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.

In vitro analysis of extracted dens invaginatus using various radiographic imaging techniques.

AIM: Dens Invaginatus (DI) is a rare malformation of the teeth, showing a broad spectrum of morphologic variations. The aim of this study was to perform in vitro radiographic analyses of three extracted dens invaginatus (DI) teeth with complex root anatomy using plain radiographs, CBCT, MRI and micro CT techniques. MATERIALS AND METHODS: Study design: Three maxillary lateral incisors (A, B and C) from two patients were extracted due to poor prognosis and were radiographically analysed. Initially, conventional two dimensional digital radiographs were taken. Subsequently CBCT, micro CT and MRI analyses were performed. RESULTS: According to the Schulze and Brand system of classification, teeth A, B and C were classified as A2, B3 and B2 respectively. To detect the relationship between the invagination to the oral cavity and pulp chamber, conventional two dimensional radiographs were of no help. CBCT and MRI images were found to be complementary to each other but provided lesser structural detail than micro CT images. CONCLUSION: Reporting on these three DI teeth, normal conventional radiographs did not provide detailed structural information about the malformation due to geometric distortion and lack of information. Even though Oehlers classification system is the most widely used, classification by Schulze and Brand is more applicable in rare and deviant teeth.

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.

A Rare Bilateral Presentation of Multiple Dens Invaginatus, Shovel-Shaped Incisor and Talon Cusp With Mesiodens.

The aim of this paper is to describe a unique and unusual case of concomitant appearance of morphological dental anomalies in the maxillary anterior region, along with its management in a patient with no systemic abnormality. This case report describes the clinical and radiographic features of talon cusp, dens invaginatus, shovel-shaped incisors and a supernumerary tooth occurring in a single patient, which is a rare presentation. All 4 permanent maxillary incisors had dens invaginatus, the permanent maxillary canines showed the presence of talon cusps, the permanent maxillary central incisors were shovel-shaped and an erupted mesiodens was also observed. Treatment included restorative, surgical and orthodontic approaches.

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 invaginatus: a qualitative-quantitative analysis. Case report of an upper second molar.

Dens invaginatus (D.I.) is a developmental anomaly caused by the infolding of the surface of a tooth crown before calcification has occurred. Its aetiology is controversial and remains unclear. It occurs in all dentitions with a prevalence that ranges from 0.25% to 7.74% and is mostly seen in the maxillary permanent incisors, particularly in the lateral incisors. Posterior teeth are infrequently involved. The purpose of this study was to investigate the morpho-structure of a second upper molar dens invaginatus compared with a control tooth. Ground and decalcified sections were prepared and histo-morphological evaluation of dental tissues was performed by using light microscopy, microradiography, and confocal laser scanning microscopy analysis (CLSM). The mechanical behaviour was tested by means of microhardness (HV) test. The results of our investigation showed structural anomalies of hard tissues, such as a difference in enamel prism diameter, in number and diameter of peripulpal dentinal tubules and in surface and diameter of cementocyte lacunae between D.I. and control tooth.

A Rare Case of Radicular Dens Invaginatus (Dens in Dente) in a Dog.

A rare case of radicular dens invaginatus (dens in dente) was found during dental cleaning of a 5-year-old male Rottweiler dog. Radiographic examination revealed intense radiopacity, which extended from the crown to the apical root region of the affected tooth. Macroscopically, the crown of the left maxillary first molar tooth (209) had irregular and deformed buccal and lingual surfaces. Microscopic examination revealed dentine invagination in the pulp cavity in of the crown and root and pulp necrosis. Based on the gross, radiographic and histological findings, a diagnosis of radicular dens invaginatus was made.

[Dens invaginatus. Review of the literature and diagnostic and therapeutic guidelines]. / Dens invaginatus. Literaturübersicht und Leitlinien zur Diagnostik und Therapie.

Dens invaginatus is a clinically relevant malformation of teeth resulting from an infolding of enamel and dentine into the dental structure during tooth formation, hence the former denomination "dens in dente". The dens invaginatus shows multiple morphological variations of crown and root formation. This frequently leads to caries, pulpal and periodontal involvement with necrosis and loss of attachment. Therefore, early diagnosis and prevention are of utmost importance. Due to the complexity of the malformation, treatment options in former days were limited. This article presents a profound review of the literature regarding etiology, epidemiology and histology. It discusses clinical appearance and diagnosis and it provides guidelines for decision-making and treatment of invaginated teeth.

Type 2 dens invaginatus in a maxillary lateral incisor: a case report of a conventional endodontic treatment.

Dens invaginatus is a rare malformation of the teeth resulting from the invagination of the tooth crown before biological mineralization occurs. In most cases, the thin or incomplete enamel lining of the invagination cannot prevent the entry of bacteria into the pulp, which leads to pulp necrosis with an eventual periapical inflammatory response. The treatment options include preventive sealing or filling of the invagination, root canal treatment, endodontic apical surgery and extraction. The root canal treatment of such teeth is often complicated because of their anatomical complexity. This case describes a successful non-surgical endodontic treatment of a maxillary lateral incisor with type 2 dens invaginatus with a large periradicular lesion. At follow-up examinations after 6 and 12-months, the tooth was asymptomatic and the healed lesion was evident radiographically

Tratamiento de diente evaginado mediante técnica de apexificación: reporte de caso / Treatment of dens evaginatus by apexification technique: a case report

El diente evaginado (DE) es una anomalía del desa-rrollo que se define como un tubérculo o protube-rancia que se extiende desde la superficie oclusal del diente afectado. La fractura o desgaste de esta pro-longación, internamente compuesta por tejido pul-par, puede causar diversas enfermedades pulpares, como pulpitis, necrosis pulpar e incluso dar lugar a una periodontitis apical. En el presente caso clíni-co se muestra el tratamiento de DE en un segundo premolar superior izquierdo que presentaba como diagnóstico necrosis pulpar y absceso alveolar cró-nico. El tratamiento consistió en realizar la terapia endodóntica con técnica de apexificación empleando BiodentineTM (AU)

Dens evaginatus (DE) is a dental developmental defect defined as a tubercle or protuberance that extends from the occlusal surface of the affected tooth. Fracture or wear of this extension, internally composed of pulp tissue, can cause diverse pulp diseases, such as pulpitis, pulpal necrosis and it can even induce apical periodontitis.The following clinical case shows the treatment of DE in a maxillary left second premolar diagnosed with pulp necrosis and chronic alveolar abscess. The treatment of choice was endodontic therapy using BiodentineTM (AU)

Unusual variant of type 3 dens invaginatus in a maxillary canine: a rare case report.

A 13-year-old boy presented with clinical symptoms of periapical inflammation related to the right maxillary canine. A bizarre radiographic appearance of the root was considered suggestive of a compound odontome. Histological examination of the surgically extracted canine revealed a very rare variant of Oehlers' type 3 invagination. The invagination originated in a pit above the cingulum as a narrow coronal channel that opened into a large cavity inside the dilated root. The radicular part of the invagination contained all components of the attachment apparatus. The root canal and its apical foramen were slit-like and circular. Radiographic appearance of two roots separated by a wide interradicular area in a normally single-rooted tooth is indicative of this variant of type 3 invagination. Timely prophylactic treatment and follow-up or early endodontic treatment confined to the coronal channel are crucial to prevent pulp necrosis and consequent loss of the tooth.

Management of a Permanent Maxillary Lateral Incisor with Vital Pulp and Necrotic Dens Invaginatus Type III.

This is a case report on the management of a vital lateral incisor with a radiolucent cervical area associated with the presence of necrotic pulp due to a dens invaginatus (DI) type III. A nine-year-old boy presented to a university pediatric dental clinic with dental trauma. The examination showed poor oral hygiene, an uncomplicated fracture in the permanent maxillary left central incisor, and a fistula near the permanent maxillary right lateral incisor. A radiograph showed that the right lateral incisor had incomplete root development and a type III DI. Although sensitive to thermal pulp testing, tracing of the fistula indicated that the radiolucent area was associated with the DI, extending laterally to the periodontal ligament. Endodontic treatment was performed only in the invagination, keeping the root canal of the lateral incisor vital. After two years of follow-up, complete root formation and injury repair associated with invagination were observed.

A previously unreported association between Nance-Horan syndrome and spontaneous dental abscesses.

Atypical dentofacial structures may be the first indicator of other anomalies linked to a syndrome. This case describes the management of a 9-year-old girl referred for the routine management of supernumerary teeth. The anomalous form of her teeth, together with multiple supernumerary units and a history of congenital cataracts, were suggestive of a diagnosis of Nance-Horan syndrome. This is an X-linked disorder, in which females usually demonstrate mild expression; this case was unusual in respect to the marked phenotype expressed. Unusually, the girl developed 2 spontaneous abscesses of her noncarious upper incisor teeth; a feature never previously described in this syndrome. This report details the patient's dental management and discusses the possible pathogenesis of the dental abscesses, together with the genetic implications of this syndrome.

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.

Ekman-Westborg-Julin syndrome. A case report.

A rare case of the Ekman-Westborg-Julin syndrome in a 15-year-old boy is presented. The patient had general macrodontia with gigantic mandibular third molars. Other dental anomalies, such as peak-shaped cuspids, central cusps, dens in dente, multituberculism, and single conical molar roots, were also present.

Severe dens invaginatus malformation: report of two cases.

Two cases of severe dens invaginatus malformation of teeth are presented. In the first case apical abscess formation occurred before root end closure. In the second case the dysmorphic tooth form may be considered a possible cause of retarded eruption.

Double dens in dente with a central cusp and multituberculism in bilateral maxillary supernumerary central incisors: report of a case.

A case of bilateral molarized teeth in the maxillary central incisor region is reported. The bilateral central incisor teeth were extracted in a 13-year-old boy and examined radiographically and histologically. Both malformed teeth were diagnosed as double dens in dente with a central cusp and multituberculism in maxillary supernumerary central incisors.

Double dens invaginatus of molarized maxillary central incisors, premolarization of maxillary lateral incisors, multituberculism of the mandibular incisors, canines and first premolar, and sensorineural hearing loss.

Molarization and premolarization of anterior teeth have never been reported before. Double dens invaginatus is an extremely rare condition. We describe an affected female who had developmental delay and congenital progressive sensorineural hearing loss. Double dens invaginatus of molarized maxillary central incisors and premolarized maxillary lateral incisors were present. In addition, multituberculated mandibular incisors, canines, and first premolar were observed. Histologically, tooth structure was unremarkable. Family history of dental abnormalities and hearing loss was denied. Clinical and radiographic examinations were those performed when the patient was 7 and 13 years old. The basic defect is postulated to be of mesenchymal origin.