. The locations of the primary root canal and the invagination were assessed from spiral computed tomography scan images. Usually, the invagination is present on palatal/lingual side. However, in this case, the invagination was unusually located on labial side, which has yet not been reported. The tooth also showed certain unusual morphological features.

치내치를 동반한 감염된 미성숙 영구치의 재생형 근관치료

Endodontic management of an immature permanent tooth with dens invaginatus poses a challenge to efficient treatment planning for the clinicians. Because it is difficult to shape, disinfect, and seal the canal space effectively, teeth with complex root canal structures often require particularly extensive and thorough treatment approaches. The purpose of this case report was to share clinical insight from the results of short-term followups after regenerative endodontic treatment with a dens invaginatus. Two immature maxillary lateral incisors with Oehlers type I and III dens invaginatus and infected necrotic pulp were treated using regenerative endodontic procedures. For the type III dens invaginatus case, an unusual approach toward redesigning the complex internal structure was taken, in order to have sufficient infection control and sealing. Cone-beam computed tomography (CBCT) and a surgical operating microscope were used to aid visualization and treatment. As a result, regenerative endodontic treatment appears to be effective for managing immature permanent teeth with complex dens invaginatus, and can lead not only to clinical and radiographic resolution, but also increased thickness of the dentinal walls.

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

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.

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.