Talon cusps occurring concurrently with dens invaginatus on a permanent maxillary lateral incisor: a case report and literature review.

A talon cusp is a prominent accessory horn-like structure that projects from the cingulum or cementoenamel junction of the maxillary or mandibular teeth. It can occur in primary and permanent dentition and can lead to occlusal interference, irritation of the tongue, pulpal necrosis, caries, and periodontal problems. Talon cusp has been reported to affect both sexes, and may be unilateral or bilateral. Talon cusps occur most often on the palatal surface of permanent maxillary incisors. A comprehensive literature review revealed only 6 reported cases of facial talon cusps. A talon cusp occurring simultaneously with dens invaginatus in a tooth is extremely rare; to date, only 9 case reports have been published. This article presents a unique case of concurrent dens invaginatus and palatal and facial talon cusps in the right maxillary central incisor of a 12-year-old girl.

The diagnosis and conservative treatment of a complex type 3 dens invaginatus using cone beam computed tomography (CBCT) and 3D plastic models.

AIM: To investigate the use of 3D plastic models, printed from cone beam computed tomography (CBCT) data, for accurate diagnosis and conservative treatment of a complex case of dens invaginatus. SUMMARY: A chronic apical abscess with a draining sinus tract was diagnosed during the treatment planning stage of orthodontic therapy. Radiographic examination revealed a large radiolucent area associated with an invaginated right maxillary central incisor, which was found to contain a vital pulp. The affected tooth was strategic in the dental arch. Conventional periapical radiographs provided only partial information about the invagination and its relationship with the main root canal and with the periapical tissues. A limited-volume CBCT scan of the maxilla did not show evidence of communication between the infected invagination and the pulp in the main root canal, which could explain the pulp vitality. A novel method was adopted to allow for instrumentation, disinfection and filling of the invagination, without compromising the vitality of the pulp in the complex root canal system. The CBCT data were used to produce precise 3D plastic models of the tooth. These models facilitated the treatment planning process and the trial of treatment approaches. This approach allowed the vitality of the pulp to be maintained in the complex root canal space of the main root canal whilst enabling the healing of the periapical tissues. KEY LEARNING POINTS: Even when extensive periapical pathosis is associated with a tooth with type III dens invaginatus, pulp sensibility tests should be performed. CBCT is a diagnostic tool that may allow for the management of such teeth with complex anatomy. 3D printed plastic models may be a valuable aid in the process of assessing and planning effective treatment modalities and practicing them ex vivo before actually performing the clinical procedure. Unconventional technological approaches may be required for detailed treatment planning of complex cases of dens invaginatus.

Dens invaginatus: a review and orthodontic implications.

Dens invaginatus (DI) is a developmental anomaly resulting in a deepening or invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues. Presence of DI is considered to increase the risk of caries and pulpal pathology, but they are often missed in the initial orthodontic assessment as they present with no clinical signs of an anomaly. In absence of adequate oral hygiene and maintenance, bacterial contamination of these malformations can lead to the development of early caries and consequent pulpal death. Early diagnosis of these lesions is critical as they can negatively impact any planned orthodontic treatment and assessment of the prognosis of these lesions is therefore necessary prior to the commencement of orthodontic treatment. In this article, we aim to illustrate the need for appropriate diagnosis and multidisciplinary approach in the management of DI in patients undergoing orthodontic treatment.

Assessment of dens invaginatus and its characteristics in maxillary anterior teeth using cone-beam computed tomography.

This cone-beam computed tomographic (CBCT) study aimed to evaluate the prevalence of dens invaginatus (DI) and its characteristics in maxillary anterior teeth in a Saudi population. A total of 505 CBCT scans were evaluated, including a total of 2790 maxillary anterior teeth. The patients' demographic data, including age and sex, were recorded. The presence of DI and the related characteristics including bilateral occurrence; DI type according to Oehlers classification; and presence of periapical radiolucency, open apex, and/or nearby impacted teeth were analyzed. The associations between DI and the other factors were analyzed using the chi-square and fisher exact tests. DI was detected in 7.3% of the patients and 1.6% of the teeth examined. Most of the DI-affected teeth were maxillary lateral incisors (76.1%), followed by mesiodens (19.6%) and maxillary central incisors (4.3%), while no DI was observed in the maxillary canines. Bilateral DI was found in 24.3% of the affected patients. Oehlers type I DI was the most frequent (80%). Periapical radiolucencies, open apices, and nearby impacted teeth were observed in 10.9%, 4.3%, and 30% of the invaginated teeth, respectively. DI was significantly associated with tooth type (P < 0.0001) but not with sex (P > 0.05). Although most of the DI cases are limited to the crown, CBCT imaging is essential for DI evaluation and management.

Unusual Location of Dens Invaginatus Causing a Difficult-to-Diagnose Pulpal Involvement.

This article reports on an unusual case of dens invaginatus in a maxillary third molar that was causing severe symptoms of irreversible pulpitis. This malformation was not clinically or radiographically identified, and the occurrence of referred pain made the early identification of the responsible tooth difficult. Determination of the tooth that was the source of symptoms was only possible after an observation period and fast aggravation of the pathologic process to cause pulp necrosis and extreme tenderness to percussion. The diagnosis of dens invaginatus was made only after extraction and sectioning. Histopathologic and histobacteriologic features of this case are illustrated.

[Dens in dente: report of 3 cases and review of the literature].

PURPOSE: To explore the diagnosis and clinical treatment of dens in dente. METHODS: Preventive resin restoration, root canal treatment, apical barrier technique and apexification were used to treat three cases of dens in dente, respectively. The curative effects were assessed by general examinations and imageological examinations during postoperative follow-up visits. RESULTS: Three patients with different type and degree of dens in dente achieved good therapeutic effect and favorable prognosis through different treatment methods. CONCLUSIONS: Dens in dente is complex clinically and the treatment is difficult. Clinicians should improve the understanding of dens in dente. The keys to successful treatment are early diagnosis and early treatment. In addition, it is important to take proper measures according to the type and degree of dens in dente, to preserve the diseased tooth as much as possible.

Dens invaginatus. Part 2: clinical, radiographic features and management options.

AIM: To describe the possible clinical and radiographic features of this developmental anomaly, review previous treatment recommendations and suggest management options based on the classification of the problem. SUMMARY: This paper describes the clinical and radiographic features related to the different types of dens invaginatus and highlights those features which may indicate the presence of a previously undetected invagination. Aids to clinical diagnosis are described together with a description of the possible radiographic features, which may suggest the presence of an invagination. Previous treatment suggestions are described and suggestions as to possible management options, based on current endodontic knowledge and the classification of the problems are described. KEY LEARNING POINTS: * Thorough clinical and radiographic examination is required to diagnose and successfully treat minor to severe invaginations. * Modern clinical techniques may facilitate the management of invaginations once considered untreatable.

Unicystic ameloblastoma of the maxilla: a case report.

Unicystic ameloblastoma is believed to be less aggressive and responds more favorably to conservative surgery than the solid or multicystic ameloblastomas. This report is a rare case of unicystic ameloblastoma of the maxilla that was treated by enucleation under suspicion of a radicular cyst related to a dens in dente. The neoplastic nature of the lesion became evident only when the enucleated material was available for histologic examination. With this report, the authors illustrate the importance and complexity of a differential diagnosis of lesions with a cystic aspect in the anterior region of the maxilla, among them - inflammatory radicular cysts, odontogenic keratocysts, adenomatoid odontogenic and unicystic ameloblastoma. Relevant diagnostic problems and choice of treatment of unicystic ameloblastoma are presented along with a review of the literature.

Triple dens invaginatus in a single tooth: Rarest of rare case report.

Dens invaginatus is a rare malformation affecting the teeth. The teeth that are most commonly affected are the permanent maxillary lateral incisors. The mandibular posterior teeth are rarely affected by dens invaginatus. In most of the cases, a single dens invaginatus is seen affecting the tooth. Cases of double dens invaginatus affecting a single tooth are rare, and those of triple dens invaginatus in a single tooth are even rarer. Here, we present a case of a 14-year-old where three dens invaginatus were seen in the mandibular second premolar. This is the fourth case of three dens invaginatus in a single tooth as only three have been reported previously.

An update on the diagnosis and treatment of dens invaginatus.

Dens invaginatus is a malformation with varying anatomical features, posing challenges to treatment. Early and accurate diagnosis plays a significant role in selecting the appropriate treatment. The diagnosis of teeth with a complex root canal system including dens invaginatus has made progress with the application of three-dimensional imaging techniques in endodontics. Advanced treatment options provide hope for teeth that could not be saved before. This review discusses diagnostic methods and treatment options for teeth with dens invaginatus, and provides guidelines for the management of dens invaginatus cases in clinic. Current as well as traditional diagnostic techniques are summarized. Treatment options including state-of-the-art alternatives are presented for coronal dens invaginatus and radicular dens invaginatus.

Dens invaginatus: diagnosis and management strategies.

Dens invaginatus is a developmental malformation, in which there is an infolding of enamel into dentine. These infolds represent stagnation sites for bacteria and can predispose to dental caries. The carious infection can spread via enamel and dentine to contaminate the pulp and cause soft tissue necrosis. The altered and sometimes complex anatomy of affected teeth can make endodontic management challenging. Early diagnosis is therefore essential as prophylactic treatment of the dens can prevent degeneration and pulpal necrosis. The aim of this article is to review the aetiology, classification, diagnosis and management of teeth affected with dens invaginatus. Emphasis will be placed on describing the clinical features of this anomaly. Treatment options, management strategies and the challenges faced in managing this condition will be discussed.

Multiple and relapsing supernumerary teeth associated to dens invaginatus. Review of the literature and case report.

The aim of this paper is to show problems related to supernumerary teeth therapy according to their formation and mineralization. The clinical case of an 11-year old boy suffering from alteration of the eruptive sequence of the upper incisor teeth caused by 2 supernumerary teeth in the premaxilla, is reported. What is interesting about this case is that after the surgical removal of the supernumerary teeth, with a radiographic examination taken 6 months later, 2 other supernumerary teeth were observed. The authors point out that while the clinical approach can be the same for different situations it is not possible to have the same approach for the surgical therapy which may be different from case to case.

Dens invaginatus of the mandibular first molars in a dog.

A 6-year-old dog was presented for draining tracts associated with both mandibular first molar teeth. Radiographs of the affected teeth showed periapical bone lysis. Surgical tooth extractions were performed and the tooth segments were submitted for histopathologic examination. Microscopic evaluation of the teeth showed in folding of the enamel and dentin consistent with a diagnosis of dens invaginatus. Examination performed 13-months following the extraction procedures indicated uncomplicated healing at the extraction sites and no other visible evidence of endodontic disease.

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.

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.

INTRODUCTION: This 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. METHODS: We 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. RESULTS: The 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. CONCLUSIONS: CBCT can be recommended as an effective diagnostic device for identifying DI because it provides an accurate representation of the external and internal dental anatomy.

Management of dens in dente associated with a chronic periapical lesion.

Dens in dente is characterised as a developmental anomaly resulting from invagination of the enamel organ into the dental papilla. It is a rare malformation of teeth, showing a wide spectrum of morphological variations such as gemination, microdontia, taurodontism, dentinogenesis imperfecta, supernumerary tooth and hyperplasias, resulting frequently in early pulp necrosis. Maxillary lateral incisors are the commonest teeth to be affected by dental malformations-supernumerary tooth, talon cusp, congenitally missing tooth and dens in dente. We describe the management of a case of dens in dente in a maxillary lateral incisor with a periradicular lesion.

Double Dens Invaginatus with Multiple Canals in a Maxillary Central Incisor: Retreatment and Managing Complications.

Dens invaginatus is a developmental anomaly that often presents a perplexing challenge to the endodontist. It involves the maxillary central incisor less commonly than the maxillary lateral incisor. Double dens invaginatus is even rarer. Herein a unique case of dens invaginatus in a maxillary central incisor is presented. The tooth had an inadequate previous root canal treatment. On retreatment, multiple canals and double dens invaginatus were found. The invaginations were Oehlers type 3b and type 2. The complex morphology was diagnosed and confirmed with cone-beam computed tomography imaging and managed with a combined surgical and orthograde approach. Four canals and a blind sac along with an open apex were found. There were many intercommunications between the canals. During the treatment, a complication of a separated instrument occurred, which was managed successfully. The 1-year follow-up shows successful outcome of the treatment. Dens invaginatus may be more complicated than it seems. It needs meticulous treatment by a specialist. Failure or a delay in referring the case to a specialty setting may further increase the complications. With the advancements in equipment and materials, it is possible to save even severe cases of dens invaginatus.

Diagnosis and management of unusual dental abscesses in children.

Although the majority of dental abscesses in children originate from dental caries or trauma, a few are associated with unusual conditions which challenge diagnosis and management. Recent research findings have shed light on these unusual entities and greatly improved understanding of their clinical implications. These conditions include developmental abnormalities such as dens invaginatus in which there is an invagination of dental tissues into the pulp chamber and dens evaginatus in which a tubercle containing pulp is found on the external surface of a tooth crown. In addition, inherited conditions which show abnormal dentine such as dentine dysplasia, dentinogenesis imperfecta, and osteogenesis imperfecta predispose the dentition to abscess formation. Furthermore, 'spontaneous' dental abscesses are frequently encountered in familial hypophosphataemia, also known as vitamin D-resistant rickets, in which there is hypomineralization of dentine and enlargement of the pulp. In addition to developmental conditions, there are also acquired conditions which may cause unusual dental abscesses. These include pre-eruptive intracoronal resorption which was previously known as 'pre-eruptive caries' or the 'fluoride bomb'. In addition, some undiagnosed infections associated with developing teeth are now thought to be the mandibular infected buccal cysts which originate from infection of the developing dental follicles. In the present paper, these relatively unknown entities which cause unusual abscesses in children are reviewed with the aim of updating the general practitioner in their diagnosis and management.