Type 2 Dens Invaginatus in a Maxillary Lateral Incisor: A Case Report of a Conventional Endodontic Treatment

Dens invaginatus is a rare malformation of the teeth resulting from the invagination of the tooth crown before biological mineralization occurs. In most cases, the thin or incomplete enamel lining of the invagination cannot prevent the entry of bacteria into the pulp, which leads to pulp necrosis with an eventual periapical inflammatory response. The treatment options include preventive sealing or filling of the invagination,root canal treatment, endodontic apical surgery and extraction. The root canal treatment of such teeth is often complicated because of their anatomical complexity. This case describes a successful non-surgical endodontic treatment of a maxillary lateral incisor with type 2 dens invaginatus with a large periradicular lesion. At follow-up examinations after 6 and 12-months, the tooth was asymptomatic and the healed lesion was evident radiographically.

calcium hydroxide, dens invaginatus, root canal treatment

1. Sübay R K, Kayatas M. Dens invaginatus in an immature maxillary lateral incisor: a case report of complex endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 102: e37–41, 2006.

2. Sathorn C, Parashos P. Contemporary treatment of class II dens invaginatus. Int Endod J, 40: 308–316, 2007.

3. Hülsmann M. dens invaginatus: aetiology, classification, prevalence, diagnosis, and treatment considerations. Int Endod J, 30: 79–90, 1997.

4. Steffen H, Splieth, C. Conventional treatment of dens invaginatus in maxillary lateral incisor with sinus tract: one year follow-up. J Endod, 30: 726–731, 2004.

5. Oehlers F A C. Dens invaginatus. I. Variations of the invagination process and associated anterior crown form. Oral Surg Oral Med Oral Pathol, 10: 1204–1218, 1957.

6. Chen Y H M, Tseng C C, Ham W M. Dens invaginatus: review of formation and morphology with 2 case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 86: 347–352, 1998.

7. Soares J, Santos S, Silveira F, Nunes E. Calcium hydroxide barrier over the apical root-end of a type III dens invaginatus after endodontic and surgical treatment. Int Endod J, 40: 146–155, 2007.

8. Pai S F, Yang S F, Lin L M. Nonsurgical endodontic treatment of dens invaginatus with large periradicular lesion: a case report. J Endod, 30: 448–451, 2004.

9. Silva Neto U X da, Hirai V H G , Papalexiou V, Gonçalves S B, Westphalen V P D, Bramante C M, Martins W D. Combined endodontic therapy and surgery in the treatment of dens invaginatus type 3: case report. J Can Dent Assoc, 71: 855–858, 2005.

10. Gound T G, Maixner D. Nonsurgical management of a dilacerated maxillary lateral incisor with type III dens invaginatus: a case report. J Endod, 30: 448–451, 2005.

11. Jaramillo A, Fernández R, Villa P. Endodontic treatment of dens invaginatus: a 5-year follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 101: e15–21, 2006.

12. Fava L R G. The double-flared technique: an alternative for biomechanical preparation. J Endod, 9: 76–80, 1983.

13. Yeh S C, Lin Y T, Lu S Y. Dens invaginatus in the maxillary lateral incisor. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 87: 628–631, 1999.

14. Ikeda H, Yoshioka T, Suda H. Importance of clinical examination and diagnosis: a case of dens invaginatus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 79: 88–91, 1995.

15. Hülsmann M, Hengen G O. Severe dens invaginatus malformation: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 82: 456–458,1996.

16. Er K, Kufltarc› A, Özan U, Tafldemir T. Nonsurgical endodontic treatment of dens invaginatus in a mandibular premolar with large periradicular lesion: a case report. J Endod, 33: 322–324, 2007.

17. Desai R S, Vanaki S S, Puranik R S, Rashmi G S, Nidawani P. An unusual combination of idiopathic generalized shortroot anomaly associated with microdontia, taurodontia, multiple dens invaginatus, obliterated pulp chambers and infected cyst: a case report. J Oral Pathol Med, 35: 407–409, 2006.

18. Kronfeld R. Dens in dente. J Dent Res, 14: 49–66, 1934.

19. Nallapati S. Clinical management of a maxillary lateral incisor with vital pulp and type 3 dens invaginatus: a case report. J Endod, 30: 672–674, 2004.

20. Grossman L I. Endodontic case reports. Dent Clin North Am, 18: 509–528, 1974.

21. Creaven J. Dens invaginatus-type malformation without pulpal involvement. J Endod, 1: 79–80, 1975.

22. Rottstein I, Stabholz A, Heling I, Friedman S. Clinical considerations in the treatment of dens invaginatus. Endod Dent Traumatol, 3: 249–254, 1987.

23. Gonçalves A, Gonçalves M, Oliveira D P, Gonçalves N. Dens invaginatus type III: report of a case and 10-year radiographic follow-up. Int Endod J, 10: 873–879, 2002.

24. Fisher M A, Berzins D W, Bahcall J K. An in vitro comparison of bond strength of various obturation materials to root canal dentin using a push-out test design. J Endod, 33: 856–858, 2007.

25. Silva Neto U X, Moraes I G de, Westphalen V P D, Menezes R, Carneiro D, Fariniuk L F. Leakage of 4 resin-based root-canal sealers used with a single cone technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 104: e53–57, 2007.

26. Tanomaru-Filho, Jorge E G, Tanomaru J M G, Gonçalves M, P. Radiopacity evaluation of new root canal filling materials by digitalization of images. J Endod, 33: 249–251, 2007.