Dens invaginatus of a maxillary lateral incisor: endodontic treatment

A right maxillary central incisor and an adjacent lateral incisor with a dens invaginatus were identified as requiring endodontic treatment. Both teeth were treated by nonsurgical means. Thirteen months postoperatively the central incisor showed evidence of periapical resolution, whereas the lateral incisor did not. The lateral incisor was then treated with apical curettage, an apicoectomy, and retrograde amalgam filling. One year after the surgical procedure the periapical tissues of both the lateral and central incisors exhibited satisfactory resolution. This case demonstrates that certain cases of dens invaginatus can be successfully treated only with a surgical approach.     

Endodontic and surgical management of a maxillary lateral incisor with type III dens invaginatus: a 12-month follow-up

This article reports the endodontic and surgical management and 12-month follow-up of a maxillary lateral incisor diagnosed as type III dens invaginatus. A 21-year-old male patient presented to our clinics with complaints of pain and swelling in the right maxillary region. Intraoral and radiographical examination disclosed the presence of a peg-shaped maxillary right lateral incisor diagnosed as type III dens invaginatus. Root canal treatment combined with periapical surgery was initiated. After the completion of root canal treatment for both maxillary right central and lateral incisors, periapical surgery was scheduled. During the surgery, periapical granulation tissue was curreted and bovine-derived hydroxil apatite (Unilab-Surgibone, Mississauga, Ontario, Canada) covered with collagen membrane (Unilab-Surgibone) was placed in the resorptive areas. ProRoot MTA (Dentsply, Tulsa, OK) was placed as a root end filling material. Postoperative 12-month follow-up revaled a satisfactory healing process.     

Combined endodontic and surgical management of a mandibular lateral incisor with a rare type of dens invaginatus

Dens invaginatus is a developmental malformation of teeth that most commonly affects permanent maxillary lateral incisors. Presence of dens invaginatus in mandibular permanent teeth is relatively rare. The purpose of this report is to describe the combined nonsurgical and surgical management of a mandibular lateral incisor associated with a rare type of dens invaginatus. Pulp involvement of the malformed tooth, periapical abscess, and severe periodontal destruction were observed. The signs (sinus tracts) and symptoms ceased after completion of the treatment. Satisfactory healing of the periradicular lesion was observed at the 6-month and 2-year follow-up examinations.     

左上侧切牙Ⅲ型牙内陷牙髓及牙周联合治疗1例

本文报告1例因牙齿根面畸形导致严重根尖病变及牙周破坏的牙周牙髓联合病变的左上侧切牙,瘘道长期不愈,腭侧窄而深牙周袋,严重根尖病变及牙槽骨垂直吸收。通过显微根管治疗、根尖手术、引导牙周组织再生术治疗,实现了控制根尖及牙周感染,达到了保留患牙的目的。     

左上侧切牙Ⅲ型牙内陷牙髓及牙周联合治疗1例

本文报告1例因牙齿根面畸形导致严重根尖病变及牙周破坏的牙周牙髓联合病变的左上侧切牙,瘘道长期不愈,腭侧窄而深牙周袋,严重根尖病变及牙槽骨垂直吸收。通过显微根管治疗、根尖手术、引导牙周组织再生术治疗,实现了控制根尖及牙周感染,达到了保留患牙的目的。     

Combined endodontic therapy and surgery in the treatment of dens invaginatus Type 3: case report

An accurate understanding of the morphology of the root canal system is a prerequisite for successful root canal treatment. Invaginated teeth have a complex root canal configuration that cannot be instrumented effectively and should be treated by both endodontic therapy and surgery. A case of dens invaginatus Type 3 in a maxillary lateral incisor with a periapical lesion and its successful treatment by these combined methods is reported.     

Endodontic treatment of dens invaginatus type III with three root canals and open apical foramen

AIM: To describe the conservative endodontic treatment and the 1-year follow-up of a permanent maxillary lateral incisor with dens invaginatus. SUMMARY: Frequently, the root canal treatment of invaginated teeth is challenging because of problems associated with gaining access to the root canals and with variations of canal morphology associated with this type of malformation. The present case describes the complex root canal treatment of dens invaginatus in a maxillary lateral incisor with three root canals (Oehler type III), incomplete apex formation, necrotic pulp and abscess formation. After gaining access to two root canals and the invagination with the help of a dental operating-microscope, the canals and the invagination were instrumented and calcium hydroxide dressing was applied for 6 months. Apexification and osseous bone repair were achieved, and the canals were filled with gutta-percha. A follow-up after 1 year showed that the tooth was free of any clinical symptoms and the periapical condition was normal. KEY LEARNING POINTS: The present case demonstrated that conservative root canal treatment can be performed successfully even in sever cases of dens invaginatus. The use of a dental operating microscope can help in the management of complicated cases of invaginated teeth through conventional root canal treatment.     

Complex treatment of dens invaginatus type III in maxillary lateral incisor

Abstract— The complex anatomy and diagnosis of dens invaginatus make endodontic treatment of such teeth difficult. This case describes combined nonsurgical and surgical treatment of a maxillary lateral incisor with a normally shaped canal and a dens invaginatus type III with a lateroradicular lesion. The root canal was treated conventionally with gutta-percha and a zinc oxide-eugenol sealer. The root was surgically exposed and the canal of the dens invaginatus was cleaned, instrumented and obturated with gutta-percha and a zinc oxide-eugenol sealer. At follow-up 3 years 6 months later, the tooth was asymptomatic and radiographically showed repair of the lesion in the region of the dens invaginatus.     

Complex treatment of dens invaginatus type III in maxillary lateral incisor.

The complex anatomy and diagnosis of dens invaginatus make endodontic treatment of such teeth difficult. This case describes combined nonsurgical and surgical treatment of a maxillary lateral incisor with a normally shaped canal and a dens invaginatus type III with a lateroradicular lesion. The root canal was treated conventionally with gutta-percha and a zinc oxide-eugenol sealer. The root was surgically exposed and the canal of the dens invaginatus was cleaned, instrumented and obturated with gutta-percha and a zinc oxide-eugenol sealer. At follow-up 3 years 6 months later, the tooth was asymptomatic and radiographically showed repair of the lesion in the region of the dens invaginatus.     

A review of dens invaginatus (dens in dente) in permanent and primary teeth: report of a case in a microdontic maxillary lateral incisor.

An unusual presentation of dens invaginatus affecting a microdontic permanent lateral incisor in a 19-year-old female patient is reported and pertinent literature reviewed. The patient was referred to the oral and maxillofacial radiology clinic of the authors' institution for radiographic examination of her maxillary teeth. Dens invaginatus was identified on the maxillary right lateral incisor in the anterior periapical radiographs. The tooth was microdontic and clinically simulated a primary tooth. Dens invaginatus occurs rarely in primary dentition although it is fairly common in permanent teeth. Only 4 instances of dens invaginatus affecting the primary dentition have been reported in the literature. The etiology, pathophysiology, association with other dental anomalies, as well as management aspects of this common anomaly, are discussed.     

Non-surgical root canal treatment of dens invaginatus type 2 in a maxillary lateral incisor

AIM: To describe the clinical management of an unusual dens invaginatus type 2. SUMMARY: A case of dens invaginatus in a maxillary lateral incisor with a periapical lesion is reported. The patient presented with pain and localized swelling. Despite the complex anatomy and diagnosis of dens invaginatus, non-surgical root canal treatment was performed successfully. Key learning points Dens invaginatus may be presented in many forms, and the aetiology of this phenomenon is not fully understood. Due to abnormal anatomical configuration, dens invaginatus presents technical difficulties in its clinical management. Non-surgical root canal treatment can be performed successfully.     

Complex endodontic treatment of an immature type III dens invaginatus. A case report

Aim To report the endodontic treatment of an immature maxillary central incisor with dens invaginatus. Summary Dens invaginatus is a rare malformation of teeth, probably resulting from an infolding of the dental papilla during tooth development. The present case describes the complex endodontic treatment of a type III dens invaginatus in an immature maxillary central incisor with a necrotic pulp and abscess formation. The initial treatment goal was to achieve apexification of the pseudocanal root and conservative root canal treatment in the main canal. Following 1‐year of treatment with calcium hydroxide dressings, radiography revealed a healing response, but no sign of a hard tissue barrier at the apex. Periapical surgery with the placement of a zinc oxide cement (IRM) root‐end filling was considered successful at the 4‐year follow‐up. Key learning points • The complexity of the canal system and open apex in dens invaginatus present a challenge to endodontic treatment. • Correct diagnosis and treatment planning are fundamental to treatment of dens invaginatus. • Periapical surgery is indicated in cases of unsuccessful apexification in immature teeth with dens invaginatus and nonvital pulp.     

Non-surgical root canal treatment of dens invaginatus type 2 in a maxillary lateral incisor

AIM: To describe the clinical management of an unusual dens invaginatus type 2. SUMMARY: A case of dens invaginatus in a maxillary lateral incisor with a periapical lesion is reported. The patient presented with pain and localized swelling. Despite the complex anatomy and diagnosis of dens invaginatus, non-surgical root canal treatment was performed successfully. KEY LEARNING POINTS: * Dens invaginatus may be presented in many forms, and the aetiology of this phenomenon is not fully understood. * Due to abnormal anatomical configuration, dens invaginatus presents technical difficulties in its clinical management. * Non-surgical root canal treatment can be performed successfully.     

1例上颌侧切牙牙内陷根管再治疗病案报告

牙内陷又称牙中牙,多发于上颌侧切牙。本篇文章报导的病例是OehlersⅡ型牙内陷,伴根尖未发育完全,且于外院做过根管不完善的治疗。拍摄根尖片及锥形束CT(CBCT)了解患牙根管形态及根尖周状况,制定治疗方案并实施,根管再治疗取得良好的临床预后。     

Management of 2 Teeth Diagnosed with Dens Invaginatus with Regenerative Endodontics and Apexification in the Same Patient: A Case Report and Review

Introduction

This review and case report present the treatment of a 10-year-old boy with both permanent maxillary lateral incisors demonstrating Oehlers type II dens invaginatus and pulpal involvement. Treatment was complicated by dental anxiety, supraventricular tachycardia, immature tooth development, and facial cellulitis.

Methods

An infected necrotic pulp of the permanent maxillary left lateral incisor was treated by apexification and endodontic treatment with mineral trioxide aggregate. The necrotic pulp of the permanent maxillary right lateral incisor was treated with canal debridement and dressing under general anesthesia.

Results

Periapical healing of both teeth occurred, with the right lateral incisor showing continued root growth, thickening of the dentinal root walls, and completed apex formation. This tooth responded normally to pulp testing. Twenty-eight months after initial treatment, the right lateral incisor displayed progressive sclerosis of the canal.

Conclusions

This case demonstrates possible pulpal regeneration of an infected maxillary right lateral incisor with dens invaginatus and an immature apex after minimal canal debridement.     

Clinical management of dens invaginatus in a maxillary lateral incisor with the aid of cone‐beam computed tomography – a case report

Abstract – This report describes non‐surgical endodontic treatment of Oehlers’ type III dens invaginatus in a maxillary lateral incisor with the aid of postobturation cone‐beam computed tomography (CBCT). The endodontic treatment was initiated with the aid of a surgical operating microscope, and two canals, one of which represented the invagination, were instrumented, irrigated under passive ultrasonic activation and obturated with the lateral condensation technique. As postobturation periapical radiographs suggested the presence of untereated and/or unfilled areas in the root canal and invagination, CBCT was taken to assess the possibility of further treatment. The CBCT scans demonstrated inaccessible and unfilled canal and invagination areas because of complex internal morphology characterized by (i) C‐ or ring‐shaped cross‐sectional canal configuration with constrictions at different points in different root levels and (ii) a prominent intraradicular cavity that was communicated with the enamel‐lined invagination and opened into the apical periodontium. Thus, it was judged that further endodontic treatment was not feasible. A 14‐month follow‐up revealed a satisfactory clinical and radiographic outcome, suggesting that the chemomechanical debridement may have sufficed to induce periapical healing. CBCT greatly helped the decision of avoiding further intervention that could have been difficult to negotiate.     

The challenges of treating a fused tooth

This paper describes and discusses the multidisciplinary treatment involving a permanent maxillary lateral incisor fused to a supernumerary tooth, both presenting pulp necrosis and periapical lesion. A 15-year-old male patient sought treatment complaining of pain, swelling and mobility on the maxillary right lateral incisor. After clinical and radiographic examination, root canal preparation was performed according to the crown-down technique and a calcium hydroxide dressing was placed for 15 days. The patient returned and the definitive endodontic filling was done with thermomechanical compaction of gutta-percha and sealer. After 18 months, clinical and radiographic examinations were carried out and no pain or swelling was reported. Two years after endodontic treatment, the patient returned for periodontal and cosmetic treatments. Nine months later, a cone-beam computed tomography (CBCT) revealed that the previously detected periodontal defect and periapical lesion were persistent. Apical endodontic surgery was indicated. The supernumerary tooth was removed, the communicating distal surface was filled and the surgical site received bioactive glass and demineralized bovine organic bone. The pathological tissue was submitted to histopathological examination and the diagnosis was periapical cyst. One year after the apical endodontic surgery, CBCT showed bone formation at maxillary lateral incisor apical area. Two years after the surgery, the restoration was replaced due to aesthetic reasons and periapical radiograph showed success after 5 years of treatment. A correct diagnosis and establishment of an adequate treatment plan resulted in a successful management of the case.     

A complex treatment of dens invaginatus

Abstract Dens invaginatus is a developmental malformation of teeth. A case is presented of successful treatment of a peg lateral incisor with a severe dens invaginatus extending to the root apex. Both conventional endodontic therapy and periapical surgery were ineffective in resolving a persistent, long-standing sinus tract. Removal of the tooth in the present case would have created a difficult prosthetic problem. Intentional replantation, with improved access to the apical part of the canal was attempted as a last resort. A 10-month recall radiograph is presented showing successful healing of the periapical lesion. Pre-treatment and post-treatment photographs are presented to show successful esthetic treatment, using bonded composite resin.     

Endodontic treatment of dens invaginatus with a periradicular lesion: case report

A left maxillary lateral incisor with Type III dens invaginatus with a periradicular lesion was treated non-surgically. Pulp involvement and periapical abscess subsequent to contamination through the invagination space were observed. The signs (sinus tract) and symptoms ceased after treatment. Complete healing of the periradicular lesion was observed at the one-year follow-up examination.     

Repair of large periapical radiolucent lesions of endodontic origin without surgical treatment

The aim of this paper is to present two case reports of pulp necrosis and radiolucent periapical lesions, which were treated without surgical treatment. The first was a mandibular molar with periapical lesion of endodontic origin extending towards the furcation in a 20-year-old woman, and the second affected a maxillary right lateral incisor with a large periapical lesion in a 22-year-old woman. The endodontic treatments were carried out in two sessions, with crown-down instrumentation, irrigation with 2.5% sodium hypochlorite and intracanal medication with calcium hydroxide paste. After 30 days, the root canals were filled with gutta-percha and Sealapex sealer by the lateral condensation technique. The clinical and radiographic examination after 1 year revealed complete repair. The appropriate diagnosis of lesions of endodontic origin and the treatment and obturation of the infected canals allowed complete repair of these large radiolucent periapical lesions without surgical treatment.