Restorative Dentistry and Endodontics

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

DOI QR Code

Successful nonsurgical treatment of type II dens invaginatus with 5 root canals using a self-adjusting file: a case report

  • Received : 2022.12.12
  • Accepted : 2023.02.22
  • Published : 2023.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

The present report describes the endodontic treatment of an Oehlers type II dens invaginatus in a maxillary lateral incisor with 5 root canals, an extremely rare condition. Apical periodontitis and related symptoms were noted. Cone-beam computed tomography was used to aid the diagnosis, reveal tooth morphology, and assist in canal location. The pulp chamber was carefully accessed, and the root canals were explored under magnification. All root canals were prepared with an R25 Reciproc Blue system and sodium hypochlorite (NaOCl) irrigation. After initial preparation, a self-adjusting file (SAF) with NaOCl and ethylenediaminetetraacetic acid was used to complement the disinfection. Additionally, calcium hydroxide medication was applied. Vertical compaction was used to fill the canals with a calcium silicate-based endodontic sealer and gutta-percha. After 12 months, the patient exhibited healing of the periapical region, absence of symptoms, and normal dental function. In conclusion, this nonsurgical treatment protocol was successful in promoting the cure of apical periodontitis. Both complementary disinfection with an SAF and use of calcium hydroxide medication should be considered when choosing the best treatment approach for dens invaginatus with very complex anatomy.

Keywords

Acknowledgement

This study was supported by grants from Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq).

References

  1. Wolcott J, Ishley D, Kennedy W, Johnson S, Minnich S, Meyers J. A 5 yr clinical investigation of second mesiobuccal canals in endodontically treated and retreated maxillary molars. J Endod 2005;31:262-264. https://doi.org/10.1097/01.don.0000140581.38492.8b
  2. Song M, Kim HC, Lee W, Kim E. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod 2011;37:1516-1519. https://doi.org/10.1016/j.joen.2011.06.032
  3. Nosrat A, Schneider SC. Endodontic management of a maxillary lateral incisor with 4 root canals and a dens invaginatus tract. J Endod 2015;41:1167-1171. https://doi.org/10.1016/j.joen.2015.02.013
  4. 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 contd. https://doi.org/10.1016/0030-4220(57)90077-4
  5. Rotstein I, Stabholz A, Heling I, Friedman S. Clinical considerations in the treatment of dens invaginatus. Endod Dent Traumatol 1987;3:249-254. https://doi.org/10.1111/j.1600-9657.1987.tb00632.x
  6. Goncalves A, Goncalves M, Oliveira DP, Goncalves N. Dens invaginatus type III: report of a case and 10-year radiographic follow-up. Int Endod J 2002;35:873-879. https://doi.org/10.1046/j.1365-2591.2002.00575.x
  7. 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
  8. Metzger Z, Teperovich E, Zary R, Cohen R, Hof R. The self-adjusting file (SAF). Part 1: respecting the root canal anatomy--a new concept of endodontic files and its implementation. J Endod 2010;36:679-690. https://doi.org/10.1016/j.joen.2009.12.036
  9. Matherne RP, Angelopoulos C, Kulild JC, Tira D. Use of cone-beam computed tomography to identify root canal systems in vitro. J Endod 2008;34:87-89. https://doi.org/10.1016/j.joen.2007.10.016
  10. Nagendrababu V, Chong BS, McCabe P, Shah PK, Priya E, Jayaraman J, Pulikkotil SJ, Setzer FC, Sunde PT, Dummer PM. PRICE 2020 guidelines for reporting case reports in endodontics: a consensus-based development. Int Endod J 2020;53:619-626. https://doi.org/10.1111/iej.13285
  11. 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
  12. Koteeswaran V, Chandrasekaran S, Natanasabapathy V. Endodontic management of double dens invaginatus in maxillary central incisor. J Conserv Dent 2018;21:574-577. https://doi.org/10.4103/JCD.JCD_93_18
  13. Bishop K, Alani A. Dens invaginatus. Part 2: clinical, radiographic features and management options. Int Endod J 2008;41:1137-1154.
  14. Metzger Z. The self-adjusting file (SAF) system: an evidence-based update. J Conserv Dent 2014;17:401-419. https://doi.org/10.4103/0972-0707.139820
  15. Siqueira JF Jr, Alves FR, Almeida BM, de Oliveira JC, Rocas IN. Ability of chemomechanical preparation with either rotary instruments or self-adjusting file to disinfect oval-shaped root canals. J Endod 2010;36:1860-1865. https://doi.org/10.1016/j.joen.2010.08.001
  16. Paque F, Peters OA. Micro-computed tomography evaluation of the preparation of long oval root canals in mandibular molars with the self-adjusting file. J Endod 2011;37:517-521. https://doi.org/10.1016/j.joen.2010.12.011
  17. Metzger Z, Teperovich E, Cohen R, Zary R, Paque F, Hulsmann M. The self-adjusting file (SAF). Part 3: removal of debris and smear layer-a scanning electron microscope study. J Endod 2010;36:697-702. https://doi.org/10.1016/j.joen.2009.12.037
  18. Rocas IN, Provenzano JC, Neves MS, Alves FR, Goncalves LS, Siqueira JF Jr. Effects of calcium hydroxide paste in different vehicles on bacterial reduction during treatment of teeth with apical periodontitis. J Endod 2023;49:55-61. https://doi.org/10.1016/j.joen.2022.10.008
  19. Vera J, Siqueira JF Jr, Ricucci D, Loghin S, Fernandez N, Flores B, Cruz AG. One- versus two-visit endodontic treatment of teeth with apical periodontitis: a histobacteriologic study. J Endod 2012;38:1040-1052. https://doi.org/10.1016/j.joen.2012.04.010
  20. Leonardo MR, Almeida WA, Ito IY, da Silva LA. Radiographic and microbiologic evaluation of posttreatment apical and periapical repair of root canals of dogs' teeth with experimentally induced chronic lesion. Oral Surg Oral Med Oral Pathol 1994;78:232-238. https://doi.org/10.1016/0030-4220(94)90153-8
  21. Hernandez SR, Perez AR, Baasch AC, Brisson-Suarez K, Sellera DP, Ferrari PH, Alberdi JC, Carreira CM, Gomes-Azevedo S, Alves FR, Rocas IN, Siqueira JF Jr. Management of teeth with dens invaginatus and apical periodontitis: a case series. J Am Dent Assoc 2022;153:470-478. https://doi.org/10.1016/j.adaj.2021.10.009
  22. De Rossi A, Carvalho FK, Queiroz AM, Silva RA, Nelson-Filho P, Silva LA. The treatment of a maxillary lateral incisor with unusual morphology with long-term follow-up. Int Endod J 2013;46:1183-1190. https://doi.org/10.1111/iej.12110
  23. Jaramillo A, Fernandez R, Villa P. Endodontic treatment of dens invaginatus: a 5-year follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e15-e21. https://doi.org/10.1016/j.tripleo.2005.08.008
  24. Sundqvist G, Figdor D, Persson S, Sjogren U. Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:86-93. https://doi.org/10.1016/S1079-2104(98)90404-8
  25. Ricucci D, Siqueira JF Jr. Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. J Endod 2010;36:1277-1288. https://doi.org/10.1016/j.joen.2010.04.007
  26. 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