RESUMO
Dens Invaginatus (DI) is a developmental anomaly which eventually leads to pulp necrosis and has several clinical implications in sufficient instrumentation and obturation of the root canal system. The present clinical report presents a rare case of a maxillary canine affected with DI leading to pulp necrosis combined with a previous dental trauma, which also led to irreversible pulp damage of the adjacent lateral incisor. A 14-year-old male patient with a history of dental trauma at the right maxillary region, one year earlier, was referred with pain and swelling at the apical area of the right maxillary canine. After CBCT evaluation, complete removal of the invagination was decided. All the procedures were performed under operating microscope and canal obturation was done with apical plug technique using MTA. Two-year follow-up radiographic assessment confirmed complete healing of the periapical tissues for both teeth. The present case describes a rare case of dens invaginatus in a maxillary canine pointing out the importance of obtaining a thorough dental history upon diagnosis, performing also a careful clinical and radiographic evaluation and subsequent treatment planning, especially when addressing complex pathologies and unusual dental malformations. In such cases with high degree of complexity, preoperative CBCT examination is required for decision making and subsequent appropriate management. Key words:Dens Invaginatus, maxillary canine, endodontic treatment.
RESUMO
INTRODUCTION: Crown fracture with pulp involvement and concomitant complications is a traumatic injury that may have several clinical considerations for dentists and patients. The aim of the present study was to appraise existing scientific evidence on factors related to pulp survival after complicated crown fracture following vital pulp therapy. METHODS: An electronic search was performed on 8 sources of published and unpublished literature, as of August 18, 2021. Randomized controlled trials and nonrandomized studies were included, involving patients undergoing treatment in teeth (mature or immature), with vital pulp, after complicated crown fracture. Risk of bias of included studies was examined and assessed through RoB 2.0 or the Risk of Bias in Nonrandomized Studies of Interventions tool, conditional on study design. Random effects meta-analyses were conducted, where applicable, and the certainty of evidence was evaluated through the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Of the 506 initial articles, 24 were eligible for inclusion in the qualitative synthesis, and 7 ultimately contributed to meta-analyses. Based on synthesized evidence, in teeth treated with pulpotomy, there was no difference in successful clinical/radiographic outcome denoting pulp survival, when either bioceramic material versus CaOH2 (2 studies, Risk Ratio [RR] = 1.07; 95% confidence interval [CI], 0.99-1.16; P = .09; I2 = 0.0%), or mineral trioxide aggregate versus CaOH2 (2 studies, RR = 0.94; 95% CI, 0.76-1.16; P = .56; I2 = 0.0%). For different pulp management procedures, in pooled immature and mature teeth samples, there was no evidence that pulpotomy performed better than pulp capping with either CaOH2 or mineral trioxide aggregate (5 studies/6 comparisons, RR = 1.06; 95% CI, 0.71-1.58; P = .77; I2 = 74.8%). Risk of bias for randomized controlled trials ranged from raising some concerns to low, whereas nonrandomized studies were recorded as serious to critical risk of bias. CONCLUSIONS: The quality of the evidence was very low to moderate. The need for more carefully designed clinical trials in the field is profound, to inform high-quality clinical decision making.