Assessment of dens invaginatus and its characteristics in maxillary anterior teeth using cone-beam computed tomography.

This cone-beam computed tomographic (CBCT) study aimed to evaluate the prevalence of dens invaginatus (DI) and its characteristics in maxillary anterior teeth in a Saudi population. A total of 505 CBCT scans were evaluated, including a total of 2790 maxillary anterior teeth. The patients' demographic data, including age and sex, were recorded. The presence of DI and the related characteristics including bilateral occurrence; DI type according to Oehlers classification; and presence of periapical radiolucency, open apex, and/or nearby impacted teeth were analyzed. The associations between DI and the other factors were analyzed using the chi-square and fisher exact tests. DI was detected in 7.3% of the patients and 1.6% of the teeth examined. Most of the DI-affected teeth were maxillary lateral incisors (76.1%), followed by mesiodens (19.6%) and maxillary central incisors (4.3%), while no DI was observed in the maxillary canines. Bilateral DI was found in 24.3% of the affected patients. Oehlers type I DI was the most frequent (80%). Periapical radiolucencies, open apices, and nearby impacted teeth were observed in 10.9%, 4.3%, and 30% of the invaginated teeth, respectively. DI was significantly associated with tooth type (P < 0.0001) but not with sex (P > 0.05). Although most of the DI cases are limited to the crown, CBCT imaging is essential for DI evaluation and management.

Dens invaginatus: a review and orthodontic implications.

Dens invaginatus (DI) 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. Presence of DI is considered to increase the risk of caries and pulpal pathology, but they are often missed in the initial orthodontic assessment as they present with no clinical signs of an anomaly. In absence of adequate oral hygiene and maintenance, bacterial contamination of these malformations can lead to the development of early caries and consequent pulpal death. Early diagnosis of these lesions is critical as they can negatively impact any planned orthodontic treatment and assessment of the prognosis of these lesions is therefore necessary prior to the commencement of orthodontic treatment. In this article, we aim to illustrate the need for appropriate diagnosis and multidisciplinary approach in the management of DI in patients undergoing orthodontic treatment.

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.

[Dens in dente: report of 3 cases and review of the literature].

PURPOSE: To explore the diagnosis and clinical treatment of dens in dente. METHODS: Preventive resin restoration, root canal treatment, apical barrier technique and apexification were used to treat three cases of dens in dente, respectively. The curative effects were assessed by general examinations and imageological examinations during postoperative follow-up visits. RESULTS: Three patients with different type and degree of dens in dente achieved good therapeutic effect and favorable prognosis through different treatment methods. CONCLUSIONS: Dens in dente is complex clinically and the treatment is difficult. Clinicians should improve the understanding of dens in dente. The keys to successful treatment are early diagnosis and early treatment. In addition, it is important to take proper measures according to the type and degree of dens in dente, to preserve the diseased tooth as much as possible.

Triple dens invaginatus in a single tooth: Rarest of rare case report.

Dens invaginatus is a rare malformation affecting the teeth. The teeth that are most commonly affected are the permanent maxillary lateral incisors. The mandibular posterior teeth are rarely affected by dens invaginatus. In most of the cases, a single dens invaginatus is seen affecting the tooth. Cases of double dens invaginatus affecting a single tooth are rare, and those of triple dens invaginatus in a single tooth are even rarer. Here, we present a case of a 14-year-old where three dens invaginatus were seen in the mandibular second premolar. This is the fourth case of three dens invaginatus in a single tooth as only three have been reported previously.

Hallazgos imagenológicos de dens in dente tipo II con formato de odontoma dilatado en un mesiodiente / Imaging findings of a dilated odontoma shaped type II dens in dente in a mesiodens

Introduction: there are three types of dens in dente: Type I, minimal invagination confined to the crown of the tooth which does not extend beyond the amelocemental junction; Type II, invagination extends to the pulp chamber, but remains within the root canal with no communication with the periodontal ligament; and Type III, invagination extends to the root of the affected tooth, beyond the cementoenamel junction. The term dilated odontoma is used to describe the most severe variant of invagination (Type III), which is characterized by crown and/or root dilation of the affected tooth. Objective: describe a rare case of a dilated odontoma shaped dens in dente in a mesiodens and its imaging findings, diagnosed by cone beam computed tomography. Case presentation: a 14-year-old male patient was referred for radiographic examination of the mandible and maxilla to determine the cause of abnormal tooth eruption chronology. Two mesiodens were found on the maxilla. Due to the peculiar morphology of the mesiodens on the right side, cone beam computed tomography was performed. Multiplanar reconstructions revealed an oval structure on the eruption path of the upper right central incisor, in contact with its palatal surface. Coronal and sagittal reconstructions showed that invagination extended beyond the cementoenamel junction, without any additional apical/lateral formation. Conclusions: the final diagnosis was dilated odontoma shaped type II dens invaginatus in a mesiodens(AU)

Introducción: existen tres categorías de dens in dente: Tipo I, invaginación mínima confinada a la corona del diente y que no se extiende más allá de la unión amelo-cementaria; Tipo II, la invaginación se extiende a la cámara de la pulpa, pero permanece dentro del canal de la raíz, sin comunicación con el ligamento periodontal; y Tipo III, la invaginación se extiende a la raíz del diente afectado, más allá de la unión cemento-esmalte. El término odontoma dilatado se utiliza para describir la variante más grave de la invaginación (tipo III), que se caracteriza por la dilatación de la corona y/o laraíz del diente afectado. Objetivo: describir un caso raro de un dens in dente con formato de odontoma dilatado en un mesiodiente y sus hallazgos imagenológicos, diagnosticados mediante tomografía computarizada de haz cónico. Presentación del caso: paciente varón, 14 años de edad, fue enviado a un servicio de Radiología Odontológica con el fin de determinar la causa de anómala cronología de la erupción dental en maxilar superior y mandíbula. Dos mesiodientes fueron identificados en el maxilar superior. El mesiodiente del lado derecho llamó la atención debido a su peculiar morfología, por lo que se realizó la tomografía computarizada de haz cónico. Las reconstrucciones multiplanares revelaron una estructura ovalada ubicada en el trayecto de erupción del incisivo central superior derecho, en contacto con su superficie palatina. Reconstrucciones coronales y sagitales demostraron que era posible identificar la extensión de la invaginación más allá de la unión cemento-esmalte, sin constitución de forma apical/lateral accesoria. Conclusiones: el diagnóstico final fue dens invaginatus tipo II en forma de odontoma dilatado en un mesiodiente(AU)

Hallazgos imagenológicos de dens in dente tipo II con formato de odontoma dilatado en un mesiodiente / Imaging findings of a dilated odontoma shaped type II dens in dente in a mesiodens

Introduction: there are three types of dens in dente: Type I, minimal invagination confined to the crown of the tooth which does not extend beyond the amelocemental junction; Type II, invagination extends to the pulp chamber, but remains within the root canal with no communication with the periodontal ligament; and Type III, invagination extends to the root of the affected tooth, beyond the cementoenamel junction. The term dilated odontoma is used to describe the most severe variant of invagination (Type III), which is characterized by crown and/or root dilation of the affected tooth. Objective: describe a rare case of a dilated odontoma shaped dens in dente in a mesiodens and its imaging findings, diagnosed by cone beam computed tomography. Case presentation: a 14-year-old male patient was referred for radiographic examination of the mandible and maxilla to determine the cause of abnormal tooth eruption chronology. Two mesiodens were found on the maxilla. Due to the peculiar morphology of the mesiodens on the right side, cone beam computed tomography was performed. Multiplanar reconstructions revealed an oval structure on the eruption path of the upper right central incisor, in contact with its palatal surface. Coronal and sagittal reconstructions showed that invagination extended beyond the cementoenamel junction, without any additional apical/lateral formation. Conclusions: the final diagnosis was dilated odontoma shaped type II dens invaginatus in a mesiodens(AU)

Introducción: existen tres categorías de dens in dente: Tipo I, invaginación mínima confinada a la corona del diente y que no se extiende más allá de la unión amelo-cementaria; Tipo II, la invaginación se extiende a la cámara de la pulpa, pero permanece dentro del canal de la raíz, sin comunicación con el ligamento periodontal; y Tipo III, la invaginación se extiende a la raíz del diente afectado, más allá de la unión cemento-esmalte. El término odontoma dilatado se utiliza para describir la variante más grave de la invaginación (tipo III), que se caracteriza por la dilatación de la corona y/o laraíz del diente afectado. Objetivo: describir un caso raro de un dens in dente con formato de odontoma dilatado en un mesiodiente y sus hallazgos imagenológicos, diagnosticados mediante tomografía computarizada de haz cónico. Presentación del caso: paciente varón, 14 años de edad, fue enviado a un servicio de Radiología Odontológica con el fin de determinar la causa de anómala cronología de la erupción dental en maxilar superior y mandíbula. Dos mesiodientes fueron identificados en el maxilar superior. El mesiodiente del lado derecho llamó la atención debido a su peculiar morfología, por lo que se realizó la tomografía computarizada de haz cónico. Las reconstrucciones multiplanares revelaron una estructura ovalada ubicada en el trayecto de erupción del incisivo central superior derecho, en contacto con su superficie palatina. Reconstrucciones coronales y sagitales demostraron que era posible identificar la extensión de la invaginación más allá de la unión cemento-esmalte, sin constitución de forma apical/lateral accesoria. Conclusiones: el diagnóstico final fue dens invaginatus tipo II en forma de odontoma dilatado en un mesiodiente(AU)

An update on the diagnosis and treatment of dens invaginatus.

Dens invaginatus is a malformation with varying anatomical features, posing challenges to treatment. Early and accurate diagnosis plays a significant role in selecting the appropriate treatment. The diagnosis of teeth with a complex root canal system including dens invaginatus has made progress with the application of three-dimensional imaging techniques in endodontics. Advanced treatment options provide hope for teeth that could not be saved before. This review discusses diagnostic methods and treatment options for teeth with dens invaginatus, and provides guidelines for the management of dens invaginatus cases in clinic. Current as well as traditional diagnostic techniques are summarized. Treatment options including state-of-the-art alternatives are presented for coronal dens invaginatus and radicular dens invaginatus.

Dens invaginatus: diagnosis and management strategies.

Dens invaginatus is a developmental malformation, in which there is an infolding of enamel into dentine. These infolds represent stagnation sites for bacteria and can predispose to dental caries. The carious infection can spread via enamel and dentine to contaminate the pulp and cause soft tissue necrosis. The altered and sometimes complex anatomy of affected teeth can make endodontic management challenging. Early diagnosis is therefore essential as prophylactic treatment of the dens can prevent degeneration and pulpal necrosis. The aim of this article is to review the aetiology, classification, diagnosis and management of teeth affected with dens invaginatus. Emphasis will be placed on describing the clinical features of this anomaly. Treatment options, management strategies and the challenges faced in managing this condition will be discussed.

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.

Dens evaginatus and dens invaginatus in a double tooth: A rare case report.

The presence of dens invaginatus (DI) and dens evaginatus (DE) on same tooth is a rare phenomenon. However, when these dental anomalies occur on a double tooth, it becomes an extremely rare phenomenon. The authors report a rare case of DI and DE on fused permanent maxillary central incisor with supernumerary tooth in a 40-year-old male. The present article also focuses on the differentiating fusion from gemination and also reviews preventive and management strategies for tooth with complex dental anatomy.

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.

A retrospective comparative study of cone-beam computed tomography versus rendered panoramic images in identifying the presence, types, and characteristics of dens invaginatus in a Turkish population.

INTRODUCTION: This study assessed the presence, characteristics, and type of dens invaginatus (DI) by using cone-beam computed tomography (CBCT) and panoramic images rendered from CBCT images. In addition, the findings of the imaging techniques were compared. METHODS: We evaluated 300 CBCT images to determine the type of DI, the presence of an impacted tooth near the DI, and the presence of apical pathosis. The McNemar test was used to compare the prevalence of DI according to CBCT and panoramic images rendered from CBCT images. RESULTS: The presence of DI was lower on panoramic images rendered from CBCT images (3% of the patients) compared with on CBCT images (10.7% of the patients) (P < .001). According to the CBCT images, the distribution of teeth with DI was as follows: maxillary lateral incisors (75%), maxillary central incisors (6.8%), mandibular premolars (4.6%), mesiodens (9%), maxillary canines (2.3%), and mandibular canines (2.3%). Type I DI was the most commonly observed type of invaginatus (65.9%), followed by type II (29.5%) and type III (4.6%). All patients with type III DI and 25% of the patients with type II DI had apical pathosis at the time of referral, but periapical lesions were not observed in teeth with type I DI. In total, 13.6% of DI cases had impacted teeth. CONCLUSIONS: CBCT can be recommended as an effective diagnostic device for identifying DI because it provides an accurate representation of the external and internal dental anatomy.

A rare presentation of multiple dens invaginatus in maxillary dentition.

Dens invaginatus is a developmental disturbance of the tooth and usually occurs in the maxillary lateral incisor of permanent dentition. In this article, a rare case of dens invaginatus affecting multiple permanent maxillary teeth is described.

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.

Diagnosis and management of a maxillary lateral incisor exhibiting dens invaginatus and dens evaginatus.

This case report, involving an indigenous Australian, presents the diagnosis and non-surgical endodontic management of a 22 with developmental abnormalities. They include a dens evaginatus and a dens invaginatus that extends to an apical burst in a second truncated root. Cone-beam computed tomography and endodontic microscopy were not available to the clinician. This case report focuses on ambiguities appearing in the literature relating to classification and terminology associated with the abovementioned developmental anomalies. It also demonstrates the need to methodically collect and cautiously interpret available information before initiating endodontic intervention. Axial inclination, distance perception, internal demarcation and spatial awareness, together with an understanding of dental anatomy, embryology and histology and associated physiology and pathology, allowed the clinician to accurately predict the point, the angle and the depth of coronal access. Sensibility of the dentino-pulpal complex was maintained. Critical thinking, experience, innovation, problem-solving and established principles can compensate for inaccessible technologies.

The diagnosis and conservative treatment of a complex type 3 dens invaginatus using cone beam computed tomography (CBCT) and 3D plastic models.

AIM: To investigate the use of 3D plastic models, printed from cone beam computed tomography (CBCT) data, for accurate diagnosis and conservative treatment of a complex case of dens invaginatus. SUMMARY: A chronic apical abscess with a draining sinus tract was diagnosed during the treatment planning stage of orthodontic therapy. Radiographic examination revealed a large radiolucent area associated with an invaginated right maxillary central incisor, which was found to contain a vital pulp. The affected tooth was strategic in the dental arch. Conventional periapical radiographs provided only partial information about the invagination and its relationship with the main root canal and with the periapical tissues. A limited-volume CBCT scan of the maxilla did not show evidence of communication between the infected invagination and the pulp in the main root canal, which could explain the pulp vitality. A novel method was adopted to allow for instrumentation, disinfection and filling of the invagination, without compromising the vitality of the pulp in the complex root canal system. The CBCT data were used to produce precise 3D plastic models of the tooth. These models facilitated the treatment planning process and the trial of treatment approaches. This approach allowed the vitality of the pulp to be maintained in the complex root canal space of the main root canal whilst enabling the healing of the periapical tissues. KEY LEARNING POINTS: Even when extensive periapical pathosis is associated with a tooth with type III dens invaginatus, pulp sensibility tests should be performed. CBCT is a diagnostic tool that may allow for the management of such teeth with complex anatomy. 3D printed plastic models may be a valuable aid in the process of assessing and planning effective treatment modalities and practicing them ex vivo before actually performing the clinical procedure. Unconventional technological approaches may be required for detailed treatment planning of complex cases of dens invaginatus.

Dens invaginatus: review, relevance, and report of 3 cases.

Dens invaginatus is a rare developmental morphoanatomical variation resulting from the infolding of the dental papilla before biological mineralization that allows the invagination of inner dental epithelium. Permanent maxillary lateral incisors are most commonly affected, and the condition is frequently bilateral, but it may also prevail in permanent maxillary central incisors. The purpose of this paper was to provide an overview of the etiopathogenesis, frequency of occurrence, and clinical and radiographic features and to discuss 3 dens invaginatus cases.