Diagnosis and endodontic treatment of type II dens invaginatus by using cone-beam computed tomography and splint guides for cavity access

Cone Beam Computed Tomography in the Diagnosis of Dens Invaginatus: Case Report

“…DI primarily occurs in permanent dentition; however, cases have been reported in supernumerary teeth, microdontia, macrodontia, hypodontia, oligodontia, taurodontism, fusion and germination (Hülsmann;Neves et al, 2010;Capar et al;Zubizarreta Macho et al). The maxillary teeth are more commonly affected than mandibular teeth (Bansal & Pratap).…”

“…Regarding to the crown morphology of the teeth with DI, it may vary ranging from the most unusual and different shapes with a multitude of shapes and sizes (Neves et al; Kfir et al;Vier-Pelisser et al, 2014;Zubizarreta Macho et al), such as a greater buccolingual diameter, grooves, slots, slight deformations, conical shape, plug shape, barrel shape or talon cusp shape (Neves et al; Durack & Patel; Kfir et al; Zubizarreta Macho et al). In the present case reported, the tooth presented with the conoid form.…”

“…Thus, early diagnosis is essential to avoid more complex treatments (Ceyhanli et al; Capar et al). The treatment options for DI include preventive sealing or filling of the invagination, surgical or nonsurgical root canal treatment, intentional replantation, and extraction (Bansal & Pratap;Kaneko et al, 2011;Pradeep et al;Jaya et al;Kfir et al;Brooks & Ribera;Capar et al;Zubizarreta Macho et al). According to Vier-Pelisser et al, (2014) extraction is indicated in teeth with large anatomical irregularities, which precludes endodontic and supernumerary treatment.…”

“…According to the literature, the frequency varies from 0.04 % to 10 % (Hovland, 1977;Hülsmann;Pradeep et al;Jaya et al;Brooks & Ribera, 2014;Ceyhanli et al, 2014;Kaya-Büyükbayram et al;Teixeidó et al;Zubizarreta Macho et al, 2015), predominating in female (3:1) (Alani & Bishop, 2008;Mishra et al), affecting either the deciduous or the permanent dentition (Alani & Bishop; Jaya et al). The most affected permanent teeth are the maxillary lateral incisors (Oehlers, 1957;Cohenca & Berg, 2013;Jaya et al;Kfir et al;Brooks & Ribera;Ceyhanli et al;Kaya-Büyükbayram et al, Muppa et al;Vier-Pelisser et al, 2014;Capar et al;Zubizarreta Macho et al;Nosrat & Schneider), frequently bilaterally (43 %) (Hülsmann; Durack & Patel; Mishra et al; Pradeep et al; Cohenca & Berg; Jaya et al; Zubizarreta Macho et al), followed by central incisors, including supernumerary teeth, maxillary cuspids, mandibular incisors, and mandibular premolars affecting the molars rarely (Oehlers; Cohenca & Berg; Jaya et al), rarely affecting the molars (Bansal & Pratap, 2010;Matsusue et al, 2011).…”

“…The type I is an enamel lined minor invagination occurring within the confines of the tooth crown not extending beyond the cementoenamel junction; in type II, the invagination extends apically beyond the cementoenamel junction, but remains confined within it as a blind sac and it may or may not communicate with the dental pulp; in type III, the invagination penetrates through the root, perforating the apical area and having a second foramen in the apical or periodontal area, but there is no immediate communication with the pulp (Oehlers;Kfir et al;Ceyhanli et al;Kaya-Büyükbayram et al;Vier-Pelisser et al, 2014;Capar et al;Zubizarreta Macho et al;Nosrat & Schneider).…”