Orthodontic movement after regenerative endodontic procedure in mature permanent tooth associated with dens invaginatus: a case report with 4-year follow-up.

BACKGROUND: Regenerative endodontic procedures (REPs) are innovative treatments aimed at restoring damaged dental structures. However, the effect of orthodontic movement on REP-treated teeth is not well understood and may have significant long-term consequences. This study aimed to evaluate the impact of orthodontic movement on a mature permanent tooth associated with dens invaginatus that has undergone a regenerative endodontic procedure (REP). CASE PRESENTATION: This report describes the case of a 13-year-old healthy male who presented with pulp necrosis and a chronic apical abscess (tooth number 2.2). Following REP according to the American Association of Endodontists' guidelines, the patient began non-extraction orthodontic treatment with fixed appliances after a 9-month healing period, which lasted 17 months in the upper arch. Subsequent follow-ups at 24, 36 and 48 months post-REP revealed an asymptomatic state with minimal cervical discoloration and diminished cold sensitivity. Radiographic analyses revealed periapical healing, mild apical remodeling on tooth 2.2, and moderate apical remodeling on other maxillary incisors. The treated tooth displayed a positive response to both REP and orthodontic treatment, yet further research is required to determine the long-term effects of orthodontics on REP-treated teeth. CONCLUSION: Orthodontic movement following REPs in mature permanent teeth is feasible and do not seem to prone teeth to orthodontic tooth resorption. Our experience indicates that a 9-month healing period allows successful orthodontic outcomes following REPs. Nonetheless, the predictability of outcomes and the ideal healing period before orthodontic movement is initiated remain to be established.

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.

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.

Endodontic management considerations for Type III dens invaginatus based on anatomical characteristics: A case series.

Dens invaginatus (DI) is a developmental anomaly of the teeth characterised by the in-folding of the enamel into the dentin. Oehlers' Type III DI is the most serious form, in which the inherently invaginated channels communicate with periodontal and dental pulp tissue, increasing the risk of bacterial contamination. However, varying and complex anatomical features make diagnosis and treatment challenging. Conventional endodontic therapies promote healing by avoiding unnecessary interventions (e.g., surgical or other invasive treatments). Radiographic examination can reveal the structural details of such malformations. We obtained multiple procedural details for treating Type III DI based on radiographic analyses from our clinical experience. In addition, we introduce a new classification strategy for the management of Type III DI that is more applicable to treatment needs. This study aimed to discuss the anatomical features and current treatment considerations of Type III DI.

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.

Radicular invaginatus caused by the developmental abnormalities of epithelial root sheath / 中华口腔医学杂志

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.

Management of Type III Dens Invaginatus in a Mandibular Premolar: A Case Report

Dens invaginatus is a well-known malformation of teeth, which probably results from an invagination of enamel organ into dental papilla during tooth development. The endodontic treatment of invaginated teeth may be challenging due to difficulties in accessing the root canals and also due to complex variations of internal morphology. This article presents the endodontic management and follow-up in a rare case of right mandibular second premolar with Oehlers' type III dens invaginatus. The result of cold pulp testing was positive for this tooth but it was associated to a sinus tract and periapical lesion. Herein, it is described the root canal therapy of this tooth combined with periapical surgery, emphasizing the importance of proper diagnosis and planning by using cone beam computed tomography (CBCT). This case report presents the proper periapical healing 6 months after the combination of nonsurgical and surgical treatments. It also shows that CBCT is an important auxiliary examination to avoid errors in diagnosis and subsequent treatment of dental anomalies.

Dens invaginatus é uma malformação dentária já bem reconhecida, que provavelmente resulta de uma invaginação do órgão do esmalte para dentro da papila dentária durante o desenvolvimento do dente em questão. O tratamento endodôntico de dentes invaginados pode ser um desafio devido às dificuldades de acesso aos canais radiculares e também devido à complexidade da morfologia interna. Este artigo apresenta o manejo endodôntico e o acompanhamento de um caso raro de segundo pré-molar inferior direito com dens invaginatus Tipo III de Oehlers. O resultado do teste de sensibilidade pulpar ao frio foi positivo para este dente, mas o mesmo estava associado a uma fístula e lesão periapical. Relata-se o tratamento de canal deste dente associado à cirurgia periapical, enfatizando a importância de um correto diagnóstico e plano de tratamento, utilizando a tomografia computadorizada de feixe cônico (TCFC). Este relato de caso mostra reparo periapical adequado 6 meses após a combinação dos tratamentos não-cirúrgico e cirúrgico. Mostra também que a TCFC é um importante exame auxiliar para evitar erros no diagnóstico e posterior tratamento de anomalias dentárias.

Tratamento endodôntico de três tipos de dens invaginatus: relato de quatro casos

O dens invaginatus, também conhecido como dens in dens,é uma anomalia de desenvolvimento que apresenta alteração da forma e volume, podendo afetar a coroa e a raiz.Devido à sua complexa anatomia, o tratamento endodôntico é mais difícil de ser realizado. Serão apresentados quatro casos de tratamento endodôntico em dentes portadores dessa anomalia, sendo um do tipo I, um do tipo II e dois do tipo III, segundo a classificação de Oehlers. Em três casos realizou-se somente tratamento endodôntico e em um, o retratamento endodôntico com complementação cirúrgica.A proservação em longo prazo dos casos 2 e 4 demonstrou reparo periapical com fechamento apical. O caso 1 mostrou uma remoção total da invaginação e a formação de uma barreira mineralizada apical. A proservação do caso 3 não foi possível porque o paciente mudou-se de cidade. Apesar do tratamento do dens invaginatus ser complexo, ele pode ser realizado com sucesso quando se apoia em um correto diagnóstico e planejamento. Em alguns casos, se necessário,ele pode ser complementado com intervenção cirúrgica

Concommitant occurance of dens invaginatus and talon cusp: A case report / Ocorrência simultânea de dens invaginatus e cúspide talon: relato de caso

PURPOSE: Morphological dental anomalies of the maxillary lateral incisors are relatively common. However, their simultaneous occurrence is a relatively rare event. We report a case of dens invaginatus and talon cusp concurrently affecting maxillary lateral incisors. The etiology, pathophysiology, association with other dental anomalies, as well as various treatment modalities of these anomalies are discussed. CASE DESCRIPTION: An 18-year-old male patient reported with a complaint of crowding of maxillary front teeth. On intraoral examination, permanent dentition with Class I malocclusion with anterior crowding was observed. Tooth 12 showed a radiopaque invagination from a lingual pit but confined to the crown of the tooth. This invagination was approximately circular with a central core of radiolucency, which was consistent with the diagnosis of a dens invaginatus type I. Tooth 22 showed the talon cusp as a typical inverted cone with enamel and dentine layers and a pulp horn extending only into the base of the cusp. Talon cusp was treated by prophylactic enameloplasty to avoid plaque accumulation, the deep lingual pit was sealed using composite resin and regular clinical and radiographic follow-up was advised. Patient was scheduled for orthodontic treatment to correct crowding of maxillary anterior teeth. CONCLUSION: We emphasize the fact that detailed clinical and radiographic examination of the maxillary lateral incisors is vital in avoiding complications.

OBJETIVO: Anomalias morfológicas dentárias dos incisivos laterais superiores são relativamente comuns. No entanto, a sua ocorrência simultânea é um evento relativamente raro. Relatamos um caso de dens invaginatus e cúspide talon simultaneamente afetando incisivos laterais superiores. A etiologia, fisiopatologia, associação com outras anomalias dentárias, bem como várias modalidades de tratamento destas anomalias são discutidas. DESCRIÇÃO DO CASO: Um paciente de 18 anos, sexo masculino, relatou com queixa de apinhamento dos dentes anteriores superiores. Ao exame intraoral observou-se dentição permanente com má oclusão Classe I com apinhamento anterior. O dente 12 mostrou uma invaginação radiopaca lingual, confinada à coroa do dente. Esta invaginação era aproximadamente circular, com um núcleo central de radioluscência, que foi compatível com o diagnóstico de dens invaginatus tipo I. O dente 22 apresentou uma cúspide talon como um cone invertido típico com esmalte e dentina em camadas. A cúspide talon foi tratada por ameloplastia profilática para evitar acúmulo de placa, a fissura lingual foi selada com resina composta e foram aconselhados controles clínicos e radiográficos. O paciente foi encaminhado para tratamento ortodôntico para corrigir o apinhamento dos dentes anteriores superiores. CONCLUSÃO: Enfatizamos o fato de que o exame clínico e radiográfico detalhado dos incisivos laterais superiores é vital para evitar complicações.

Multi-lobed mesiodens with a palatal talon cusp: a rare case report

Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch and the talon cusp is a rare dental developmental anomaly seen on the lingual surface of anterior teeth. This paper presents a rare clinical case of development of talon cusp in a mesiodens with multiple lobes, which interfered with both occlusion and appearance of an 11-year-old patient. During clinical interview, the patient reported difficulty on mastication. Clinical and radiographic examination revealed that a supernumerary tooth with completely formed root was causing an occlusal interference. The supernumerary tooth was diagnosed as multi-lobed mesiodens associated with a palatal talon cusp. The treatment plan consisted in the extraction of the supernumerary tooth followed by orthodontic treatment for diastema closure and tooth alignment.

Mesiodens é um dente supranumerário mais comumente visto no arco maxilar na linha média, e a cúspide em garra (talon cusp) é uma anomalia dental de desenvolvimento rara que ocorre na face lingual de dentes anteriores. Este artigo apresenta um caso clínico raro de desenvolvimento de uma cúspide em garra em um mesiodens multilobulado que causava interferência tanto na oclusão quanto na aparência de um paciente de 11 anos de idade. Durante a entrevista clínica, o paciente relatou dificuldade na mastigação. Exame clínico e radiográfico revelou que um dente supranumerário com raiz completamente formada estava causando interferência oclusal. O dente supranumerário foi diagnosticado como sendo um mesiodens multilobulado associado a uma cúspide em garra palatina. O plano tratamento consistiu na extração do dente supranumerário seguida de tratamento ortodôntico para fechamento de diastema e alinhamento dos dentes.

Tratamiento endodóntico en elemento portador de dens invaginatus, asociado a la rarefacción ósea periapical: caso clínico / Endodontic treatment of a dens invaginatus tooth associated with a periapical bone rarefaction: a clinical case

El presente trabajo relata un episodio en el incisivo lateral superior izquierdo, de dens invaginatus (diente invaginado), con aspecto coronario conoideo, asociado a necrosis pulpar y rarefacción ósea periapical. Paciente de sexo femenino, de 13 años, mostraba, al examen clínico, alteración cromática de corona clínica, sin antecedentes de trauma; ausencia de síntoma doloroso espontáneo, si bien provocado por percusión vertical. En ocasión de una planificación ortodóntica se evidenció en examen radiográfico de diagnóstico, rarefacción ósea periapical circunscripta, con imagen sugestiva de dens invaginatus de tipo II a lo largo de la corona y la porción cervical radicular. El tratamiento endodóntico indicado se inicia con la cavidad de acceso y transposición del dens invaginatus, que obstruía la luz del canal. Después del tratamiento endodóntico, en un período de observación de 3 meses, se detecta disminución de la rarefacción ósea periapical.

Tratamiento y seguimiento a distancia de un dens in dente en un diente con ápice inmaduro / Treatment and distance follow-up of a dens in dente with incomplete apex formation

En el presente trabajo se describe un caso clínico en un incisivo lateral permanente que, además de estar afectado por un dens in dente tipo II, presentaba apexogénesis incompleta, reabsorción externa y una amplia lesión periapical. Dado que el tratamiento de estas lesiones requiere de un adecuado acceso endodóntico, se comenzó por abordar el conducto salvando las dificultades que la invaginación del esmalte ofrecía. Concluido este primer paso y con el fin de lograr que las lesiones repararan y que el ápice se cerrara, por un año el conducto fue tratado con una pasta alcalina compuesta por hidróxido de calcio y clorofenol alcanforado. Los contoles clínico-radiográficos se realizaron cada tres meses y el recambio de la pasta sólo se hizo en dos oportunidades. Logrados los objetivos propuestos, se efectuó el tratamiento endodóntico definitivo y la reconstrucción coronaria provisoria hasta realizar la restauración definitiva. Los resultados obtenidos muestran que si bien el tratamiento de un diente con esta anomalía suele ser una intervención muy compleja, si se logra un adecuado acceso al conducto, se simpilifica el trabajo y aumentan las posibilidades de éxito, sin necesidad de recurrir a intervenciones complementarias.

Dens evaginatus: revisión de la literatura, fisiopatología y régimen de tratamiento completo / Dens evaginatus: literature review, pathophysiology, and comprehensive treatment regimen

El dens evaginatus (DE) es una anomalía dental rara que se ha documentado desde 1925. Sucede primariamente en personas de ascendencia asiática y se presenta como una protrusión de un tubérculo desde las superficies oclusales de los dientes posteriores y las superficies linguales de los dientes anteriores. Los tubérculos tienen una capa de esmalte que cubre un núcleo de dentina que contiene una extensión de la pulpa. Estas protrusiones de tipo cuspideo son susceptibles de producir exposición pulpar por desgaste o fractura debida a la maloclusión, lo que produce complicaciones pulpares al poco tiempo de la erupción. La intervención endodóncica en dientes permanentes con raices inmaduras es poco predecible para las pulpas inflamadas y deja al diente con una estructura radicular comprometida cuando se tratan pulpas necróticas. Los esfuerzos para asegurar una madurez radicular han incluido tratamiento profiláctico o preventivo con varios grafos de invasividad pulpar. Las opciones de tratamiento han cambiado a medida que los materiales y la tecnología han mejorado. El objetivo es revisar la literatura y la patofisiología respecto al DE, y presentar un régimen de tratamiento completo, incluyendo un enfoque verdaderamente profiláctico, sin invasión pulpar. Se documenta un estudio de un mestizo con DE. El tratamiento de cuatro premolares inferiores afectados con tres categorías diagnósticas distintas ilustrará varios aspectos del protocolo de tratamiento presentado, y la morfología dental de anomalía se presenta, para ayudar a la identificación clínica (J Endod 2006; 32: 1-9)

Dens evaginatus (DE) is an uncommon dental anomaly, having been well documented since 1925. It occurs primarily in people of Asian descent and is exhibited by protrusion of a tubercle from occlusal surfaces of posterior teeth, and lingual surfaces of anterior teeth. Tubercles have an enamel layer covering a dentin core containing a thin extension of pulp. These cusp-like protrusions are susceptible to pulp exposure from wear or fracture because of malocclusion, leading to pulpal complications soon after eruption. Endodontic intervention of permanent teeth with immature roots is unpredic for inflamed pulps, and leaves a tooth with compromised root structure when treating necrotic pulps. Efforts to ensure root maturity have involved preventive or prophylactic treatment with varying degrees of pulp invasiveness. Treatment options have changed as technology and materials have improved. The goal is to review the literature and pathophysiology regarding DE, and present a new comprehensive treatment regimen, including a truly prophylactic approach without pulpal invasiveness. A case study of a mestizo with DE is documented. Treatment of four affected mandibular premolars exhibiting three distinct diagnostic categories will illustrate various aspects of the treatment protocol presented, and tooth morphology of the anomaly is shown to aid clinical recognition (J Endod 2006;32:1-9)

Apicificação em Deans Invaginatus: relato de caso / Apicification in Deans Invaginatus: case report

Deans Invaginatus, descrito muitas vezes como um dente dentro do outro, é, na verdade, uma invaginação das camadas calcificadas do dente para dentro do tecido pulpar. A invaginação forma uma cavidade de esmalte que se projeta dentro da polpa e, a esse defeito estão associadas, com frequência, infecção pulpar e periapical. O presente trabalho descreve um caso de Dens Invaginatus que apresenta forame apical aberto, paredes pulpares divergentes e extensa lesão periapical no incisivo lateral superior direito. Foram realizados o preparo biomecânico do canal e posterior preenchimento com hidróxido de cálcio. Vinte cinco meses do início do tratamento, o dente foi obturado após verificação clínica do fechamento apical e redução da lesão periapical

Tratamiento de conductos de un "dens in dente" con lesión periapical crónica. Caso clínico / Treatment of ducts of a \"dens in dente\" with chronic periapical lesion. Case report

El Dens in Dente es una anomalía estructural debido a la invaginación del epitelio del esmalte que se produce durante la etapa de formación de la pieza dentaria. Cuando requiere un tratamiento de conductos, éste representa un desafío muy grande ya que la anatomía anormal del conducto radicular aumente la complejidad del caso. Se presenta el caso de un Dens in Dente con lesión apical crónica en el periápice, donde luego de realizar el tratamiento de conductos se logra la resolución de la lesión luego de un año de seguimiento.

Tratamiento de conductos en dos casos clínicos poco usuales en endodoncia / Root canal therapy of two unusual endodontic cases

El presente reporte incluye dos casos, uno acerca de un diente con invaginación y el otro, el caso de un diente con una aguja de coser dentro del conducto. La patología pulpar y perirradicular ocurre a través de la invaginación de un diente con "dens in dente". Se pueden encontrar dificultades durante la limpieza, ensanchado y obturación como resultado de la compleja morfología interna, desarrollo incompleto de la raíz, así como la presencia de objetos metálicos extraños. Se realizó apexificación con hidróxido de calcio después de haber limpiado y ensanchado el conducto radicular en ambos casos para proveer condiciones favorables para la salud periapical y el éxito de la obturación

Talon cusp / Talon cusp

O objetivo deste trabalho é discutir os principais aspectos relacionados a uma anomalia de forma pouco frequente e com características peculiares denominada talon cusp. Através de uma ampla revisäo da literatura será abordado um assunto de interesse näo só para a Odontopediatria, como também para qualquer profissional da área odontológica.

Terapéutica endodóncica. Un dens in dens / Endodontic therapy. A dens in dente

El tratamiento de estos casos clínicos está sometido a un bajo porcentaje de éxitos terapéuticos por la complejidad de su patología, dependiendo de su capacidad de resolución

Caso clínico: dens in dente / Clinical case: dens in dente

Apresentaçäo de um caso de Dens in dente com canal infectado onde adotaram, com sucesso, o tratamento endodôntico convencional