Restorative Dentistry and Endodontics

The Korean Academy of Conservative Dentistry (대한치과보존학회)
권호 표지
DOI QR코드

DOI QR Code

A case report of multiple bilateral dens invaginatus in maxillary anteriors

  • Chung, Shin Hye (Dental Research Institute and Department of Dental Biomaterials, School of Dentistry, Seoul National University) ;
  • Hwang, You-Jeong (Department of Dentistry, CHA Bundang Medical Center, CHA University) ;
  • You, Sung-Yeop ;
  • Hwang, Young-Hye (Department of Endodontic Dentistry, Seoul Dental Hospital for the Disabled) ;
  • Oh, Soram (Department of Conservative Dentistry, Kyung Hee University Dental Hospital)
  • Received : 2019.07.16
  • Accepted : 2019.09.24
  • Published : 2019.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

The present report presents a case of dens invaginatus (DI) in a patient with 4 maxillary incisors. A 24-year-old female complained of swelling of the maxillary left anterior region and discoloration of the maxillary left anterior tooth. The maxillary left lateral incisor (tooth #22) showed pulp necrosis and a chronic apical abscess, and a periapical X-ray demonstrated DI on bilateral maxillary central and lateral incisors. All teeth responded to a vitality test, except tooth #22. The anatomic form of tooth #22 was similar to that of tooth #12, and both teeth had lingual pits. In addition, panoramic and periapical X-rays demonstrated root canal calcification, such as pulp stones, in the maxillary canines, first and second premolars, and the mandibular incisors, canines, and first premolars bilaterally. The patient underwent root canal treatment of tooth #22 and non-vital tooth bleaching. After a temporary filling material was removed, the invaginated mass was removed using ultrasonic tips under an operating microscope. The working length was established, and the root canal was enlarged up to #50 apical size and obturated with gutta-percha and AH 26 sealer using the continuous wave of condensation technique. Finally, non-vital bleaching was performed, and the access cavity was filled with composite resin.

Keywords

References

  1. Alani A, Bishop K. Dens invaginatus. Part 1: classification, prevalence and aetiology. Int Endod J 2008;41:1123-1136. https://doi.org/10.1111/j.1365-2591.2008.01468.x
  2. Oehlers FA. Dens invaginatus (dilated composite odontome). I. Variations of the invagination process and associated anterior crown forms. Oral Surg Oral Med Oral Pathol 1957;10:1204-1218. https://doi.org/10.1016/0030-4220(57)90077-4
  3. Backman B, Wahlin YB. Variations in number and morphology of permanent teeth in 7-year-old Swedish children. Int J Paediatr Dent 2001;11:11-17. https://doi.org/10.1046/j.1365-263x.2001.00205.x
  4. Casamassimo PS, Nowak AJ, Ettinger RL, Schlenker DJ. An unusual triad: microdontia, taurodontia, and dens invaginatus. Oral Surg Oral Med Oral Pathol 1978;45:107-112. https://doi.org/10.1016/0030-4220(78)90232-3
  5. Ekman-Westborg B, Julin P. Multiple anomalies in dental morphology: macrodontia, multituberculism, central cusps, and pulp invaginations. Report of a case. Oral Surg Oral Med Oral Pathol 1974;38:217-222. https://doi.org/10.1016/0030-4220(74)90059-0
  6. Ruprecht A, Batniji S, Sastry KA, el-Neweihi E. The incidence of dental invagination. J Pedod 1986;10:265-272.
  7. Siraci E, Gungor HC, Cehreli ZC. Dens invaginatus and talon cusp co-occurring in a mandibular central incisor: a case report. J Dent Child (Chic) 2008;75:177-180.
  8. Nagaveni NB, Umashanikara KV, Vidyullatha BG, Sreedevi S, Radhika NB. Permanent mandibular incisor with multiple anomalies - report of a rare clinical case. Braz Dent J 2011;22:346-350. https://doi.org/10.1590/S0103-64402011000400015
  9. Anthonappa RP, Yiu CK, King NM. A novel combination of dens evaginatus and dens invaginatus in a single tooth--review of the literature and a case report. J Clin Pediatr Dent 2008;32:239-242. https://doi.org/10.17796/jcpd.32.3.ex27q2022065pt48
  10. Kerebel B, Kerebel LM, Daculsi G, Doury J. Dentinogenesis imperfecta with dens in dente. Oral Surg Oral Med Oral Pathol 1983;55:279-285. https://doi.org/10.1016/0030-4220(83)90328-6
  11. Subramaniam A, Kamtane S, Desai R, Thakre G. Dens in dente of maxillary third molar. J Oral Maxillofac Pathol 2008;12:88-89. https://doi.org/10.4103/0973-029X.44617
  12. Knezevic G. Dens invaginatus with ameloblastoma. Oral Surg Oral Med Oral Pathol 1980;49:274. https://doi.org/10.1016/0030-4220(80)90061-4
  13. Conklin WW. Bilateral dens invaginatus in the mandibular incisor region. Oral Surg Oral Med Oral Pathol 1978;45:905-908. https://doi.org/10.1016/S0030-4220(78)80014-0
  14. Hulsmann M. Dens invaginatus: aetiology, classification, prevalence, diagnosis, and treatment considerations. Int Endod J 1997;30:79-90. https://doi.org/10.1111/j.1365-2591.1997.tb00679.x
  15. Capar ID, Ertas H, Arslan H, Tarim Ertas E. A retrospective comparative study of cone-beam computed tomography versus rendered panoramic images in identifying the presence, types, and characteristics of dens invaginatus in a Turkish population. J Endod 2015;41:473-478. https://doi.org/10.1016/j.joen.2014.12.001
  16. Gangwar A, Singal D, Giri KY, Agarwal A, Keerthi SS. An immature type II dens invaginatus in a mandibular lateral incisor with Talon's cusp: a clinical dilemma to confront. Case Rep Dent 2014;2014:826294. https://doi.org/10.1155/2014/826294
  17. Er K, Kustarci A, Ozan U, Tasdemir T. Nonsurgical endodontic treatment of dens invaginatus in a mandibular premolar with large periradicular lesion: a case report. J Endod 2007;33:322-324. https://doi.org/10.1016/j.joen.2006.09.001
  18. Cho WC, Kim MS, Lee HS, Choi SC, Nam OH. Pulp revascularization of a severely malformed immature maxillary canine. J Oral Sci 2016;58:295-298. https://doi.org/10.2334/josnusd.15-0715
  19. Afkar M, Gholamshahi M, Mohammadi M. Nonsurgical treatment of type II dens invaginatus in a maxillary lateral incisor using cone-beam computed tomography. Iran Endod J 2018;13:132-134.
  20. Zhang P, Wei X. Combined therapy for a rare case of type III dens invaginatus in a mandibular central incisor with a periapical lesion: a case report. J Endod 2017;43:1378-1382. https://doi.org/10.1016/j.joen.2017.03.002
  21. Brooks JK, Ribera MJ. Successful nonsurgical endodontic outcome of a severely affected permanent maxillary canine with dens invaginatus Oehlers type 3. J Endod 2014;40:1702-1707. https://doi.org/10.1016/j.joen.2014.06.008
  22. Schwartz SA, Schindler WG. Management of a maxillary canine with dens invaginatus and a vital pulp. J Endod 1996;22:493-496. https://doi.org/10.1016/S0099-2399(96)80086-0
  23. Vier-Pelisser FV, Morgental RD, Fritscher G, Ghisi AC, Borba MG, Scarparo RK. Management of type III dens invaginatus in a mandibular premolar: a case report. Braz Dent J 2014;25:73-78. https://doi.org/10.1590/0103-6440201302351
  24. Canger EM, Kayipmaz S, Celenk P. Bilateral dens invaginatus in the mandibular premolar region. Indian J Dent Res 2009;20:238-240. https://doi.org/10.4103/0970-9290.52887
  25. Gallacher A, Ali R, Bhakta S. Dens invaginatus: diagnosis and management strategies. Br Dent J 2016;221:383-387. https://doi.org/10.1038/sj.bdj.2016.724
  26. Shadmehr E, Farhad AR. Clinical management of dens invaginatus type 3: a case report. Iran Endod J 2011;6:129-132.
  27. Gupta R, Tewari S. Nonsurgical management of two unusual cases of dens in dente. J Indian Soc Pedod Prev Dent 2005;23:190-192. https://doi.org/10.4103/0970-4388.19008
  28. Agrawal PK, Wankhade J, Warhadpande M. A rare case of type III dens invaginatus in a mandibular second premolar and its nonsurgical endodontic management by using cone-beam computed tomography: a case report. J Endod 2016;42:669-672. https://doi.org/10.1016/j.joen.2016.01.001
  29. Teixido M, Abella F, Duran-Sindreu F, Moscoso S, Roig M. The use of cone-beam computed tomography in the preservation of pulp vitality in a maxillary canine with type 3 dens invaginatus and an associated periradicular lesion. J Endod 2014;40:1501-1504. https://doi.org/10.1016/j.joen.2014.01.033
  30. Kharangate N, Figueiredo NR, Fernandes M, Lambor R. Bilateral dens invaginatus in the mandibular premolars - Diagnosis and treatment. Contemp Clin Dent 2015;6:428-431. https://doi.org/10.4103/0976-237X.161911
  31. Vincent-Townend J. Dens invaginatus. J Dent 1974;2:234-238. https://doi.org/10.1016/0300-5712(74)90024-4
  32. Teplitsky P, Singer D. Radicular anomaly of a maxillary canine; endodontic treatment. J Endod 1987;13:81-84. https://doi.org/10.1016/S0099-2399(87)80160-7
  33. Olmez S, Uzamis M, Er N. Dens invaginatus of a mandibular central incisor: surgical endodontic treatment. J Clin Pediatr Dent 1995;20:53-56.
  34. Chaniotis AM, Tzanetakis GN, Kontakiotis EG, Tosios KI. Combined endodontic and surgical management of a mandibular lateral incisor with a rare type of dens invaginatus. J Endod 2008;34:1255-1260. https://doi.org/10.1016/j.joen.2008.07.014