The Use of Cone-beam Computed Tomography in the Preservation of Pulp Vitality in a Maxillary Canine with Type 3 Dens Invaginatus and an Associated Periradicular Lesion

Introduction

Dens invaginatus type 3 is an anomaly characterized by an invagination of enamel and dentin that can extend up to the root apex. It may pose treatment challenges when nonsurgical root canal therapy is deemed necessary. Conventional diagnostic aids such as periapical radiographs play an important role in the assessment of complex root canal morphologies. However, these modalities may sometimes yield insufficient diagnostic information. Cone-beam computed tomographic imaging produces 3-dimensional digital images and provides the clinician with a more in-depth understanding of the true morphology of the root canal system.

Methods

This case report describes the diagnosis and conservative treatment of an unusual case of a maxillary canine with an infected type 3 dens invaginatus and an associated periradicular lesion in which the vitality of the surrounding pulp was maintained. Mineral trioxide aggregate was used to fill the entire invagination, whereas the circular true root canal system around the invagination with vital pulp was left untreated.

Results

At the 1-year follow-up examination, clinical and radiographic findings showed that a diligent nonsurgical endodontic treatment can result in satisfactory periradicular healing and complete root formation.

Conclusions

The use of cone-beam computed tomographic imaging as an auxiliary tool for both diagnosis and planning the treatment of these anomalies is highlighted.