Combined surgical and conservative endodontic management of Oehler's type 3b dens invaginatus aided by guided tissue regeneration.

The present case describes the successful healing of a periapical lesion associated with the left maxillary lateral incisor (# 22, Federation Dentaire Internationale) having a type 3b dens invaginatus tooth morphology. The treatment was complicated by the presence of blunderbuss root apex and large periapical lesion (>10 mm) with through and through bone defect (Bucco palatal cortical bone perforation, Von Arx Type 1b). An adolescent boy reported palatal swelling and pus discharge in relation to tooth #22. A thorough clinical and radiographic examination revealed tooth #22 as having a type 3b dens invaginatus with an open apex and a diagnosis of pulp necrosis and acute apical abscess. The case was managed by non-surgical root canal treatment followed by endodontic surgery using principles of guided tissue regeneration. A 5-year recall revealed an asymptomatic functional tooth with complete healing.

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.

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 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.

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.

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.

Management of teeth with dens invaginatus and apical periodontitis: A case series.

BACKGROUND: Dens invaginatus is a dental anomaly that can predispose the tooth to pulp and periapical pathology. CASE DESCRIPTION: Different endodontists treated 6 maxillary incisors with dens invaginatus associated with apical periodontitis. Cone-beam computed tomography was used to help with diagnosis and treatment planning in most patients. Four patients received diagnoses of Oehlers type II dens invaginatus and the other 2 as type III. In some patients with type II, the invagination had to be perforated to permit access to the apical part of the true root canal. Both the true canal and the invagination (pseudocanal) were treated in all cases using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation and supplementary disinfection approaches. Calcium hydroxide medication was used in all but 1 case. The root canal and invagination were often filled using thermoplasticized gutta-percha techniques, sometimes using an apical plug with a bioceramic material in teeth with large apical openings. All treated patients had favorable clinical and radiographic outcomes. PRACTICAL IMPLICATIONS: Regardless of the complex anatomic variations, common strategic therapeutic approaches were identified that might serve as recommendations for proper management of teeth with dens invaginatus and apical periodontitis. These approaches include cone-beam computed tomographic planning, aggressive disinfection using sodium hypochlorite ultrasonic or sonic activation and calcium hydroxide intracanal medication, and thermoplasticized gutta-percha obturation of both the root canal and invagination.

Successful Pulp-Preserving Treatment for Peri-invagination Periodontitis of Double Dens Invaginatus With Oehlers Type IIIA and IIIB: A Case Report.

Dens invaginatus (DI), which often occurs in the maxillary lateral incisor, is an important issue in endodontics because the treatment complexity increases depending on the degree of invagination and the vitality or nonvitality of the pulp. An 11-year-old female patient with a sinus tract in the gingiva of the maxillary lateral incisors showed peri-invagination periodontitis and double DI on radiography. Cone-beam computed tomographic imaging was used to examine the structure in the root canal in detail, and Oehlers type IIIA and IIIB DI was found. It was also shown that the patient's bone defect was caused by type IIIA. Because a healthy reaction was observed in the pulp test, the final diagnosis was peri-invagination periodontitis associated with type IIIA of the double DI with vital pulp. We expected the lesion to heal by treating only the type IIIA invaginated pseudo-root canal while preserving the healthy pulp. The invaginated root canal was cleaned under a microscope using ultrasonic instruments and nickel-titanium files to minimize irritation to the pulp. Because the lesion shrinkage was confirmed by cone-beam computed tomographic imaging taken 3 months after the start of treatment, vertical compaction of the warm gutta-percha technique was performed. At the 6-month postoperative recall, the pulp was normal, and the lesions were further improved. Treatment of the main root canal of double DI is complicated. However, proper diagnosis and careful cleaning of the invaginated root canal are essential for healing while preserving the pulp.

Multiple dens invaginatus in Wilson's disease: A case report.

Wilson's disease (WD) is a rare autosomal recessive genetic disease that affects copper metabolism. Anomalies can be seen in the dento-maxillofacial structures of WD patients. Dens invaginatus (DI) is an uncommon tooth anomaly, and its incidence in decidious and permanent molars is even lower. This case report primarily explored the multiple DI of a patient with WD. A 9-year-old boy was admitted to our clinic with complaints of pain and swelling in the right lower molar area. It was learnt that the patient was diagnosed with WD after he was born. Fistula, submandibular lymphadenopathy and diffuse swelling were detected. Using cone-beam computed tomography (CBCT), multiple DIs were observed in bilateral bimaxillary four first molars and deciduous molars. When the patient's systemic condition was considered, extraction was planned under oral antibiotic therapy and was performed. During the 6-month follow-up, uneventful healing was observed.

Unusual Location of Dens Invaginatus Causing a Difficult-to-Diagnose Pulpal Involvement.

This article reports on an unusual case of dens invaginatus in a maxillary third molar that was causing severe symptoms of irreversible pulpitis. This malformation was not clinically or radiographically identified, and the occurrence of referred pain made the early identification of the responsible tooth difficult. Determination of the tooth that was the source of symptoms was only possible after an observation period and fast aggravation of the pathologic process to cause pulp necrosis and extreme tenderness to percussion. The diagnosis of dens invaginatus was made only after extraction and sectioning. Histopathologic and histobacteriologic features of this case are illustrated.

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.

Management of Dens Invaginatus Type II Associated with Immature Apex and Large Periradicular Lesion Using Platelet-rich Fibrin and Biodentine.

Dens invaginatus (DI) poses peculiar challenges in endodontic treatment of teeth because of distortion of pulpal space. A case of Oehlers type II DI with open apex and large periapical lesion is reported. The case was managed using cone-beam computed tomography (CBCT), operating microscope, platelet-rich fibrin (PRF), and Biodentine. A 15-year-old male patient presented with palatal swelling. Pulp sensibility testing of right maxillary lateral incisor was negative. Intraoral periapical digital radiograph revealed an Oehlers type II DI with open apex and periapical radiolucency. A CBCT scan was performed to study the anatomy, determine the true extent of the periapical lesion, and form a treatment plan. A diagnosis of Oehlers type II DI with pulp necrosis and acute periapical abscess was made. Two-visit endodontic treatment was performed. In the first visit, the invaginated central mass was removed under operating microscope, chemo-mechanical preparation was done, and double antibiotic paste dressing was placed. In the second visit, the canal was sealed with apical matrices of PRF and Biodentine as filling material. The patient was asymptomatic and radiographs revealed continued healing of the osseous defect at follow-up visits. A CBCT scan at 30 months showed complete continuity of periodontal ligament space, healing of labial and palatal cortical plates, and formation of intercortical bone. The advances in endodontic armamentarium and technology, like CBCT and operating microscope, have made successful treatment of challenging cases possible. PRF and Biodentine as apical matrices and filling material, respectively, proved to be effective in the present case.

Combined Endodontic and Surgical Treatment of Dens Invaginatus-Associated Extraoral Fistula: A Case Report with Seven-year Follow-up.

Dens invaginatus (dens in dente) is a developmental malformation of permanent or deciduous teeth that has various complex forms. It most commonly affects permanent maxillary lateral incisor teeth, and rarely affects the mandibular teeth. In this report, a rare case of dens invaginatus of a mandibular lateral tooth with an extraoral fistula is presented. A 10-year-old patient was referred to our clinic with extraoral symptoms that could not be diagnosed by medical doctors. Successful treatment with endodontic treatment and periapical surgery is described. Seven-year follow-up of the case is provided.

Management of dens in dente associated with a chronic periapical lesion.

Dens in dente is characterised as a developmental anomaly resulting from invagination of the enamel organ into the dental papilla. It is a rare malformation of teeth, showing a wide spectrum of morphological variations such as gemination, microdontia, taurodontism, dentinogenesis imperfecta, supernumerary tooth and hyperplasias, resulting frequently in early pulp necrosis. Maxillary lateral incisors are the commonest teeth to be affected by dental malformations-supernumerary tooth, talon cusp, congenitally missing tooth and dens in dente. We describe the management of a case of dens in dente in a maxillary lateral incisor with a periradicular lesion.

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.

Sinusitis maxilar de origen odontogénica: diagnóstico y tratamiento quirúrgico / Maxillary sinusitis of odontogenic origin. surgical diagnosis and treatment

La sinusitis odontogénica afecta la mucosa de los senos maxilares y puede ser causada por la evolución de una lesión en el diente con formación de pus periapical que avanza en el interior de la cavidad sinusal. Se presenta un caso de un paciente con dens in dente en el diente incisivo lateral superior derecho, que sufrió el proceso de caries evolucionando en la región periapical, contaminando la mucosa sinusal de este lado, lo que causó el dolor, abultamiento y el desplazamiento del diente. La cirugía se realizó a través de acceso de Caldwell-Luc para el curetaje de la lesión, lo que indica la presencia en el diagnóstico histopatológico la presencia de quiste abscedado y sinusitis. Después de 18 meses de control, se observó la regeneración ósea y el reposicionamiento alveolar espontáneo de los dientes implicados. Los autores advierten que cíngulos profundos y dens in dente son las enfermedades de los dientes que merecen atención para el diagnóstico y la prevención de los procesos de caries con el fin de evitar complicaciones mayores.

Odontogenic sinusitis affects mucous membrane of the maxillary sinus and can be caused by the evolution of a tooth injury with formation of periapical abscess that advances into the sinus cavity. We present a patient with dens in dente in the upper right lateral incisor tooth, which suffered carious process and periapical abscess, contaminating the sinus mucosa on this side, which caused pain, bulging and tooth displacement. Surgery was performed via a Caldwell-Luc access for curettage of the lesion, indicating the presence in the histopathological diagnosis of radicular cyst abscess and sinusitis. After 18 months of control, alveolar bone regeneration and spontaneous repositioning of teeth involved was observed. The authors warn that cingulum deep in dens in dente are diseases of the tooth that deserve attention for the diagnosis and prevention of carious processes in order to avoid further complications.

Dens invaginatus type II associated with an impacted mesiodens: a 3-year follow-up.

Dens invaginatus is a developmental anomaly resulting in a deepening or invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues. The prevalence has been reported to vary from 0.04% to 10%. Dens invaginatus commonly affects lateral incisors and very rarely affects the mesiodens. This article presents a rare case of type II dens invaginatus affecting an impacted mesiodens in a 13-year-old boy and describes its gross and histological features. The associated tooth was dilated and showed invaginated enamel and dentin extending beyond the cement enamel junction. In this case, the clinical diagnosis was confirmed by histological evaluation of the internal morphology using a hard tissue microtome to section the tooth.

Dens invaginatus: a case report.

Dens invaginatus, also known as dens in dente, is a rare anomaly affecting human dentition. The condition results in invagination of an amelodental structure within the pulp. This case report discusses the current management protocol of dens invaginatus as demonstrated in an adolescent female and describes treatment options. As with most conditions, early diagnosis and preventive measures help minimize complications in dens invaginatus cases.