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.

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.

CBCT imaging and root canal treatment for taurodontism in mandibular second molar - A case report and literature review.

The mandibular second molar exhibits a wide range of intricate root canal variations, which can present challenges and difficulties in achieving successful root canal treatment. This report focuses on two specific cases involving a root canal variation in a typical taurodontism of the mandibular second molar. To provide a comprehensive analysis and illustration of the anatomical structure of intraoral taurodontism and the important considerations for root canal treatment, we utilized advanced imaging techniques such as cone beam computed tomography (CBCT) and a dental microscope. By combining these tools, we were able to gain a deeper understanding of the complex root canal system and make informed decisions during the treatment process.

Root canal treatment of type Ⅱ and ⅢA double dens invaginatus in maxillary lateral incisor: a case report / 华西口腔医学杂志

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.

Atypical Radicular Anatomy in Permanent Human Teeth: A Systematic Review.

The aim of the present study is to classify and quantify the anatomical variations of teeth in terms of form and number of root canals reported in human teeth employing the classification systems proposed previously. An electronic (PubMed) and manual search were performed to identify case reports noting any of the anatomical variations. Each alteration was studied independently. The electronic search was performed using the following keywords: anatomical aberration, root canal, permanent Dentition, case report, c-shaped canal, dens invaginatus, palato-radicular groove, palato-radicular groove, palato-gingival groove, radix entomolaris, dental fusion, dental gemination, taurodontism, dilaceration. The initial search revealed 1497 papers, of which 938 were excluded after analyzing the titles and abstracts. Therefore, 559 potential papers were considered. Of those, 140 articles did not meet the inclusion criteria. For the final revision, 419 papers were considered. We found that the mandibular first premolar had the highest prevalence of C-shaped canals. Dens invaginatus was more frequently found in the mandibular lateral incisor. Taurodontism was more prevalent in the maxillary first molar and in the mandibular first molar. Dilaceration was not clearly associated with a particular tooth. The classifications systems used in this review allowed for the better understanding and analysis of the many anatomical variations present in teeth. The variations in shape most found were dens invaginatus and radix entomolaris. The most frequently reported anatomical variation was in the number of canals.

The C-shaped root canal systems in mandibular second molars in an Emirati population.

Our study aimed to describe the root and canal morphology of mandibular second molars in Emirati population and to study the prevalence and types of morphological change in C-shaped canal configuration along the root length in an effort to describe C-shaped molars as a unit. Cone beam computed tomography (CBCT) scans of Emirati patients were analyzed in multiple plans and root and canal configuration of mandibular second molars were evaluated. Moreover, specific types of morphological change in C-shaped canal configuration along root length were studied and reconstructed using 3D reconstruction software. A total of 508 mandibular second molars were evaluated. Among the non-C-shaped mandibular second molars, two separate roots were the most prevalent root morphology (78.3%). The mesial root's most common root canal configuration was Vertucci Type II (46.5%), and in the distal root, Vertucci Type I (90.5%). The prevalence of C-shaped mandibular second molars was 17.9% and was significantly prevalent (P < 0.001) in females. Specific types of morphological change in C-shaped molars along the root length were observed and described for the first time, in which the most common types of morphological change were C1-C2-C3d (18%), C1-C3c-C3d (15.4%), C4-C3c-C3d (7.7%), and C3c-C3c-C3d (7.7%). This study showed wide variations in the root and canal morphology in mandibular second molars in Emirati population with a relatively high prevalence of C-shaped canal configuration (17.9%). Moreover, specific types of morphological change in C-shaped configuration were detected and described for the first time in this population.

Taurodontism in maxillary and mandibular molars using cone beam computed tomography in a dental center in Saudi Arabia.

BACKGROUND: Taurodontism is a dental anomaly characterized by altered crown root ratio that is often diagnosed by radiographic evaluation. A three-dimensional cone beam computed tomography (CBCT) can aid in the diagnosis and treatment of taurodontic teeth. Only one study has reported the prevalence of taurodontism in a Saudi population. OBJECTIVE: Determine prevalence and other characteristics of taurodontism in permanent maxillary and mandibular molars, by CBCT in a dental center in Saudi Arabia. DESIGN: Cross-sectional. SETTING: College of dentistry. SUBJECTS AND METHODS: The first and second molars, maxillary and mandibular, from study participants of Saudi origin from Jazan region of Saudi Arabia were evaluated for taurodontism based on the criteria of Shifman and Chanannel. The degree of taurodontism was determined by the taurodontism index. Results were tabulated for analysis and the chi-square test was applied for the differences between age groups, genders, and maxillary and mandibular teeth. MAIN OUTCOME MEASURES: Characteristics of taurodontism. SAMPLE SIZE: 1839 teeth in 300 individuals. RESULTS: Taurodontism was seen in 24 (8%) of the study participants and in 71 teeth (3.9%). Taurodontism was significantly more prevalent in individuals between 21 and 40 years of age. Hypotaurodontism (67.6%, n=48) was most prevalent, followed by mesotaurodontism (23.9%, n=17) and hypertaurodontism (8.5%, n=6). The maxillary molars were more commonly involved than mandibular, but the results were not statistically significant. No significant differences in gender were observed. CONCLUSIONS: Dental clinicians should be familiar with the condition due to the clinical implications in oral surgery, endodontics and prosthodontics. The possibilities of a complex root canal system, an additional canal, difficulties in canal negotiation, instrumentation and subsequent obturation can be challenging for the clinician. LIMITATIONS: Conducted in a single dental center hence future studies with larger sample sizes in different regions of Saudi Arabia should be conducted to more accurately measure the prevalence. CONFLICTS OF INTEREST: None.

Comparison of root and canal anatomy of taurodont and normal molar teeth: A retrospective cone-beam computed tomography study.

OBJECTIVE: To determine the frequency of taurodontism in maxillary and mandibular molar teeth using cone-beam computed tomography (CBCT) and to compare the differences in root and canal morphologies between taurodont and nontaurodont molars. METHODS: CBCT images of 1200 patients were analysed. First, the frequency of taurodontism in maxillary and mandibular molar teeth was calculated. The Shifman and Chanannel taurodontic index was used to diagnose taurodontic teeth. Subsequently, the root and canal morphologies were compared with those of 250 normal teeth randomly selected from each tooth group. P < 0.05 values were considered significant in statistical tests. The chi-square test was used for differences according to sex, age and tooth position. Z-test was used for comparing percentages between independent groups. RESULTS: The occurrence rate of taurodontism was 7.78 % and 12.72 % in maxillary first and second molar teeth, respectively, and 1.99 % and 2.41 % in mandibular first and second molar teeth, respectively. Women had more taurodont teeth than men. The frequency of root fusion was greater in taurodont maxillary molars. The percentage of C-shaped roots in taurodont mandibular second molars was significantly higher than in cynodonts (19.15 % and 8.4 %, respectively). CONCLUSIONS: Taurodont teeth show wide variations in root and canal morphology. The degree of change in morphology is associated with the severity of taurodontism.

Taurodontism in the first permanent molars in Van der Woude syndrome compared to isolated cleft palate.

OBJECTIVES: To analyse prevalence, pattern, and severity of taurodontism in individuals with Van der Woude syndrome (VWS) exhibiting cleft palate and compare with aged-matched non-syndromic cleft palate (NSCP) and non-cleft controls. MATERIALS AND METHODS: One hundred and seventy-eight dental panoramic tomographs (DPTs) (105 girls and 73 boys) consisting of 42 VWS patients (x¯=8.55±1.02 years), 42 NSCP patients (x¯=8.59±1.02 years), and 94 normative non-cleft children (x¯=8.79±1.16 years) were assessed and their first permanent molars evaluated. Measurement 3 of the taurodontism index developed by Shifman and Chanannel with the Tulensalo modification was used. Prevalence, pattern, and severity were compared between groups. Statistical differences were determined by one-way analysis of variance and Fisher test. Repeatability was calculated by Cohens Kappa test. RESULTS: The prevalence of taurodontic molars was 59.5% in VWS, 45.2% in NSCP, and 26.6% in non-cleft controls. The prevalence and severity of taurodontism in VWS and NSCP were significantly higher than in non-cleft children in all first permanent molars. There was no significant difference in prevalence and severity between VWS and NSCP. The odds for having taurodontism in the VWS group was approximately double compared to the NSCP group. Most of the taurodontic molars showed hypotaurodontism and taurodontism occurred bilaterally more frequently than unilaterally. CONCLUSION: This study shows a higher prevalence of taurodontism in VWS and NSCP. Most taurodontic molars are hypotaurodontic and most occur bilaterally.

Taurodontism and C-shaped anatomy: is there an association?

OBJECTIVES: To evaluate the relation between taurodontism and C-shaped configuration, as well as the prevalence and classification according to sex, left/right position, and arc length in the mandibular premolar and molar teeth using cone beam computed tomography (CBCT). METHODS: The presence of taurodontism and C-shaped configuration were evaluated using CBCT scans and classified by two independent radiologists. The sex, location in the jaw (left-right), and mandibular arc length measurements were recorded. The Chi-square test was used to determine the presence of taurodontism and C-shape configuration according to sex, left/right location, and independent-sample t tests were used to assess the relation between the arc length. RESULTS: The prevalence of taurodontism was significantly higher in the female population, whereas the C-shaped configuration was more frequent in males (p < 0.05). In both sexes, the most common type was hypotaurodont (7.5%). In the molars, the prevalence was significantly higher in second molars, and the most common C-shaped configuration type was C3 (39.3%). The prevalence was significantly higher in the first premolar, with C2 (22.4%) being the most frequent type in the premolars (p < 0.05). The arc length and location in the jaw were not significantly affected (p > 0.05). CONCLUSIONS: A high correlation was revealed between taurodontism and complicated C-shape canal configurations. Practitioners should be very careful about the presence of C-shape morphology in taurodontism treatment, and various types of C-shaped morphology ranging from coronal to the apical direction.

Is there any relationship between hypodontia and hyperdontia with taurodontism, microdontia and macrodontia? A retrospective study.

BACKGROUND: Hypodontia and hyperdontia may occur with other dental anomalies such as microdontia, taurodontism, talon cusp, macrodontia and germination. AIMS: The aim of this study to evaluate the relationship between hypodontia and hyperdontia with taurodontism, macrodontia and microdontia. SUBJECTS AND METHODS: In this retrospective study, 2,348 Turkish patients aged 7 to 12 years and treated between 01.01.2017 and 01.01.2018 in Bahcelievler Oral and Dental Health Hospital were evaluated. Data were collected and differences in the distribution of hypodontia and hyperdontia including other dental anomalies were analysed. RESULTS: Of the total sample of 2,348 patients, 1,126 (48%) were girls, 1,222 (52%) were boys. Hypodontia was found in 177 children (93 girls (53%), 84 boys (47%)). The prevalence of hypodontia and hyperdontia were 7.5% and 0.9%. Taurodontism is the most common dental anomalies in hypodontia patients (39%) followed by microdontia (10%). Taurodontism was more prevalent in girls (42%) than in boys (36.5%). Microdontia was found in 10 patients and macrodontia was observed in 9 hypodontia patients. Hyperdontia was found in 21 children [8 girls (38%), 13 boys (62%)]. The most common supernumerary tooth found was mesiodens (85%) and it's more prevalent in boys (67%) than in girls (33%). Taurodontism is the most common dental anomaly (48%) following macrodontia (19%) and were found to be much more prevalent in boys (53%) (23%) than in girls (37.5%) (12.5%). Microdontia was found in only 1 boy (%7.7) in hyperdontia patients. CONCLUSION: Hypodontia and hyperdontia with taurodontism, microdontia, and macrodontia need much more complex treatment plan. All cases should be evaluated using interdisciplinary approach for appropriate treatment choice. This helps in longterm and effective treatment planning according to a child's individual requirements.

Taurodontism.

Taurodontism was hitherto considered to be a marker of oro-facial disorders. Since then, it has been reported with a moderately high-to-high prevalence on panoramic radiographs in case series of otherwise normal individuals in Brazilian, Middle Eastern and East Asian communities. This now understood higher than-formerly expected prevalence is important to the endodontist, orthodontist and restorative dentist. Therefore, the oral and maxillofacial radiologists should be aware of this phenomenon and its measurements to advise better their clinical colleagues.

Oculo-auriculo-vertebral spectrum with radial defects, a bifid condyle and taurodontism: A case report.

Goldenhar syndrome (GS) is a rare congenital anomaly involving the first and second branchial arches. It is an autosomal dominant genetic disorder in which there is abnormal prenatal development of the head and face leading to the subsequent asymmetry of craniofacial structures. It is generally sporadic, with its incidence ranging from 1:3,500 to 1:5,600 live births and a gender ratio of 3:2 (male:female). Goldenhar syndrome is considered to be a variant of hemifacial microsomia, characterized additionally by vertebral anomalies and epibulbar dermoids. Facio-auricular dysplasias represent a single disorder with great variability of expression, and an isolated ear malformation may represent the mildest expression of the disorder. This report presents a case of the oculo-auriculo-vertebral spectrum (OAVS) with radial defects, a unilateral bifid condyle and taurodontism. The presence of a bifid condyle and taurodontism has not been previously reported in the literature. Whether this is a coincidental or new finding has to be hypothesized and confirmed. The documentation of all such new findings is of utmost importance for updating the existing literature.

Klinefelter's syndrome and taurodontism.

OBJECTIVE: Taurodontism is a dental anomaly characterized by an enlarged pulp chamber and apycal displacement of the pulpar floor. The prevalence of taurodontism in normal population is controversial. It has been reported that taurodontism is frequently observed in Klinefelter's patients. The purpose of this study was to assess the prevalence of taurodontism in a group of Italian Klinefelter's patients and in a randomly selected male population of Italy and to compare the results with published data. MATERIALS AND METHODS: Digital panoramic radiographs of 16 Klinefelter's patients and of 100 normal males were retrospectively studied in order to investigate the prevalence of taurodontism in these groups of patients. RESULTS: Taurodont teeth were observed in 2 of the 16 Klinefelter's patients (12.5%) and in 2 of 100 normal males (2.0%). CONCLUSIONS: Our results confirm the higher prevalence of taurodontism in Klinefelter's patients compared to the normal population (12.5% vs. 2.0%). Due to the wide discrepancy of incidence of taurodontism reported in literature (0.04%-48.0% in normal population; 12.5%-88.0% in Klinefelter's patients), we conclude that it is not possible to state which is the prevalence of taurodontism in a normal population nor among Klinefelter's patients.

Dental abnormalities in individuals with pathogenic germline variation in DICER1.

Pathogenic germline variation in the microRNA processing gene DICER1 gives rise to an autosomal dominant, tumor-predisposition disorder. Conditional deletion of Dicer1 in murine dental epithelium shows that it controls tooth patterning, size, number, and shape. The human dental phenotype of people with germline pathogenic variation in DICER1 is unknown. DICER1-carriers (n = 57) and family controls (n = 55) were evaluated at the NIH Clinical Center dental clinic as part of a comprehensive medical evaluation. Digital panoramic radiographs, bite-wing radiographs, and oral photographs were collected. A single observer, blind to DICER1 status, reviewed the dental records and determined the presence or absence of 11 dental characteristics as described in the clinic notes, radiographs, or oral photographs. Subjective phenotypes were reviewed on radiographs by two examiners (blind to DICER1 status) for the presence or absence of the dental characteristics to reduce inconsistencies. By simple association, bulbous crown, periodontitis, and taurodontism were all significant (p < .05). Logistic regression with chi-square maximum likelihood estimates showed that bulbous crown and periodontitis remained significant. Recognition of these phenotypes may aid identification of individuals and families at risk for DICER1-associated neoplasms. These findings may also guide dental care for individuals with germline DICER1 pathogenic variation.

Bilateral taurodontism in permanent maxillary first molar.

Taurodontism is a dental anomaly caused due to the failure of Hertwig's epithelial sheath to invaginate at the proper horizontal level. A huge pulp chamber, displacement of the pulpal floor apically, and no constriction at the level of the cementoenamel junction are the key features representing a taurodontic tooth. This condition is most commonly associated with permanent molars. This clinical entity occurs in the form of an isolated, singular trait in majority of the cases. However, seldom, it may be associated with syndromes or ectodermal anomalies. The large and deep pulp chamber makes instrumentation of canals difficult, thereby challenging an endodontist. This case report describes the endodontic challenge faced in cases of taurodontism as well as the clinical steps involved in its successful endodontic management. Furthermore, it shows the typical presence of bilateral hypertaurodontism with respect to the maxillary first molar.

Dens in dente Tipo III A: relato de caso / Dens invaginatus type III A: case report

Introdução: dens in dente é uma anomalia rara de desenvolvimento, caracterizada pela invaginação dos tecidos dentários, podendo variar de um ligeiro aumento da fosseta do cíngulo a um profundo sulco, que pode se estender até o ápice dentário. Objetivo: o objetivo do presente artigo foi relatar um caso clínico e descrever as peculiaridades dos achados clínicos e radiográficos de um dens in dente Tipo III A, com ênfase na descrição de sua morfologia completamente atípica, além das dificuldades que foram encontradas no diagnóstico e durante o tratamento endodôntico. Caso clínico: o paciente compareceu ao ambulatório de uma clínica de Endodontia com queixa de dor e leve edema. Ao exame clínico e radiográfico, observou-se imagem sugestiva de dens in dente no elemento #22, sendo, então, proposto tratamento endodôntico convencional, com estudo tomográfico. Resultados: após 1 ano e 6 meses de acompanhamento, o paciente encontrava-se assintomático. Notou-se reparo satisfatório, com formação óssea, apesar da sobre-extensão do cone. Conclusão: foi possível perceber a importância da tomografia computadorizada de feixe cônico como auxiliar no diagnóstico e planejamento da conduta frente a casos de dens in dente, principalmente por aumentar as chances de sucesso, evitando a perda precoce de elementos dentários (AU).

Introduction: Dens invaginatus is a rare dental anomalycharacterized by invagination of dental tissues, which maybe from a slight increase in the pit of the cingulum to a deep groove that may extend to the tooth apex. This report describes clinical and radiographic findings and the morphology of a completely atypical and unique anomaly, and discusses the difficulties in the diagnosis and endodontic treatment of the root canal of teeth with this complex anatomy. Clinical case: Patient seen in the outpatient clinic of the Endodontic Service with a complaint of pain and mild edema. Clinical and radiographic examinations were suggestive of invagination itooth #22, and conservative endodontic treatment and CT scans were indicated. Results: Patient was asymptomatic and had no functional disorders at 18 months of follow-up. Repair and new bone formation were satisfactory, despite cone overextension. Conclusion: Cone-beam CT seems to be an important method of diagnosis and treatment planning in cases of dens invaginatus, especially because it increases the chances of treatment success and prevents the early loss of teeth (AU).

Tratamento com MTA Repair HP de extensa perfuração radicular após iatrogenia: relato de caso / Treatment with MTA Repair HP of extensive root perforation after iatrogeny: case report

Objetivo: relatar um caso clínico de perfuração radicular causada por iatrogenia, em terço cervical e médio de um incisivo central superior, dente 21, com presença de lesão óssea periapical. Relato de caso: clinicamente, pôde-se constatar ausência de edema e fístula. Na avaliação da condição pulpar e dos tecidos perirradiculares, o dente apresentou dor na palpação, ausência de mobilidade e de dor em percussão vertical e horizontal. Após os exames de imagem obtidos por meio de tomografia computadorizada de feixe cônico (TCFC; Prexion 3D), constatou-se lesão perirradicular extensa, canal radicular obliterado e perfuração radicular em face vestibular após tentativa de acesso cirúrgico. Como escolha de tratamento, optou-se por recuperar o trajeto original do canal de maneira a obter acesso intracanal, realização do preparo químico-mecânico e obturação pela técnica do cone único, para posteriormente promover o selamento adequado da perfuração com MTA Repair HP (Angelus, Londrina, PR, Brasil). Após seis meses, o dente apresentava-se assintomático e, radiograficamente, observou-se o reparo da lesão periapical. Considerações finais: o correto planejamento, o conhecimento dos materiais utilizados e a abordagem terapêutica foram de suma importância para o manejo adequado do caso. (AU)

Objective: to report a clinical case of root perforation, caused by iatrogeny in the cervical and middle third of an upper central incisor, tooth 21, with presence of periapical bone lesion. Case report: clinically, there was no edema and fistula. Facing the evaluation of the pulp condition and the periradicular tissues, the tooth presented pain on palpation, absence of mobility and pain on vertical and horizontal percussion. After the imaging exams, obtained by cone-beam computed tomography (CBCT; Prexion 3D), extensive periradicular lesion, obliterated root canal and root perforation were observed in the buccal face after attempted surgical access. As a choice of treatment, we chose to recover the original path of the canal in order to obtain intracanal access, chemicomechanical preparation and obturation by the single-cone technique to later promote proper sealing of the perforation with MTA Repair HP (Angelus, Londrina, PR, Brazil). After six months, the tooth was asymptomatic and, radiographically, the repair of the periapical lesion was observed. Final considerations: the correct planning, knowledge of the materials used and therapeutic approach were of paramount importance for the proper management of the case. (AU)

Middle distal canal of mandibular first molar: A case report and literature review.

A successful root canal treatment can only be achieved by gaining adequate access to all root canals, ensuring adequate mechanical preparation, and disinfection as well as placing a three-dimensional impermeable filling in these root canals. Practitioners must be very careful when detecting the root canals in mandibular first molar tooth, because it shows a wide variety of root canal variations and it is the first permanent tooth erupted in the mouth that frequently requires endodontic treatment. Our case report presents the endodontic retreatment of a left permanent mandibular first molar having two roots that consist of three distal canals and two mesial canals (Type XVIII root canal pattern). After all the root canals were identified with endodontic explorer adequate preparation and disinfection were provided, the root canals were filled with calcium hydroxide-based canal sealer and gutta-percha and the crown was restored with resin composite at the second appointment. In addition, a short review of literature for similar cases is presented in this paper.