Dens invaginatus and treatment options based on a classification system: report of a type II invagination

Abstract

Dens invaginatus is a dental malformation which may give endodontic complications. Treatment may vary in relation to anatomy, and a classification system for dens invaginatus forms the basis for discussion. A clinical case, classified as a type II invagination (Oehlers' classification), is also presented. Clinical and radiographic examination revealed an invagination penetrating into the apical third of the root canal in tooth number 12. The tooth was immature with an open apex, apical pathosis and a labial fistula. To control the infection, ultrasonic removal of the invagination was necessary, as the invagination prevented complete cleaning and shaping of the root canal. After chemo-mechanical preparation and dressing with calcium hydroxide, an apical plug of MTA was placed, followed by restoration of the tooth with resin-bonded composite. Healing of the lesion with hard tissue formation was confirmed at follow-up. KEY LEARNING POINTS * Knowledge about classification and anatomical variations of teeth with dens invaginatus is important in endodontic decision making. * A classification system may be helpful when treatment options are considered. * Classification of dens invaginatus requires a thorough preoperative radiographic examination.

The Treatment of Immature Teeth With Periapical Lesions Using Ca(OH)2 and MTA: A Case Report

“…Then, to prevent the dis- advantages of long-term calcium hydroxide, we continued treatment with MTA. The successful treatment method in the current case is similar to many other published case reports, in which calcium hydroxide and MTA have been used to treat immature teeth with necrotic pulp (25)(26)(27)(28). Based on evidence, both MTA and Ca(OH) 2 can be used for the endodontic treatment of non-vital immature teeth.…”

An Immature Type II Dens Invaginatus in a Mandibular Lateral Incisor with Talon’s Cusp: A Clinical Dilemma to Confront

“…Kristoffersen et al reported an immature maxillary right lateral incisor with type II DI in which dens was removed, calcium hydroxide applied as intracanal medicament, and MTA was used as an apical barrier [18]. Similar technique, and findings were also reported in other studies [2, 10, 11, 19].…”

Management of Dens Invaginatus Type I and Open Apex: Report of Three Cases

“…During the last years, only 6 reports included surgery in their treatment plans for DI, none of them for Oehlers' type I DI. This behavior can be associated with a best comprehension of tooth anatomy and strict disinfection protocols in endodontics, complemented by new technologies such as operative microscope (8,10,11) and computed tomography (36).…”

“…In the last situation, when there is no communication with the root canal system, the pulp might remain vital. Clinical approaches to treat DI comprise restorative procedures (6,7), nonsurgical endodontic treatment (8)(9)(10), combined periapical surgery (11,12), or even extraction (13). A specific situation occurs when teeth have pulp necrosis and infection before the completion of root development or apical closure (14,15).…”