An update on the diagnosis and treatment of dens invaginatus

Abstract

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.

Dental Age, Agenesis, and Morphology in Patients With Operated Single-Suture Craniosynostoses

“…The prevalence of dens invaginatus in patients with single-suture craniosynostosis found in this study (26%) is higher than reported in the general population (ranging from 0.04% to 10%; Gunduz et al, 2013; Capar et al, 2015; Gallacher et al, 2016; Zhu et al, 2017). Periapical radiographs and OPGs are commonly used to diagnose invaginations, although they cannot accurately demonstrate the complex anatomy of the invagination or the root canal system adjacent to it (Zhu et al, 2017). Ideally, invaginations can be diagnosed with 3-dimensional images (Capar et al, 2015; Zhu et al, 2017).…”

A new system for classifying tooth, root and canal anomalies

“…Similarly, the treatment options for these anomalies would vary from the application of a fissure sealant for type I to complex root canal treatment procedures for dens invaginatus type III (Bishop & Alani , Zhu et al . ). Defining the anomaly and listing the code before the tooth number, root and canal morphology are beneficial because it would explain the reason for subsequent complex morphological variation ‘codes’ of the root and canal usually observed in severe forms of the anomaly. Listing the anomaly code after the affected root(s) if other roots are not affected is more appropriate because unique root canal treatment procedures are usually considered for that affected root(s) such as root dilacerations, which require considerable skill to avoid intra‐operative complications (Jafarzadeh & Abbott (). Defining tooth fusion with or without intercanal communications is beneficial because each has its own radiographic landmarks and treatment protocol. Clinicians should consider the pulp status in instances of fusion where there is no apparent communication between the root canal systems (Song et al .…”

Case Report: Combined nonsurgical and surgical therapy of dens invaginatus of a microdontic maxillary lateral incisor

“…Coexistence of both anomalies (peg-lateral and DI) would complicate this situation; an effective treatment plan would require endodontic therapy combined with the restorative treatment for esthetic concerns. The scarcity of case reports about microdontia combined with dens invaginatus is remarkable, with only two case reports of this anatomical feature described in the endodontic literature 7 . Jaikailash et al reported a five canal peg-lateral treated in nonsurgical approach, with all canals patent from pulp chamber to foramen 4 .…”

“…Microdontic teeth with DI are uncommon and present with a reduced labial to lingual and/or mesial to distal diameter. To date, examination of reported cases in literature, revealed the description of only two clinical situations, both affecting maxillary lateral incisors 7 . Our web search (Table 1), revealed more instances of case reports concerning microdontia combined with DI in peg-lateral maxillary incisors.…”