Root canal therapy of an anomalous maxillary central incisor: a case report

Abstract

A case of endodontic conservative treatment of a maxillary central incisor with an atypical crown and Type III dens invaginatus is presented. The greatest difficulty was to locate the root canals due to the atypical internal anatomy. There were not two clear canals, but the coronal pulp chamber showed two entrances to the root canal. The tooth presented a distal periodontal pocket and various lingual radicular grooves. The appearance of the crown was improved by alteration of its dimension using diamond rotary instruments and correction with photopolymerized resin.

Influence of cone beam computed tomography on dens invaginatus treatment planning

“…The Table 1 describes the summary of treatment of different type of dens invaginatus observed in dental literature. 4,6 Ridell et al 16 evaluated the prognosis for pulp survival in the teeth with dens invaginatus subjected to prophylactic invagination treatment. The dental records of all patients referred to the Eastman Dental Institute, Stockolm, Sweed, with diagnosis of dens invaginatus between the years 1969-1997 were reviewed.…”

“…The root canal therapy may present severe difficulties and problems because of the complex anatomy of these teeth. [2][3][4][5][6] Since the second period of 19 th century the dental literature has published about this malformation with the following synonyms: dens in dens, invaginated odontome, dilated gestant odontome, dilated composite odontome, tooth inclusion, dentoid in dens. [1][2][3][4][5][6][7] Hülsmann, 1 based on several studies, presents seven possibilities about aetiology of dens invaginatus malformation and these etiologies are controversial and still today remains unclear.…”

“…[2][3][4][5][6] Since the second period of 19 th century the dental literature has published about this malformation with the following synonyms: dens in dens, invaginated odontome, dilated gestant odontome, dilated composite odontome, tooth inclusion, dentoid in dens. [1][2][3][4][5][6][7] Hülsmann, 1 based on several studies, presents seven possibilities about aetiology of dens invaginatus malformation and these etiologies are controversial and still today remains unclear. These theories about etiology of dens invaginatus have been proposed to explain these dental malformation: growth pressure of dental arch results in buckling of the enamel organ; the invagination results from a focal failure of growth of the internal enamel epithelium while the surrounding normal epithelium continues to proliferate and engulfs the static area; the invagination is a result of a rapid and aggressive proliferation of a part of the internal enamel epithelium invading the dental papilla; Oehlers 8 considered that distortion of the enamel organ during tooth development and subsequent protrusion of a part of the enamel organ will lead to the formation of an enamellined channel ending at the cingulum or occasionally at the incisal tip; the latest might be associated with irregular crown form; a fusion of two tooth-germs; infection; traumatic dental injury; genetic factors.…”

“…This is unfortunate as the presence of an invagination is considered to increase the risk of caries, pulpal pathosis and periodontal inflammation. [2][3][4][5][6] Cone beam computed tomography (CBCT) has permitted lately the third dimension into dentistry, being a benefit to all the areas of dentistry, up to this time had not used the advantages of medical CT, due to lack of specificity. CBCT is an important tool in diagnostic, with non-destructive and non-invasive characteristics, 9,10 and this diagnosis tool allows visualization of a three-dimensional image, in which a new plane has been added: depth.…”

Dens invaginatus: a retrospective study of prophylactic invagination treatment

“…Many case reports on the treatment of DI have been published, most of them describing treatment of pulp necrosis due to DI. The risk of developing pulp complications is considered high in teeth with DI [8,19,20,22,23] and complications are reported to often occur soon after tooth eruption when the tooth has a low grade of root development [24–27]. This mitigates against the long‐time survival of the tooth.…”