J Dent Rehabil Appl Sci.  2024 Feb;40(1):31-38. 10.14368/jdras.2024.40.1.31.

Root canal therapy of anterior teeth with dens invaginatus

• Kim JS
• Bae KB
• Hwang YC
• Oh WM
• Lee BN

• KMID: 2553629
• DOI: http://doi.org/10.14368/jdras.2024.40.1.31

Abstract

Dens in dente is a developmental anomaly resulting from infolding of the enamel organ into dental papilla prior to calcification of dental tissue. The pulpal tissue of the tooth can be vulnerable for bacterial invasion through direct exposure to the oral cavity or through defective enamel and dentin of the infolding part, thereby increasing the possibility of pulpal necrosis and subsequent apical periodontitis. Treatment planning of teeth with dens invaginatus may be difficult due to the complex root canal morphology. Therefore, thorough knowledge of anatomical variations of dens invaginatus is of great importance for proper treatment planning. The focus of this case report is on Oehler’s type II and III dens invaginatus. The infolding of type III dens invaginatus extends beyond the crown and CEJ. Bacterial invasion through the infolding can easily cause inflammation of the pulpal and periradicular tissue. This case report presents endodontic treatment of type II and III dens invaginatus with the aid of CBCT.

Keyword

dens invaginatus; root canal therapy; CBCT

Figure

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  Fig. 1 Classification of Dens invaginatus by Oehlers (1957). (A) Type I. (B) Type II. (C) Type IIIa. (D) Type IIIb.

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  Fig. 2 Preoperative radiograph of maxillary left lateral incisor with Dens invaginatus (Case A).

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  Fig. 3 Cone-beam Computed Tomography (CBCT) images (Case A). (A) Coronal, (B) Middle, (C) Apical.

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  Fig. 4 Root canal therapy of maxillary left lateral incisor with Dens invaginatus. (A) Preoperative radiograph. (B) Radiograph during endodontic treatment. Initial apical file adaptation. (C) Master cone adaptation. (D) Radiograph of the last endodontic treatment. The canal filling was done.

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  Fig. 5 Preoperative radiograph of maxillary right lateral incisor with Dens invaginatus (Case B).

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  Fig. 6 Root canal therapy of maxillary right lateral incisor with Dens invaginatus. (A) Preoperative radiograph. (B, C) Radiograph during endodontic treatment. Initial apical file adaptation. Canal negotiation. (D) The canal filling was done. (E) Radiograph of 3 month recall check after endodontic treatment.

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  Fig. 7 Periradicular surgery of maxillary right lateral incisor with Dens invaginatus. (A) Preoperative radiograph. (B) Radiograph of 3 month recall check after periapical surgery. (C) Radiograph of 6 month recall check after periapical surgery.

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  Fig. 8 Cone-beam Computed Tomography (CBCT) images (Case B). (A) Coronal, (B) Middle, (C) Apical.

Reference

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