Root resorption and apical breakdown during orthodontic treatment of a maxillary lateral incisor with dens invaginatus

Abstract

A 13-year-old girl was referred for endodontic treatment of a maxillary right lateral incisor with root resorption and apical radiolucency after orthodontic treatment. Radiographically the tooth had an invagination canal (Oehlers' Type III) and responded positively to pulp testing. The invagination canal extending to the lateral resorption was opened. Vital bleeding tissue was found, and the canal was cleaned and obturated. The pulp in the main root canal remained vital. The radiolucent lesion gradually decreased during the 3-year follow-up. The bone resorption seen here, despite vital tissue in the invagination canal, was probably due to osteoclastic activity caused by a low grade chronic infection, influenced by an injury-induced inflammation in the periodontium during orthodontic treatment.

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

“…For type III cases, Grossman (1974) was the first to describe treatment of the invagination only. Subsequent case reports indicate that the invagination in type III cases is most often a separate entity, and that treatment of the invagination in many cases is sufficient (Creaven 1975, Fristad & Molven 1998, Pitt Ford 1998). From a clinical point of view, the type II invaginations often represent the most complicated cases, because pulp pathosis usually requires treatment of both the invagination and the main root canal.…”

Assessment of the prevalence and characteristics of dens invaginatus in a sample of Turkish Anatolian population

“…The pulp in the invaginated canals is predisposed to infection resulting in apical breakdown. This apical breakdown may be aggravated by orthodontic forces (6). Different classifications have been suggested to determine dens invaginatus.…”

Endodontic treatment of dens invaginatus type III with three root canals and open apical foramen

“…Whereas in some cases the isolated endodontic treatment of the invagination canal had been sufficient and maintained the vitality of the pulp (Fristad & Molven 1998, Holtzman 1998, Pitt Ford 1998, Gonçalves et al . 2002), this was not possible in the case presented here as there was pulpal necrosis at the time of initial presentation.…”

“…If prophylactic or restorative treatment is not possible, conventional root canal treatment is the method of choice (Hu È lsmann 1997, Sousa & Bramante 1998. Depending on the type and degree of malformation, endodontic therapy may be con®ned to the invagination, thus preserving the vitality of the pulp (Kaufman et al 1984, Fristad & Molven 1998, Holtzman 1998, Pitt Ford 1998, Tarja  n & Ro  zsa 1999, Gonc Ëalves et al 2002. In other cases, therapy must include both the invagination and the root canals (Walvekar & Behbehani 1997, Chen et al 1998, Yeh et al 1999, Tsurumachi et al 2002.…”