Application of personalized templates in minimally invasive management of coronal dens invaginatus: a report of two cases.

BACKGROUND: Treating the coronal dens invaginatus (CDI) with pulp infection commonly involves the removal of invagination, which increases the risk of perforation and fracture, and compromises the tooth structure. Minimally invasive endodontic management of CDI is highly recommended. This report describes two cases of type II CDI with the application of personalized templates. CASE PRESENTATION: Two cases of type II CDI, affecting the main root canal in a maxillary canine and a lateral incisor, were diagnosed. A guided endodontics (GE) approach was applied. Cone-beam computed tomography and intraoral scans were imported and aligned in a virtual planning software to design debridement routes and templates. The MICRO principle (which involves the aspects of Mechanical (M) debridement, Irrigation (I), Access cavities (C), Rectilinear routes (R), and Obstruction (O)) was proposed for designing optimal debridement routes for future applications. The templates were innovatively personalized and designed to preserve the tooth structure maximally while effectively debriding the root canal. Root canal treatment with supplementary disinfection was then performed. The follow-up of the two patients revealed favorable clinical and radiographic outcomes. CONCLUSIONS: The GE approach could be a feasible method for preserving healthy dental structure while effectively debriding the root canal, thereby achieving successful and minimally invasive endodontic treatment for CDI.

Root Canal Treatment of Oehlers Type III Dens Invaginatus in Maxillary Lateral Incisor and Remote Sinus Tract Using Dental Surgical Microscope and Cone-Beam Computed Tomography.

Dens invaginatus is a morphological abnormality of the tooth that results from a developmental anomaly during tooth formation, in which part of the enamel and dentin of the crown invaginates into the pulp cavity. This report describes a case of a maxillary lateral incisor with apical periodontitis apparently caused by Oehlers Type III dens invaginatus. The patient was a 69-year-old man who visited our clinic complaining of discomfort in the maxillary right lateral incisor. Cone-beam computed tomography (CBCT) revealed dens invaginatus of the maxillary lateral incisor and a sinus tract in the maxillary central incisor region, which was derived from apical periodontitis of the maxillary lateral incisor. The dens invaginatus was accompanied by a complex root canal morphology. Treatment, which was performed using a dental surgical microscope, had a favorable outcome. The patient remains in good condition at 1 year postoperatively.

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

BACKGROUND: Dens 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 PRESENTATION: An 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. CONCLUSION: For 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.

Nonsurgical management of type II dens invaginatus with cone beam computed tomography: A rare case.

Dens invaginatus is a progressive abnormality resulting from invagination of the crown or root before calcification. This case report presents nonsurgical endodontic treatment and nine-year follow-up results of a right maxillary canine tooth with type II dens invaginatus. A 40-year-old female patient was referred to the clinic for treatment of her maxillary right canine tooth. The invagination was managed on a two-visit appointment. On the first visit, the invagination area, which was disconnected, was completely removed from the root canal. The invagination area was instrumented, and the root canal was dressed with calcium hydroxide. At the second appointment, apexification was done using mineral trioxide aggregate compacted to the apical 3mm. Finally, the invaginated area and the root canal were obturated with a warm vertical compaction technique. At a nine-year follow-up, the invaginated tooth was asymptomatic, and the periradicular lesion showed satisfactory healing radiographically.

Dens Invaginatus in Patients With Cleft Lip and Palate: A Case Series.

Dens invaginatus is a rare developmental anomaly characterized by an infolding of the enamel organ within the crown or root of a tooth, and it is an example of a dental anomaly that has a higher incidence in patients with CL/P. If undiagnosed, dens invaginatus can lead to severe, acute pain and pulpal necrosis since it can permit direct entry of bacteria into the dental pulp. Treatment of dens invaginatus includes prophylactic sealant or composite restoration, endodontic therapy if pulpal involvement has already occurred, or extraction if aberrant tooth morphology precludes endodontic therapy. Few studies report on the incidence of dens invaginatus in patients with CL/P. The purpose of this article is to describe 4 cases of dens invaginatus in patients with CL/P which were encountered in a cleft-craniofacial orthodontic clinic. Each case describes dens invaginatus in a maxillary lateral incisor, and treatments ranged from sealant application to endodontic therapy to extraction. These cases highlight the importance of awareness of this dental anomaly among cleft team providers to facilitate early diagnosis in patients with CL/P.

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

BACKGROUND: 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. 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. CONCLUSION: Non-surgical root canal treatment of the invagination may preserve pulp vitality, and continuous root development of the tooth.

Preservation of Pulp Vitality in Type IIIA Dens Invaginatus with an Extensive Peri-invagination Lesion: a case Report with 5-year Follow-up.

Dens invaginatus may be associated with peri-invagination lesions and vital pulp concurrently. This case report examines the successful preservation of vital pulp and minimally invasive treatment of invagination for Oehlers type IIIA dens invaginatus with an extensive peri-invagination lesion. A healthy 19-year-old man presented with occasional swelling of the left maxillary anterior region. Pulp vitality tests revealed vital and healthy tooth pulp. CBCT indicated Oehlers type IIIA dens invaginatus with an invagination parallel to the pulp cavity. The diagnosis was type IIIA dens invaginatus with a peri-invagination lesion. The treatment plans involved preservation of the vital pulp and minimally invasive treatment of the invagination. A 5-year follow-up revealed that both healing of the peri-invagination lesion and preservation of the vital pulp had been successful. Pulp vitality can be preserved in type IIIA dens invaginatus associated with a peri-invagination lesion through minimally invasive treatment of the invagination.

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.

A clinical report of Type III dens invaginatus: relevant aspects of a combined therapeutic approach.

Dens invaginatus is a developmental abnormality that alters dental morphology; as a result, treating this condition is a challenge for endodontic practices. This article describes how a combination of nonsurgical and surgical therapies was utilized to treat a maxillary central incisor with Type III dens invaginatus and vital pulp. The treatment plan included using computed tomography (CT) for a detailed analysis of the dental anatomy and periapical area, endodontic and surgical procedures, and a 4-year follow-up period that included periodic clinical and radiographic examinations. The follow-up examinations revealed a regression of the apical lesion and no other signs or symptoms. Based on the present case report, the authors concluded that this combination of surgical and nonsurgical approaches was effective and that CT is a valuable auxiliary tool for the study of dental anatomy.

Endodontic retreatment of dens invaginatus presenting with gutta-percha overfilling at the attached gingiva and chronic apical periodontitis: unusual clinical report.

AIM: This work describes the retreatment of an unusual case of dens invaginatus with gutta-percha overfilling at the gingival mucosa and chronic apical periodontitis in a 34-year-old woman. Initial periapical radiograph showed the presence of type II dens invaginatus with poor quality obturation, root perforation and chronic apical periodontitis of tooth 22. BACKGROUND: Dens invaginatus is a tooth malformation caused by infolding of the dental papilla during tooth development. This anomaly has been associated with increased prevalence of pulpal and periapical diseases. CASE DESCRIPTION: Conventional endodontic retreatment was performed using rotary files and calcium hydroxide paste as intracanal dressing. After 7 days, root canal was filled with guttapercha points and Sealapex® sealer. Obturation was radiographically followed and, after 3 years, absence of fistula and periapical radiolucency was observed, thus conventional endodontic therapy proved to be successful. CONCLUSION: Conventional endodontic retreatment of type II dens invaginatus has been successful for a 3-year period, showing a better treatment alternative. CLINICAL SIGNIFICANCE: Conservative endodontic retreatment of dens invaginatus should be considered to promote periapical healing with complete reconstitution of bone and periodontal ligament regeneration without signs of recurrence over a period of 3 years. Moreover, it preserves the entire tooth.

Non-surgical endodontic treatment for dens invaginatus type III using cone beam computed tomography and dental operating microscope: a case report.

Dens invaginatus is a morphological abnormality of the tooth in which the coronal tooth enamel and dentin fold inwards towards the pulp cavity. Dens invaginatus type III (Oehlers: 1957) is characterized by infolding of the enamel and dentin as far as the root apex. This report describes a case of surgical and non-surgical endodontic therapy for a maxillary lateral incisor with type III dens invaginatus, necrotic pulp, and an associated large periradicular lesion. The patient was a 16-year-old man. Periapical radiographs suggested the presence of an untreated area of invagination. Cone beam computed tomography (CBCT) was then used for three-dimensional observation of the morphological details of this area. The CBCT scans revealed invagination and its relationship with the pulp chamber. A dental operating microscope was used to access two primary root canals and the area of invagination. The root canals were then localized, negotiated, enlarged, and filled with calcium hydroxide. Two months later, the canal and invagination were obturated with core-based gutta-percha (FlexPoint Neo: FP core-carrier technique) and restored. Cone beam computed tomography and microscopic techniques allow even complicated cases of dens invaginatus to be diagnosed and treated using non-surgical root canal management.

[Radicular invaginatus caused by the developmental abnormalities of epithelial root sheath].

Epithelial root sheath plays a key role in guiding the development of tooth root. Any problems during its growth can lead to various forms of defects or abnormalities in the development of tooth root. Radicular invaginatus may occur when the epithelial root sheath excessively proliferates and infolds into the dental papilla. In terms of tissue origin and occurrence mechanism, the radicular dens invaginatus is similar to the coronal invaginatus which is led by the proliferation and infolding of enamel organ. However, there had been no consensus on the term and classification of this type of developmental abnormality as well as the relationships among the dens invaginatus, the radicular invaginatus and the palatogingival groove. From the role of epithelial root sheath during root development, the manifestations of root developmental defects and abnormalities will be analyzed. The pathogeny, classification, clinical characteristics of the radicular invaginatus, the relationship with the dens invaginatus and the impact on treatment were specially focused on.

Conservative management of dens in dente.

Dens Invaginatus (DI) or dens in dente is an uncommon anomaly which mostly affects permanent lateral incisors, and it is very rare in molars. This article presents the conservative endodontic management of four different cases of DI and a discussion of the endodontic literature for this malformation. Three upper lateral incisors Type II, IIIa and IIIb, and an upper first molar Type II are shown. The most conservative approach possible was carried out. Three of the cases were obturated using the continuous wave technique. In one of the cases, it was possible to treat only the invagination with MTA and preserve the pulp vitality of the main canal. To make a correct diagnosis and to treat in the most conservative way possible, a DI is necessary to know its classification and use tools such as CBCT and magnification.

Long-term follow-up of single-visit pulp revascularisation for the dens evaginatus and dens invaginatus: Cases report.

This article documents cases of single-visit pulp revascularisation for dens evaginatus and dens invaginatus, without using intracranial medicaments or antibiotics, aiming to provide a potentially applicable protocol for pulp revascularisation procedure in a single-visit. Two patients with chief complaints of pain and swelling visited a dental hospital. Radiographs revealed that the causative teeth had an open apex and periapical radiolucency, and the teeth were diagnosed as pulp necrosis and acute apical abscess or symptomatic apical periodontitis. For both cases, single-visit revascularisation was completed without intracanal medicaments or antibiotics. The patients were periodically recalled to evaluate periapical healing after treatment. The apical lesion healed, and the root dentin thickening was observed. The single-visit pulp revascularisation procedure without using specific intracanal medicaments can produce clinically favourable results for these dental anomalies.

Endodontic treatment of an immature maxillary lateral incisor with type II dens invaginatus in an orthodontic patient: A case report.

This paper presents a case report of an immature maxillary lateral incisor with type II dens invaginatus, with a periapical lesion. The tooth was treated with MTA apical barrier followed by root filling with thermoplasticised GP and restoration with resin composite. Three-year radiographic follow-up showed healing of the apical lesion and normal clinical parameters.

Rare variant of dens invaginatus with accessory root and labial talon cusp in maxillary lateral incisor-Case report.

Dens invaginatus (DI) often causes dysmorphic changes in both the crown and root. This case report presents a complicated type 3a DI in a maxillary lateral incisor with labial talon cusp and root bifurcation. Although lingual talon cusp is common in maxillary lateral incisor, labial talon cusp is rare. An auxiliary palatal root in maxillary lateral incisor is also unusual. No such case involving all three variations has been described in the literature. The DI was classified as type B4 according to Schulze and Brand, as it involved division of pulp and root. DI was managed by orthograde MTA, radisectomy and periodontal regeneration was done for the palatal root. Labial talon associated with DI and can lead to early periodontal/pulpal involvement. Type 3 DI can affect the root with marked dilatation and division. Additional palatal root should be carefully detected in type 3a DI and managed with the aid of CBCT.

Endodontic management of a double-type IIIB dens invaginatus in a vital maxillary central incisor aided by CBCT: A case report.

Type IIIB dens invaginatus presents with diagnostic and treatment related challenges when in need of endodontic management as a consequence of its complex anatomy, especially when presented in a vital tooth with a periapical lesion. Apical periodontitis associated with two type IIIB invaginations in a central maxillary incisor of a 10-year-old patient was diagnosed. A cone-beam computed tomography (CBCT) scan provided essential diagnostic information and steered the treatment plan. The two invaginations were separate, with no communication between them and the pulp. The pulp appeared vital and non-inflamed. Endodontic treatment of the invaginations was carried out without intervention in the pulp. A 4-month follow-up periapical radiograph showed significant shrinkage of the lesion and a 2-year follow-up CBCT scan confirmed its complete healing. The pulp remains vital, responding normally to sensitivity tests. This outcome indicates that preserving the pulp's vitality is achievable through timely diagnosis.

Root canal treatment of type â ¡ and â ¢A double dens invaginatus in maxillary lateral incisor: a case report.

Dens invaginatus is a rare developmental anomaly of the teeth that is caused by the infolding of enamel organs or the penetration of their proliferations into dental papillae before calcification has occurred. The presence of double dens invaginatus is extremely rare. This paper describes the use of cone beam computed tomography in the evaluation of a maxillary lateral incisor with double dens invaginatus and periapical periodontitis. The tooth was treated through microscopic root canal therapy. The tooth was free of clinical symptoms, and the periradicular lesion narrowed during the follow-up period of 1 year.

Dens Evaginatus and Dens Invaginatus in Dilacerated Maxillary Lateral Incisor Diagnosed Using Cone Beam Computed Tomography - A Case Report and Review of Literature.

INTRODUCTION: Dens invaginatus (DI) and Dens evaginatus (DE), the developmental anomalies affecting the morphology of the tooth structure are extremely rare to occur. DI occurs because of invagination of a crown into dental papillae. DE is a tubercular emergence from occlusal surfaces of posterior teeth and lingual surfaces of anterior teeth. The two anomalies on separate teeth are frequently mentioned, but their co-occurrence in a single tooth is a rare entity. PATIENT CONCERNS: A 20-year-old male patient presented with the rare combination of DE and DI on a dilacerated maxillary right lateral incisor diagnosed using cone beam CT. Treatment: The patient was managed conservatively and is undergoing fixed orthodontic treatment for malocclusion. Despite its uniqueness, very few localized cases have been documented. TAKEAWAY LESSONS: These anomalies act as an etiological factor for several dental problems for neighboring & opposing tooth. Early diagnosis of such anomalies should be done so that prophylactic management can be initiated.

Use of cone beam computed tomography in the diagnosis, planning and follow up of a type III dens invaginatus case.

AIM: To present the case of a maxillary left lateral incisor with Oehlers' type III dens invaginatus in which cone beam computed tomography (CBCT) was used as an adjunctive resource in the diagnosis as well as in the planning and 2-year follow-up of the nonsurgical/surgical treatment. SUMMARY: The tooth had two root canals: a primary (main) canal with vital pulp that appeared to be closed apically and an invaginated canal that was necrotic, wide-open at the portal of exit and associated with a large chronic periapical lesion extending to the apex of the maxillary left central incisor. Radiographic tracking of a sinus tract in the labial gingiva of the affected tooth with a gutta-percha point revealed its origin to be the invagination. The CBCT scans revealed that the periapical radiolucency was significantly larger than seen radiographically as well as an increased thickness of the buccal cortical plate. Conventional root canal treatment of the primary canal was undertaken. As nonsurgical access to the invaginated canal was not possible, endodontic surgery was performed for curettage of the lesion, root-end cavity preparation using ultrasonic tips and root canal filling with white mineral trioxide aggregate (MTA). CBCT scanning after 17 months and clinical and radiographic follow-up after 24 months revealed complete periapical repair and absence of symptoms. KEY LEARNING POINTS: The combination of nonsurgical and surgical treatments produced periapical repair in a tooth with type III dens invaginatus with two root canals. CBCT may aid the diagnosis as well as the management plan and follow-up of teeth with this developmental anomaly.