Endodontic re-treatment and restorative treatment of a dens invaginatus type II through new technologies

Abstract

Background The complex anatomy of dens invaginatus makes access cavity to root canal system difficult, which has an impact on the prognosis of these teeth. A novel technique, based on new technologies, is proposed to make access cavity conservative and guided with minimal dental structure lost. Material and Methods This case report shows the root canal retreatment and the endodontic surgery of a dens invaginatus type II in a left lateral upper incisor previously treated which was affected by a chronic apical abscess and an apical fracture. A Cone Beam Computed Tomography was performed to better diagnosis the dental anatomy. An intraoral scan was performed to get a digital 3D model. A computer-guided implant planning software was used to plan the access cavity and design the splint guided. Finally, the clinical crown was restored by a resin nanoceramic veneer made by a chairside system made up of an intraoral scanning unit and a grinding unit. Last, the authors carried through the endodontic surgery to extract the apical fractured fragment. Results Follow-up appointments at 6, 12 and 18 months showed a radiographic reduction of the periapical lesion and absence of clinical signs. Conclusions The splint guide allowed a guided and conservative access cavity to root canal system. It facilitates the root canal retreatment and improves the prognosis of the teeth with dental malformations. Key words: CAD-CAM, Cone-Beam Computed Tomography, dens in dente, dens invaginatus, dental pulp cavity, endodontics.

Efficacy of Computer-Aided Static Navigation Technique on the Accuracy of Endodontic Microsurgery. A Systematic Review and Meta-Analysis

“…Zubizarreta et al also reported statistical significant differences ( p ˂ 0.05) between the endodontic access cavities planned and performed by computer-aided static navigation techniques with respect to freehand endodontic access cavities at coronal, apical, and angular deviations [ 10 ]. In addition, many authors have used computer-aided static navigation procedures to perform the endodontic access cavity in calcific metamorphosis cases [ 26 , 27 , 28 ] or dental malformations as dens invaginatus [ 29 , 30 ] or dens evaginatus [ 31 ]. Furthermore, computer-aided static navigation techniques have also been used to remove prosthetic fiber post into the root canal system [ 32 , 33 ] and guide prosthetic dental crown preparations [ 34 ].…”

Aspectos atuais da Endodontia guiada

“…3,5,8,[12][13][14][15] Outro benefício promovido pela Endodontia guiada é uma nova forma de se abordar dentes com invaginação ou com evaginação. 6,7,10 Estas malformações dentárias dificultam o sucesso da terapia endodôntica visto que a instrumentação e desinfecção dos canais é mais complexa em virtude da alteração anatômica. Com o uso do endoguide, tornou-se possível acessar essa interface radicular de forma mais prática, assegurando um tratamento satisfatório e eficaz.…”

“…Com o uso do endoguide, tornou-se possível acessar essa interface radicular de forma mais prática, assegurando um tratamento satisfatório e eficaz. 7,10,18 Quando um paciente possui um pino de fibra de vidro insatisfatório, associado a lesão periapical e que requeira remoção, o endoguide pode ser utilizado. Como estes retentores intrarradiculares apresentam adesão à dentina, alto grau de resistência e cor semelhante à dentina, sua remoção pode se tornar bastante difícil, podendo ocorrer danos à estrutura dental.…”

Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report

“…Other case reports and one case series have also shown the feasibility and reliability of GET in cases with apical periodontitis as a late complication of dental trauma [ 23 – 31 ]. To our knowledge, there is currently only one guided endodontics case report, which describes a promising 18-month outcome of a dens invaginatus malformation case treated, followed by endodontic surgery and root-end filling with mineral trioxide aggregate [ 30 ].…”