Endodontic Management of a Mandibular Incisor Exhibiting Concurrence of Fusion, Talon Cusp and Dens Invaginatus using CBCT as a Diagnostic Aid

Abstract

Teeth with aberrant anatomy present a challenge to the endodontist. Advanced tools like cone beam computed tomography aid in exploring the details of endodontic architecture in such cases. The aim of this case report is to highlight the advantage of CBCT in endodontic management of teeth with multiple dental anomalies. A mandibular lateral incisor associated with an extraoral sinus tract revealed unusual clinical anatomy. A provisional diagnosis of type III dens in dente was made based on radiographic findings. Considering the complex anatomy, CBCT was advised to get a confirmatory diagnosis. The anatomic details revealed by CBCT differed significantly from the provisional diagnosis. A final diagnosis of concurrence of fusion with a supernumerary tooth, talon cusp and type II dens invaginatus was established and endodontic treatment of the concerned tooth was carried out. Non-surgical endodontic treatment resulted in successful resolution of the sinus tract and healing of the periapical lesion. CBCT, thus proves to be an excellent diagnostic tool for management of teeth with unusual anatomy, paving way for a conservative treatment free of endodontic mishaps.

Complicated Root Canal Morphology of Mandibular Lateral Incisors Is Associated with the Presence of Distolingual Root in Mandibular First Molars: A Cone-beam Computed Tomographic Study in a Taiwanese Population

“…Anatomic variations regarding the prevalence in the number of roots, root canals, and apical foramen in PMLIs have been reported (1,(16)(17)(18)(19)(20)(21)(22)(23)(24)35). These complex anatomic aberrations make PMLIs 1 of the most difficult teeth to treat endodontically (36,37). Morphologic examination of roots and root canal configurations frequently showed PMLIs to have 1 root in 1 canal (1).…”

Dens invaginatus u odontoma dilatado, controversia de una definición. Una revisión de la literatura

“…Debido a todas las variaciones en terminología existentes, el diagnóstico radiográfico permitirá distinguir el grado de invaginación mediante la diferencia de radiodensidades localizadas según la clasificación de Oehlers 26 . Ya que no todas las imágenes permiten evaluar el tipo de malformación y que el diagnóstico de dens in dente suele ser accidental en radiografías convencionales que proporcionan una imagen bidimensional de una estructura tridimensional 32 , el uso de la TCHC es recomendable porque permite evaluar la zona de la invaginación 12 , 29 , 31 , 33 - 35 , 37 .…”