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Dens invaginatus is a developmental dental anomaly that can predispose the tooth to pulp and periradicular disease. Management of this condition can be challenging because of anatomic and microbiologic issues. This case report describes the regenerative endodontic treatment using a strategic antimicrobial protocol for management of an immature maxillary lateral incisor with type-II dens invaginatus associated with apical periodontitis in a 13-year-old patient. The tooth presented with a complex anatomy and was associated with an active sinus tract. Because the true root canal was not negotiable in its coronal part due to the presence of the dens invaginatus, the closed end of the invagination (pseudocanal) was perforated to permit access to the apical segment of the true root canal for cleaning and disinfection. Both the invagination and the true canal were treated using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation, supplementary disinfection with passive ultrasonic irrigation and interappointment calcium hydroxide medication. After 2 exchanges of calcium hydroxide medication, the sinus tract did not disappear, then the antimicrobial protocol was changed to include an antibiotic solution for irrigation and antibiotic paste for intracanal medication. After signs and symptoms disappeared, regenerative endodontic treatment was performed by inducing blood clot formation within the root canal. The coronal canal segment including the invagination was filled with Biodentine. Follow-up including cone-beam computed tomography examination showed complete healing of the apical periodontitis lesion and mineralized tissue formation at the apical portion of the true root canal. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to determine the age-based prevalence of dens invaginatus cases and to learn the radiologic findings. In addition, fractal analysis of the periapical regions of unilateral dens invaginatus cases and contralateral teeth was performed to determine the effect of possible microleakage on fractal dimension. Methods: A total of 136 patients (170 teeth) identified in panoramic radiographs taken for diagnostic purposes between January 2018 and December 2023 at our Department of Oral and Maxillofacial Radiology were included in the study. Data were analysed using IBM SPSS V23. The Chi-square test was used for comparing categorical variables between groups. The relationship between the FD values calculated around the apexes of the teeth with unilateral dens invaginatus and the contralateral teeth was analyzed by paired t test. A significance level of p < 0.050 was adopted. Results: The mean age of the cases was calculated as 28.1 (8–63) years. 66 (48.5%) of the cases were female, and 70 (51.1%) were male. The lateral incisor was the most affected tooth among these cases. Bilateral cases were observed in 34 patients. Type 2 was detected in 93 patients, Type 1 in 35 patients, and Type 3 dens invagination in 8 patients. Dens invaginatus cases were observed in 134 maxillary and 2 mandibular teeth. Periapical lesions were seen in 22 of these cases. Conclusions: Dens invaginatus cases are a congenital anomaly encountered at any age. Early diagnosis is crucial to prevent the loss of pulp vitality due to these invaginations. It should be noted that these invaginations can affect both jaws. However, due to the prevalence of occurrence in the maxillary anterior teeth and asymptomatic nonvitality, particular attention should be paid to evaluating this region. [ABSTRACT FROM AUTHOR]

Balma Guilanyà shelter (north-eastern Iberian Peninsula, Spain) contains a stratigraphic sequence spanning the Late Upper Palaeolithic to early Holocene. During excavations from 1992 to 2008, seventeen human teeth, and several cranial and postcranial bones were unearthed from the layer E (Late Glacial). In this contribution, we report new unpublished dental remains, which add to the previously dental assemblage from level E at Balma Guilanyà. The purpose of this article is to provide an updated description of the morphology of this material, as well as an analysis of the MNI, age at death, and the presence of several pathologies, approaching it from a holistic vision of the teeth assemblage from the Late Glacial. This review has made it possible to diagnose a dens invaginatus, the persistence of a deciduous upper central incisor (possibly caused by a mesiodens), teeth with cavities, deep occlusal pits conducive to cariogenesis, an atypical lower second molar and several molars with fused roots. This pattern of dental anomalies attributed to a single individual (Individual III) is not usual among hunter-gatherers who lived 13,000 years ago. Likewise, the presence of enamel hypoplasia in several teeth allows us to discuss this aetiology. These new identifiers derived from the review of the dental assemblage from Balma Guilanyà can help extend our knowledge of dental pathologies and stress markers in Late Glacial Homo sapiens populations in Western Europe. Additionally, an accumulation of teeth attributed to two individuals found in a confined area of the excavation was examined. Potential scenarios were assessed regarding the arrangement of this grouping, which presents challenges in attributing its formation to post-depositional or natural processes. This pattern would have the potential to elucidate behavioural funerary practices among late glacial hunter-gatherer populations. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Successful management of a rare case involving both dens evaginatus and dens invaginatus in the same tooth, monitored over a 24‐month follow‐up. Dens invaginatus (DI) is a congenital dental anomaly characterized by the presence of a tooth that resembles a "tooth within a tooth." Conversely, dens evaginatus (DE) is a developmental anomaly distinguished by an additional tubercle or cusp on the tooth's crown. Both DI and DE can result in pulpal and periapical diseases in the affected tooth. This article presents a case of a healthy 14‐year‐old male with recurrent swelling under the chin and a wound with pus drainage on the right side of the submental area, associated with his left mandibular lateral incisor affected by both DI and DE. Clinical and radiographic examinations revealed that the tooth was necrotic and had a chronic apical abscess. Cone beam computed tomography (CBCT) confirmed Oehlers' type III DI and a talon cusp on the lingual surface of the same tooth. The patient underwent orthograde endodontic treatment. Passive ultrasonic activation of a 5.25% NaOCl solution and a mixture of Ca(OH)2 and a 2% chlorhexidine solution were utilized to effectively clean and eliminate the persistent pus discharge. After the resolution of the patient's symptoms, the apical third of the root canal and the invaginated space were filled with a plug of mineral trioxide aggregate (MTA), while the remaining root canal was filled using a sealer‐based obturation technique. A 24‐month follow‐up visit revealed complete bone regeneration in the previously affected periradicular tissues. [ABSTRACT FROM AUTHOR]

Dens invaginatus (DI) is a developmental anomaly of the teeth characterised by the in‐folding of the enamel into the dentin. Oehlers' Type III DI is the most serious form, in which the inherently invaginated channels communicate with periodontal and dental pulp tissue, increasing the risk of bacterial contamination. However, varying and complex anatomical features make diagnosis and treatment challenging. Conventional endodontic therapies promote healing by avoiding unnecessary interventions (e.g., surgical or other invasive treatments). Radiographic examination can reveal the structural details of such malformations. We obtained multiple procedural details for treating Type III DI based on radiographic analyses from our clinical experience. In addition, we introduce a new classification strategy for the management of Type III DI that is more applicable to treatment needs. This study aimed to discuss the anatomical features and current treatment considerations of Type III DI. [ABSTRACT FROM AUTHOR]

Objective: Dens in dente is a developmental dental malformation with various anatomical traits that make treatment difficult. The importance of a timely and correct diagnosis in determining the most effective treatment approach cannot be overstated. Using three-dimensional (3D) imaging techniques has improved the diagnosis of teeth with complex anatomies, such as dens in dente. This systematic review aimed to determine the different techniques for endodontic management of teeth with Dens in dente having periapical lesions. Materials and Methods: Case reports and case series were identified in databases - PubMed-MEDLINE, Google Scholar, Research Gate, EBSCO-Host, Scopus, and Cochrane Library based on title, abstract, and full text published in the English language between January 1, 2016 and April 30, 2023. Patients who have periapical lesions and dens in dente in their permanent teeth and reporting on the results of nonsurgical or surgical intervention in terms of healing were eligible for this review, while editorial reviews, review papers, abstracts, letters to the editor, and animal studies are all excluded. Case studies on deciduous teeth, dens in dente retreatment, or dens associated with other developmental disorders are also excluded. Three authors evaluated the quality of the included studies. The quality of the included case reports and case series was evaluated using the Joanna Briggs Institute’s Critical Appraisal Checklist for Case Reports and Case Series. Results and Discussion: A total of 28 articles were suitable for inclusion, with 24 case reports and 4 case series. According to the available evidence, the condition is linked to an increased prevalence of pulp disease. Any necessary endodontic treatment may be difficult due to the aberrant anatomy. Early identification and preventive intervention rescued the teeth from further dental diseases. Conclusion: Nevertheless, thorough diagnoses and treatment planning are essential. Maintaining the vitality of the pulp or conserving the tooth using the least invasive way is the guiding principle when choosing a treatment modality. A surgical approach is only needed if the conservative approach fails. In the current systematic review, all cases showed reduction in the size of the periapical lesion or complete periapical healing.

Dens invaginatus (DI) is one of the developmental dental anomalies that results in an invagination of the enamel organ into the dental papila during odontogenesis. The purpose of this study is to report a case of nonsurgical endodontic treatment of an Oehlers type II DI in a right maxillary lateral incisor with an extensive periapical damage, along with the two-year clinical and tomographic follow-up. A 30-year-old patient was referred for endodontic treatment of tooth #12. On clinical examination, a change in the shape and color of the crown was observed. The tooth responded negative to pulp sensibility, percussion, palpation and mobility tests. After tomographic evaluation, an Oehlers type II DI was visualized, in addition to an extensive periradicular lesion. The diagnosis was asymptomatic apical periodontitis. The treatment was carried out in two sessions, through intense enhancement of the auxiliary chemical substance with passive ultrasonic irrigation, XP-Endo Finisher and the use of hydroxide-based intracanal medication. Appropriate treatment in cases with anatomic variations requires an accurate and early diagnosis based on clinical examination and radiographic images. A two-year follow-up of the present case showed that the correct diagnosis associated with appropriate instrumentation techniques, supplementary disinfection, and adequate three-dimensional sealing of the canal with filling material, resulted in regression of the periradicular lesion and bone repair. [ABSTRACT FROM AUTHOR]

Key Clinical Message Successful management of a rare case involving both dens evaginatus and dens invaginatus in the same tooth, monitored over a 24‐month follow‐up. Abstract Dens invaginatus (DI) is a congenital dental anomaly characterized by the presence of a tooth that resembles a “tooth within a tooth.” Conversely, dens evaginatus (DE) is a developmental anomaly distinguished by an additional tubercle or cusp on the tooth's crown. Both DI and DE can result in pulpal and periapical diseases in the affected tooth. This article presents a case of a healthy 14‐year‐old male with recurrent swelling under the chin and a wound with pus drainage on the right side of the submental area, associated with his left mandibular lateral incisor affected by both DI and DE. Clinical and radiographic examinations revealed that the tooth was necrotic and had a chronic apical abscess. Cone beam computed tomography (CBCT) confirmed Oehlers' type III DI and a talon cusp on the lingual surface of the same tooth. The patient underwent orthograde endodontic treatment. Passive ultrasonic activation of a 5.25% NaOCl solution and a mixture of Ca(OH)2 and a 2% chlorhexidine solution were utilized to effectively clean and eliminate the persistent pus discharge. After the resolution of the patient's symptoms, the apical third of the root canal and the invaginated space were filled with a plug of mineral trioxide aggregate (MTA), while the remaining root canal was filled using a sealer‐based obturation technique. A 24‐month follow‐up visit revealed complete bone regeneration in the previously affected periradicular tissues.

Dens invaginatus may be associated with peri-invagination lesions and vital pulp concurrently. This case report examines the successful preservation of vital pulp and minimally invasive treatment of invagination for Oehlers type IIIA dens invaginatus with an extensive periinvagination lesion. A healthy 19-year-old man presented with occasional swelling of the left maxillary anterior region. Pulp vitality tests revealed vital and healthy tooth pulp. CBCT indicated Oehlers type IIIA dens invaginatus with an invagination parallel to the pulp cavity. The diagnosis was type IIIA dens invaginatus with a peri-invagination lesion. The treatment plans involved preservation of the vital pulp and minimally invasive treatment of the invagination. A 5-year follow-up revealed that both healing of the peri-invagination lesion and preservation of the vital pulp had been successful. Pulp vitality can be preserved in type IIIA dens invaginatus associated with a peri-invagination lesion through minimally invasive treatment of the invagination. [ABSTRACT FROM AUTHOR]

Endodontic treatment in dens invaginatus anomaly is associated with challenges in all stages. This case report outlines the therapy provided for tooth #10 with occasional pain. In examinations, tenderness to percussion and touch and non-response to sensibility tests were observed, and pulp necrosis and symptomatic periapical periodontitis were diagnosed. Radiographic evaluation showed a structural anomaly related to the dens invaginatus and the associated periapical lesion. Cone-beam computed tomography confirmed the presence of DI type II. Endodontic treatment combined with photodynamic therapy and active irrigation using a dental operating microscope was successful and radiographic examinations showed periapical healing along with bone formation in 6-month and 1-year follow-ups. [ABSTRACT FROM AUTHOR]

Background: This case report demonstrates the use of three-dimensional (3D) models produced from a cone beam computed tomographic (CBCT) volume to develop a treatment strategy for a rare type of dens invaginatus (DI) in a mandibular incisor. Methods: A patient with DI Type IIIa presented for endodontic treatment. Following CBCT evaluation, the complex morphologic nature of the invagination required additional diagnostic tools for treatment planning. The fabrication of 3D models provided clarity regarding the treatment strategy. Treatment involved intracanal medication with calcium hydroxide Ca(OH)2, nonsurgical root canal therapy (NS-RCT) of the main canal, and endodontic surgery for the DI anomaly using mineral trioxide aggregate (MTA), bone graft, and platelet-rich fibrin (PRF) membrane. Results: The use of 3D models provided an invaluable guide for proper treatment. Complicating factors were diagnosed and planned for accordingly. Conclusions: It is difficult to appreciate the anatomical complexity, the extent, and the nature of the invagination of rare Type III DI morphology. CBCT imaging and 3D models played a critical role in the pre-treatment planning to ensure a predictable outcome. A 3D model is recommended as a diagnostic tool in treating complex cases where the DI morphology is wide, oblique, or the foraminal opening is irregular. [ABSTRACT FROM AUTHOR]

Background Methods and Results Conclusions Key points Dens invaginatus (DI), an unusual developmental anomaly is a challenge for the operating dentist with regard to its diagnosis and treatment. This case report presents the successful management of a Type‐3b DI in a permanent maxillary lateral incisor associated with a large radicular cyst and communicating apico‐marginal defect (Von Arx type IIb).A 19‐year‐old female patient reported pain and palatal swelling. During the clinical examination, tooth #12 exhibited tenderness to percussion, and presented a deep periodontal pocket depth (PPD) of 12 mm, along with grade I mobility. Radiographic examination revealed a large peri‐radicular radiolucency with atypical tooth morphology. Cone beam computed tomography clarified the complicated root canal anatomy to be Type‐3b DI associated with an apico‐marginal defect. The case was managed successfully by non‐surgical endodontic therapy followed by surgical intervention utilizing a guided bone regenerative (GBR) approach. Eighteen‐month follow‐up showed an asymptomatic and functional tooth with a significant reduction in pocket depth. The periapical radiographs showed continued healing of the osseous defect.The successful healing outcome of a challenging case, characterized by a complex DI morphology, a large peri‐radicular lesion, a through‐and‐through defect, and a combined endodontic‐periodontal apico‐marginal defect was achieved through accurate diagnosis, treatment planning, and execution using contemporary endodontic and periodontal treatment techniques. The application of GBR techniques during the surgical phase of treatment may have contributed to the improved regenerative healing outcome in this case, which was initially considered prognostically questionable.Why is this case new information? Type‐3b DI exhibits a complex root canal structure, each case displaying unique characteristics, necessitating a case‐specific treatment plan. In this case report the Type‐3b DI morphology was associated with a large peri‐radicular, through and through defect and combined endodontic periodontal apico‐marginal defect. The treatment approach involved incorporating guided bone regenerative (GBR) principles during the surgical phase. This case report contributes to the existing evidence on the diagnosis and successful management of Type‐3b DI with a concurrent apico‐marginal defect. What are the keys to successful management of this case? The successful management of a prognostically challenging case was achieved through a closely integrated multidisciplinary coordination between the endodontist and periodontist. Utilization of contemporary techniques and tools contributed to the successful management The use of three‐dimensional radiological examination through cone beam computed tomography enabled a precise preoperative assessment, facilitating the formulation of a treatment plan for managing both the Type‐3b DI morphology and the associated peri‐radicular lesion. Employing GBR techniques in peri‐radicular surgery may have assisted in the healing of through‐and‐through periapical defects with concurrent apico‐marginal defects (Von Arx type IIb). What are the primary limitations to the success of this case? A complex root canal anatomy associated with Type‐3b DI morphology A large peri‐radicular through and through defect with concurrent apico‐marginal defect. Difficulty in weekly and long‐term follow‐up of the patient. [ABSTRACT FROM AUTHOR]

Objective: Dens in dente is a developmental dental malformation with various anatomical traits that make treatment difficult. The importance of a timely and correct diagnosis in determining the most effective treatment approach cannot be overstated. Using three‑dimensional (3D) imaging techniques has improved the diagnosis of teeth with complex anatomies, such as dens in dente. This systematic review aimed to determine the different techniques for endodontic management of teeth with Dens in dente having periapical lesions. Materials and Methods: Case reports and case series were identified in databases ‑ PubMed‑MEDLINE, Google Scholar, Research Gate, EBSCO‑Host, Scopus, and Cochrane Library based on title, abstract, and full text published in the English language between January 1, 2016 and April 30, 2023. Patients who have periapical lesions and dens in dente in their permanent teeth and reporting on the results of nonsurgical or surgical intervention in terms of healing were eligible for this review, while editorial reviews, review papers, abstracts, letters to the editor, and animal studies are all excluded. Case studies on deciduous teeth, dens in dente retreatment, or dens associated with other developmental disorders are also excluded. Three authors evaluated the quality of the included studies. The quality of the included case reports and case series was evaluated using the Joanna Briggs Institute’s Critical Appraisal Checklist for Case Reports and Case Series. Results and Discussion: A total of 28 articles were suitable for inclusion, with 24 case reports and 4 case series. According to the available evidence, the condition is linked to an increased prevalence of pulp disease. Any necessary endodontic treatment may be difficult due to the aberrant anatomy. Early identification and preventive intervention rescued the teeth from further dental diseases. Conclusion: Nevertheless, thorough diagnoses and treatment planning are essential. Maintaining the vitality of the pulp or conserving the tooth using the least invasive way is the guiding principle when choosing a treatment modality. A surgical approach is only needed if the conservative approach fails. In the current systematic review, all cases showed reduction in the size of the periapical lesion or complete periapical healing. [ABSTRACT FROM AUTHOR]

This article documents cases of single‐visit pulp revascularisation for dens evaginatus and dens invaginatus, without using intracranial medicaments or antibiotics, aiming to provide a potentially applicable protocol for pulp revascularisation procedure in a single‐visit. Two patients with chief complaints of pain and swelling visited a dental hospital. Radiographs revealed that the causative teeth had an open apex and periapical radiolucency, and the teeth were diagnosed as pulp necrosis and acute apical abscess or symptomatic apical periodontitis. For both cases, single‐visit revascularisation was completed without intracanal medicaments or antibiotics. The patients were periodically recalled to evaluate periapical healing after treatment. The apical lesion healed, and the root dentin thickening was observed. The single‐visit pulp revascularisation procedure without using specific intracanal medicaments can produce clinically favourable results for these dental anomalies. [ABSTRACT FROM AUTHOR]

Background: This case report demonstrates the use of three-dimensional (3D) models produced from a cone beam computed tomographic (CBCT) volume to develop a treatment strategy for a rare type of dens invaginatus (DI) in a mandibular incisor. Methods: A patient with DI Type IIIa presented for endodontic treatment. Following CBCT evaluation, the complex morphologic nature of the invagination required additional diagnostic tools for treatment planning. The fabrication of 3D models provided clarity regarding the treatment strategy. Treatment involved intracanal medication with calcium hydroxide Ca(OH)2, nonsurgical root canal therapy (NS-RCT) of the main canal, and endodontic surgery for the DI anomaly using mineral trioxide aggregate (MTA), bone graft, and platelet-rich fibrin (PRF) membrane. Results: The use of 3D models provided an invaluable guide for proper treatment. Complicating factors were diagnosed and planned for accordingly. Conclusions: It is difficult to appreciate the anatomical complexity, the extent, and the nature of the invagination of rare Type III DI morphology. CBCT imaging and 3D models played a critical role in the pre-treatment planning to ensure a predictable outcome. A 3D model is recommended as a diagnostic tool in treating complex cases where the DI morphology is wide, oblique, or the foraminal opening is irregular.

Key Clinical Message: We described a type IIIb dens invaginatus, its root canal treatment, and results on 3‐ and 12‐month visits. Despite its significant challenges, proper endodontic therapy in such cases can cause positive prognosis and successful outcome. [ABSTRACT FROM AUTHOR]

The superior lateral incisors are primarily affected by the developmental deformity known as dens invaginatus (DI). Oehler's type III DI has the highest complexity rendering a root canal treatment (RCT) an arduous challenge for this type, so early diagnosis and treatment before pulp involvement are important. This report presents two maxillary lateral incisors with type IIIb DI, the left one being associated with a periapical lesion and the right one with normal pulp. A nine-year-old boy was referred to our clinic complaining of mobility of the maxillary left lateral incisor (LLI) associated with gumboil throughout the previous two months. Periapical radiolucency was visible on radiographs, as well as an invagination that crosses the apical foramen from the pulp chamber in both maxillary lateral incisors. The pulp of the main canal of LLI was vital and pseudo canals were necrotized and associated with chronic apical abscess. Based on the condition of the main pulp of maxillary lateral incisors, two separate treatments were carried out. RCT was done only for the pseudo canals in the LLI, while the main root canal was preserved. The right maxillary lateral incisor (RLI) had vital pulp with normal periapical tissue So the invagination was sealed as the tooth was erupting. During the oneyear follow-up period, the development of the root in LLI with a thick root wall and closed apex was observed in the periapical radiograph but pseudo canals became infected and the tooth became symptomatic, therefore retreatment for pseudo canals was carried out. The RLI root was developed and the tooth was clinically asymptomatic, so it didn't need further treatment. Maintaining pulp vitality is crucial for type III Dens invaginated young permanent teeth since it could support root formation and improve long-term prognosis, and in cases with pulp involvement, non-surgical RCT is clinically predictable. [ABSTRACT FROM AUTHOR]

The present case report illustrates a rare occurrence of multiple dental anomalies in a healthy 12-year-old patient including anomalies of shape and number of teeth. The developmental dental anomalies noticed in the present case scenario are dens invaginatus, taurodontism, radix entomolaris, supernumerary teeth, and pulp stones seen in multiple teeth. It is not rare to notice these anomalies individually, but their combination is rare in a single, non-syndromic patient. This report also signifies the importance of thorough extra-intra-oral and radiographic examinations of patients with dental anomalies.

Dens invaginatus (DI) often causes dysmorphic changes in both the crown and root. This case report presents a complicated type 3a DI in a maxillary lateral incisor with labial talon cusp and root bifurcation. Although lingual talon cusp is common in maxillary lateral incisor, labial talon cusp is rare. An auxiliary palatal root in maxillary lateral incisor is also unusual. No such case involving all three variations has been described in the literature. The DI was classified as type B4 according to Schulze and Brand, as it involved division of pulp and root. DI was managed by orthograde MTA, radisectomy and periodontal regeneration was done for the palatal root. Labial talon associated with DI and can lead to early periodontal/pulpal involvement. Type 3 DI can affect the root with marked dilatation and division. Additional palatal root should be carefully detected in type 3a DI and managed with the aid of CBCT. [ABSTRACT FROM AUTHOR]

Background: The clinical management of teeth with complex dens invaginatus (DI) malformations and apical periodontitis may be challenging due to the lack of routine. The aim of this case report is to describe the endodontic treatment of an immature tooth with DI and to discuss strategies for preclinical training for teeth with such malformations. Case report: A 9-year-old male presented with an immature maxillary incisor with DI (Oehlers Type II) and apical periodontitis which was diagnosed by cone beam computed tomography (CBCT). Revitalization was initially attempted but then abandoned after failure to generate a stable blood clot. Nevertheless, considerable increase in both root length and thickness could be detected after medication with calcium hydroxide followed by root canal filling with MTA as an apical plug. Conclusions: The endodontic management of teeth with DI requires thorough treatment planning. In immature teeth, under certain conditions, root maturation may occur even with conventional apexification procedures. From an educational perspective, different strategies including CBCT and 3D-printed transparent tooth models for visualization of the complex internal morphology and redesigned 3D-printed replica with various degrees of difficulty for endodontic training, can be used to overcome the challenges associated with endodontic treatment of such teeth. [ABSTRACT FROM AUTHOR]

Key Clinical Message We described a type IIIb dens invaginatus, its root canal treatment, and results on 3‐ and 12‐month visits. Despite its significant challenges, proper endodontic therapy in such cases can cause positive prognosis and successful outcome.

Objective: To document the clinical, radiographic, and histological characteristics of mandibular first molar teeth with developmental abnormalities previously attributed to dens invaginatus and enamel pearls in dogs. Materials and Methods: Affected mandibular first molar teeth from dogs were evaluated grossly and via intraoral radiography. Endodontically and/or periodontally compromised teeth were extracted and subjected to some combination of micro-computed tomography, histopathology, and immunohistochemistry with anti-amelogenin antibody. Results: Six dogs with developmental abnormalities of mandibular first molar teeth were identified, representing 11 affected teeth. The condition was bilateral in 5 dogs, while in 1 dog, only one mandibular first molar tooth was present. Patient weight ranged from 1.7 to 6 kg (median = 4.09 kg). On intraoral radiographs, root convergence or parallelism was noted in 6 of 11 teeth, and root dilaceration was noted in 3 of 11 teeth. Eight teeth required extraction due to periapical lucencies or periodontitis. On micro-CT, the abnormal teeth were characterized by the presence of abnormal, heterogenous hard tissue with beam attenuation characteristics midway between that of enamel and dentin. Enamel fissures were identified in 4 of 8 teeth, while ectopic radicular enamel was identified in 2 of 8 teeth. The abnormal tissue was traversed by channels measuring 20-40 μm in diameter. Channels communicated with the enamel fissures in 2/8 teeth, the furcation in 2/8 teeth and the pulp in 4/8 teeth. The abnormal tissue was frequently surrounded by disorganized dentin. Histologic features of enamel and dentin were absent from the abnormal tissue and immunohistochemistry to detect amelogenin in the abnormal tissue was negative in all samples. Conclusion: The dental abnormalities described here correspond to a previously unrecognized developmental abnormality involving the mandibular first molar teeth in dogs. The developmental origin of the abnormal tissue could not be ascertained, and further investigations are required to determine the mode of formation, origin of the abnormal tissue, and factors associated with development. These developmental abnormalities more closely resemble molar-incisor malformation, rather than dens invaginatus or enamel pearls as described in humans. The authors propose that affected mandibular first molar teeth simply be referred to as having carnassial tooth malformations.

Aims:Dens invaginatus, a malformation of teeth caused by infolding of the dental papilla during development or invagination of layers of the enamel organ in dental papillae. Its aetiology is unclear. The present study was conducted to investigate the characteristics of the patients with dens invaginatus anomaly.Methods:A single-center, cross-sectional, retrospective study was conducted on male subjects aged 18 to 24 years. Dens invaginatus in maxillary lateral incisors were identified using periapical radiographs. The evaluation was performed on patients with and without abnormalities.Results:A total of 316 records were evaluated and 296 individuals were eligible for the analysis. No abnormality was detected in 210 (70.9%) individuals, whereas 86 individuals (29.1%) had images of dens invaginatus. The abnormalities were bilateral in 59 (19.9%) and unilateral in 27 (9.1%) individuals. Among the 59 individuals with bilateral dens invaginatus, most subjects were from the Marmara region (27.1%). Unilateral dens invaginatus was most frequently detected in the Marmara, Black Sea, and Eastern Anatolia regions.Conclusions:This study showed that up to one-third of young adult males had images of dens invaginatus on an untargeted screening. The prevalence of dens invaginatus varied across different geographical regions of Turkey.

Introduction: dens invaginatus (DI) is a developmental anomaly that increases the risk of dental caries, early pulpal and periodontal infection of affected teeth. Hence early diagnosis is very important to prevent the complications and loss of tooth structure. Aim of this study were to assess the clinical and cone beam computed tomography (CBCT) features of 18 teeth with DI in an institution at Bengaluru city Methods: CBCT images were taken from clinical and radiology data base of department of Oral Medicine and Radiology, Vydehi Institute of Dental Sciences and Research Centre. Clinical and radiographic features were analysed in 18 teeth. Results: Age ranged from 13 to 50 years, with male predominance. The maxillary lateral incisor was the most commonly affected tooth while, most common type of DI was Oehler's type I with periapical cyst and ERR as most common possible complication. Conclusion: CBCT plays important role in timely diagnosis and thus helps in prompt treatment and prevents loss of tooth structure. CBCT gives 3 dimentional assessment of tooth, making easy for Endodontics easy to proceed with their treatment. [ABSTRACT FROM AUTHOR]

Endodontic therapy of dens invaginatus (DI) anomalies is challenging due to difficult access, inadequate cleaning and shaping, and incomplete disinfection of its complicated root canal system. The present case report describes the treatment of tooth #10 with tooth discomfort, intermittent pus discharge, and localized swelling. Sinus tract, mobility, and probing grade 1 were observed. The tooth was tender on palpation and percussion with negative responses to pulp sensibility tests. Radiographic assessments revealed an atypical structure of pulpal anatomy, probably dens invaginatus, associated with a large periapical lesion and severe root curvature. Cone-beam computed tomography confirmed the presence of DI type II. Finally, the diagnosis of pulp necrosis with chronic apical abscess of tooth #10 was made. Combining antimicrobial photodynamic therapy as an adjunctive treatment with different irrigation techniques were effective in nonsurgical endodontic management of the complicated DI type II in a maxillary lateral incisor with a large periradicular lesion and severe root curvature. Six-month and one-year recall radiographic images revealed asymptomatic tooth and progressive osseous healing. [ABSTRACT FROM AUTHOR]

Background. This study aimed the evaluation of the prevalence, characteristics, types of dens invaginatus (DI) and co-observed dental anomalies to understand dental treatment requirements in anterior teeth that are susceptible to developmental anomalies by using cone-beam computed tomography (CBCT). Methods. In this retrospective study, the anterior teeth of 958 patients were evaluated by using CBCT for the presence of DI. The demographic features, types of DI and treatment requirements were also recorded. The association between sex and the presence of DI was evaluated using chi-squared test. Results. Seventy-three DI anomalies were detected in the anterior teeth of 49 patients (18 females, 31 males). The frequency of DI was 5.11% and the most frequently involved teeth were lateral (57.53%). Forty-six teeth were classified as Type I (63.01%), 24 as Type II (32.87%), and three as Type III (4.10%). Apical pathosis was found to be 20.54% in all DIs detected and accounted for all Type III and one-third of Type II. Conclusions. CBCT imaging can be effective in the detection of dental anomalies such as DI and planning for root canal therapy and surgical treatments. Prophylactic interventions might be possible to prevent apical pathosis with the data obtained from CBCT images. [ABSTRACT FROM AUTHOR]

Abstract Background Dens invaginatus (DI) is a developmental anomaly, Oehlers Type III DI is the most complex type and early diagnosis and treatment is complicated and challenging. This report presents a rare case of a type IIIb DI associated with a periapical lesion in bilateral immature permanent mandibular central incisors. Case presentation An eight-year-old boy referred to our clinic manifesting with pain along with swelling in the mandibular incisors for the past one month. Radiographic examination showed periapical radiolucency exhibiting a scantly defined border, as well as an invagination which had a central invaginated canal extending from the pulp chamber throughout the apical foramen in both mandibular central incisors. We performed two different treatment procedures on the basis of the condition of the main pulp of the mandibular central incisors. in which only the invagination root canal was treated in the right mandibular central incisor, while the invagination and main root canals were treated in the left mandibular central incisor. During the 18-month follow-up period, the teeth were clinically asymptomatic. Imaging examinations indicated complete healing of the periapical lesion and revealed that the wall of the root canal was thickened and the open apex was closed. Conclusion For young permanent teeth with type III Dens invaginatus, it is particularly important to keep pulp vitality, which could maintain root development and allow a good long-term prognosis.

This paper discussed a patient with dens invaginatus (DI) in all maxillary incisors that was accompanied by supernumerary tooth and also bifid cingulum, lingual pit, and talon cusp on the other teeth. DI is a rare developmental malformation usually seen in the maxillary lateral incisors of permanent dentition. A healthy 22-year-old Iranian woman was referred for the treatment of carious teeth. Following comprehensive clinical and radiographic examination, that was diagnosed DI affecting all maxillary central and lateral incisors. Left maxillary central incisor was Type I and the other incisors were Type II, according to Oehlers classification. Furthermore, she had supernumerary tooth and Class III malocclusion. All teeth responded to sensibility tests, except right maxillary central incisor that was diagnosed pulp necrosis and asymptomatic apical periodontitis. Conventional root canal therapy was done for the right maxillary central incisor using mineral trioxide aggregate and gutta percha and AH26 sealer by thermoplastic method. After 18 months of follow-up, clinical and radiographical examination revealed periapical healing of the right maxillary central incisor and absence of pulp and periapical pathosis in other incisors. The early recognition of DI, correct diagnosis, and appropriate management of this tooth is essential to ensure favorable treatment outcome.

An abnormal union of two or more tooth germs in the development process results in fusion of teeth. Such clinical situations present a diagnostic dilemma and a challenge in treatment planning. This article reports the endodontic and esthetic management of an atypical permanent maxillary lateral incisor fused with a supernumerary tooth and a coronal dens invaginatus. A 22-year-old female reported an abnormally large and discolored permanent maxillary left lateral incisor (#22). Cone-beam computed tomographic evaluation revealed a complex, labiolingually thin ribbon-shaped canal system in the central portion interconnected with two other canals along with a coronal dens invaginatus. A 2-year follow-up demonstrated satisfactory clinical and radiographic outcomes after the endodontic therapy and a veneer placement on the concerned tooth.

This case report elaborates on the clinical and histopathological features of dens invaginatus in a supernumerary tooth. A 12-year-old female patient had a swelling in the upper jaw associated with mild pain and pus discharge. Intraorally, bony hard and non-tender swelling on the hard palate was present w.r.t., palatally displaced supernumerary tooth. Orthopantomogram revealed tooth-like structure superimposed with mesiodistally inclined 23. Ground and decalcified sections confirmed the diagnosis of dens invaginatus type 2. This study highlights the importance of comprehensive histopathological investigation of such cases along with history and clinical examination, the neglect of which could hamper successful treatment outcomes.

Background This study aimed the evaluation of the prevalence, characteristics, types of dens invaginatus (DI) and co-observed dental anomalies to understand dental treatment requirements in anterior teeth that are susceptible to developmental anomalies by using cone-beam computed tomography (CBCT). Methods In this retrospective study, the anterior teeth of 958 patients were evaluated by using CBCT for the presence of DI. The demographic features, types of DI and treatment requirements were also recorded. The association between sex and the presence of DI was evaluated using chi-squared test. Results Seventy-three DI anomalies were detected in the anterior teeth of 49 patients (18 females, 31 males). The frequency of DI was 5.11% and the most frequently involved teeth were lateral (57.53%). Forty-six teeth were classified as Type I (63.01%), 24 as Type II (32.87%), and three as Type III (4.10%). Apical pathosis was found to be 20.54% in all DIs detected and accounted for all Type III and one-third of Type II. Conclusions CBCT imaging can be effective in the detection of dental anomalies such as DI and planning for root canal therapy and surgical treatments. Prophylactic interventions might be possible to prevent apical pathosis with the data obtained from CBCT images.

Aim: Presentation and discussion of orthodontic-endodontic treatment of a maxillary central incisor diagnosed with infected dens invaginatus (Oehlers' type III) and associated apical periodontitis utilising ultrasonic and hand instruments and the surgical operating microscope as an auxiliary tool for both diagnosis and treatment planning. Materials and methods: This case report describes the diagnosis and conservative treatment of a unilateral case of a maxillary central incisor with an infected type III dens invaginatus and an associated periradicular lesion followed of an orthodontic movement. Results: At the 1-year follow-up examination, clinical and radiographic findings showed that a diligent nonsurgical root canal treatment resulted in satisfactory periradicular healing. Conclusions: The present report demonstrates successful nonsurgical treatment of tooth with a challenging anatomy using contemporary techniques and materials. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the prevalence of dens invaginatus (DI) and its association with periapical lesions (PLs) in a Western Indian population by means of cone-beam computed tomography (CBCT). Materials and methods: CBCT volumes of 5201 subjects were evaluated. Associations among gender, tooth type, DI type (Oehler's classification), and presence of PL were investigated. PL was codified using Estrela's Cone Beam Computed Tomography Periapical Index (CBCTPAI). Chi-square tests and descriptive statistics were used at p = 0.05. Results: Overall, 7048 CBCTs were assessed, containing 19,798 maxillary and mandibular anteriors, of which 77 maxillary teeth demonstrated DI (0.39% of all anteriors). Of all 5201 subjects, 57 had DI (1.1%). Bilateral DI was more common in females than in males (p = 0.046). DI type distribution was as follows: type I (22.1%), type II (61.03%), type IIIa (10.4%), and type IIIb (6.5%), which was significantly different (p < 0.001). Maxillary lateral incisors were the most associated with PL (p < 0.001). Type I was frequently associated with CBCTPAI scores 1 and 2 (absence of PL), whereas types II, IIIa, and IIIb were associated with CBCTPAI scores 3, 4, and 5 (presence of PL). Conclusions: A prevalence of 1.1% identifies DI as a common developmental tooth anomaly in a Western Indian subpopulation. The percentage of maxillary anteriors affected by DI and associated PLs should be considered before diagnosis and treatment planning. Clinical relevance: Knowledge about the prevalence of DI and its subtypes, and their association with/without periapical pathosis may aid clinicians in treatment planning and execution to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Dens invaginatus (DI) is a rare developmental defect in dentistry that results from invagination of the enamel organ into the dental papilla during tooth formation. However, such morphology presents cases that challenge treatment and diagnosis because of the morphology of the canal. The present study reports a case of DI in a 12-year-old boy showing a very unusual clinical and radiographic appearance of maxillary lateral incisors. The flowable composite was used to seal the invagination, and an etchant and a bonding agent were used as part of the preventative or prophylactic clinical therapy that was implemented in this instance. This offers a secure and efficient substitute therapy. This method has the potential to yield the greatest results for patients by combining expertise from endodontics and restorative dentistry., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Patekar et al.)

The association of internal root resorption (IRR) with dens invaginatus is an extremely rare finding, and its incidence may be underestimated, adding to the difficulty of endodontic treatment. A 9-year-old boy was admitted with complaints of swelling and pain. Radiological examination revealed closed apex Oehlers type II dens invaginatus and severe IRR, as well as apical third of two lateral root perforation and lesion. Calcium hydroxide applied in the regenerative endodontic protocol (REP) as intracanal medicament. Differently, bleeding was achieved by irritating the lateral perforation area. However, the tooth showed spontaneous pain and sensitivity to percussion after 2 months. The same REP was performed, but a triple antibiotic paste was used as the intracanal medicament. After 2 years, the tooth was asymptomatic, and radiographic examination revealed the decrease was cared on the previous resorption sites, and one of the openings on the lateral root surface had closed.

Aims: Dens invaginatus, a malformation of teeth caused by infolding of the dental papilla during development or invagination of layers of the enamel organ in dental papillae. Its aetiology is unclear. The present study was conducted to investigate the characteristics of the patients with dens invaginatus anomaly. Methods: A single-center, cross-sectional, retrospective study was conducted on male subjects aged 18 to 24 years. Dens invaginatus in maxillary lateral incisors were identified using periapical radiographs. The evaluation was performed on patients with and without abnormalities. Results: A total of 316 records were evaluated and 296 individuals were eligible for the analysis. No abnormality was detected in 210 (70.9%) individuals, whereas 86 individuals (29.1%) had images of dens invaginatus. The abnormalities were bilateral in 59 (19.9%) and unilateral in 27 (9.1%) individuals. Among the 59 individuals with bilateral dens invaginatus, most subjects were from the Marmara region (27.1%). Unilateral dens invaginatus was most frequently detected in the Marmara, Black Sea, and Eastern Anatolia regions. Conclusions: This study showed that up to one-third of young adult males had images of dens invaginatus on an untargeted screening. The prevalence of dens invaginatus varied across different geographical regions of Turkey. [ABSTRACT FROM AUTHOR]

Dens invaginatus or dens in dente represent anomaly of the developing tooth due to invagination of the enamel organ into the dental papilla. Dens invaginatus is usually diagnosed by standard radiological methods (RVG, OPG, and 3DCBCT). Clinical examination may reveal a mottled, dilated or conical shape of the crown. Endodontic treatment of dens invaginatus can be difficult and complex due to the deviated anatomy. This report describes the successful endodontic treatment of a maxillary lateral incisor that had dens invaginatus and a large periapical lesion. Clinical examination in a 30-year-old patient revealed an acute periapical abscess, and a dens invaginatus type II was diagnosed after radiography. Due to the existing anatomy, endodontic treatment of the main canal was performed through two access cavities, which enabled chemo-mechanical treatment and access to all parts of the root canal. The canal of the invaginated tooth was treated through the third access cavity. [ABSTRACT FROM AUTHOR]

Dens invaginatus is a dental anomaly that can predispose the tooth to pulp and periapical pathology. Different endodontists treated 6 maxillary incisors with dens invaginatus associated with apical periodontitis. Cone-beam computed tomography was used to help with diagnosis and treatment planning in most patients. Four patients received diagnoses of Oehlers type II dens invaginatus and the other 2 as type III. In some patients with type II, the invagination had to be perforated to permit access to the apical part of the true root canal. Both the true canal and the invagination (pseudocanal) were treated in all cases using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation and supplementary disinfection approaches. Calcium hydroxide medication was used in all but 1 case. The root canal and invagination were often filled using thermoplasticized gutta-percha techniques, sometimes using an apical plug with a bioceramic material in teeth with large apical openings. All treated patients had favorable clinical and radiographic outcomes. Regardless of the complex anatomic variations, common strategic therapeutic approaches were identified that might serve as recommendations for proper management of teeth with dens invaginatus and apical periodontitis. These approaches include cone-beam computed tomographic planning, aggressive disinfection using sodium hypochlorite ultrasonic or sonic activation and calcium hydroxide intracanal medication, and thermoplasticized gutta-percha obturation of both the root canal and invagination. [ABSTRACT FROM AUTHOR]

Dens invaginatus or dens in dente represent anomaly of the developing tooth due to invagination of the enamel organ into the dental papilla. Dens invaginatus is usually diagnosed by standard radiological methods (RVG, OPG, and 3DCBCT). Clinical examination may reveal a mottled, dilated or conical shape of the crown. Endodontic treatment of dens invaginatus can be difficult and complex due to the deviated anatomy. This report describes the successful endodontic treatment of a maxillary lateral incisor that had dens invaginatus and a large periapical lesion. Clinical examination in a 30-year-old patient revealed an acute periapical abscess, and a dens invaginatus type II was diagnosed after radiography. Due to the existing anatomy, endodontic treatment of the main canal was performed through two access cavities, which enabled chemo-mechanical treatment and access to all parts of the root canal. The canal of the invaginated tooth was treated through the third access cavity.

Background: The clinical management of teeth with complex dens invaginatus (DI) malformations and apical periodontitis may be challenging due to the lack of routine. The aim of this case report is to describe the endodontic treatment of an immature tooth with DI and to discuss strategies for preclinical training for teeth with such malformations. Case report: A 9-year-old male presented with an immature maxillary incisor with DI (Oehlers Type II) and apical periodontitis which was diagnosed by cone beam computed tomography (CBCT). Revitalization was initially attempted but then abandoned after failure to generate a stable blood clot. Nevertheless, considerable increase in both root length and thickness could be detected after medication with calcium hydroxide followed by root canal filling with MTA as an apical plug. Conclusions: The endodontic management of teeth with DI requires thorough treatment planning. In immature teeth, under certain conditions, root maturation may occur even with conventional apexification procedures. From an educational perspective, different strategies including CBCT and 3D-printed transparent tooth models for visualization of the complex internal morphology and redesigned 3D-printed replica with various degrees of difficulty for endodontic training, can be used to overcome the challenges associated with endodontic treatment of such teeth.

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FGF8, which is specifically expressed in the dental epithelium prior to the E12.5 bud stage, is a key player during odontogenesis, being responsible for the initiation of tooth development. Here, to investigate the impact of persistent FGF8 signaling on tooth development, we forcibly activated FGF8 signaling in the dental epithelium after the bud stage by generating K14-Cre;R26R-Fg8 mice. We found that a unique type of fused supernumerary incisors is formed, although morphologically resembling the features of type II dens invaginatus in humans. Further analysis revealed that ectopically activated epithelial FGF8 alters the cell fate of the incisor lingual outer enamel epithelium, endowing it with odontogenic potential by the activation of several key tooth genes, including Pitx2, Sox2, Lef-1, p38, and Erk1/2, and induces de novo formation of an extra incisor crown lingually in parallel to the original one, leading to the formation of an extra incisor crown and fused with the original incisor eventually. Meanwhile, the overdosed epithelial FGF8 signaling dramatically downregulates the expression of mesenchymal Bmp4, leading to severely impaired enamel mineralization. Based on the location of the extra incisors, we propose that they are likely to be rescued replacement teeth. Our results further demonstrate the essential role of FGF8 signaling for tooth initiation and the establishment of progenitor cells of dental epithelial stem cells during development. [ABSTRACT FROM AUTHOR]

An abnormal union of two or more tooth germs in the development process results in fusion of teeth. Such clinical situations present a diagnostic dilemma and a challenge in treatment planning. This article reports the endodontic and esthetic management of an atypical permanent maxillary lateral incisor fused with a supernumerary tooth and a coronal dens invaginatus. A 22-year-old female reported an abnormally large and discolored permanent maxillary left lateral incisor (#22). Cone-beam computed tomographic evaluation revealed a complex, labiolingually thin ribbon-shaped canal system in the central portion interconnected with two other canals along with a coronal dens invaginatus. A 2-year follow-up demonstrated satisfactory clinical and radiographic outcomes after the endodontic therapy and a veneer placement on the concerned tooth. [ABSTRACT FROM AUTHOR]

In recent years, intentional replantation (IR) has received more attention for its high tooth survival rate and wide range of indications. Type IIIb dens invaginatus (DI) is 1 of the most serious types of tooth malformation and is very challenging to treat. When root end surgery is not feasible, IR may be considered as an alternative to extraction. However, there is little information available on the use of IR for type IIIb DI. Therefore, this study investigated the treatment outcomes and clinical procedures used for the treatment of type IIIb DI with IR. IR was performed to treat 10 patients with type IIIb DI with periapical lesions. Each tooth was examined clinically and radiologically. IR was selected by these patients as their treatment plan after treatment procedures were discussed. An experienced endodontist and an experienced surgeon performed all treatments using the same protocol and surgical technique. Postoperative assessments were composed of clinical and radiographic examinations, tooth survival, and functional status. The follow-up period ranged from 4–39 months. After IR, 8 teeth were functioning properly with no clinical or radiologic signs of pathology. The other 2 teeth had complications after IR comprising the recurrence of periapical radiolucency and sinus tract formation in 1 patient and the development of a mucosal fenestration in another. Both of these patients received additional surgery and showed marked improvements. Our study evaluated the most clinical data to date and showed that IR may be a reliable alternative for type IIIb DI with a periapical lesion. [ABSTRACT FROM AUTHOR]

Background: Dens invaginatus (DI) is a developmental anomaly, Oehlers Type III DI is the most complex type and early diagnosis and treatment is complicated and challenging. This report presents a rare case of a type IIIb DI associated with a periapical lesion in bilateral immature permanent mandibular central incisors. Case presentation: An eight-year-old boy referred to our clinic manifesting with pain along with swelling in the mandibular incisors for the past one month. Radiographic examination showed periapical radiolucency exhibiting a scantly defined border, as well as an invagination which had a central invaginated canal extending from the pulp chamber throughout the apical foramen in both mandibular central incisors. We performed two different treatment procedures on the basis of the condition of the main pulp of the mandibular central incisors. in which only the invagination root canal was treated in the right mandibular central incisor, while the invagination and main root canals were treated in the left mandibular central incisor. During the 18-month follow-up period, the teeth were clinically asymptomatic. Imaging examinations indicated complete healing of the periapical lesion and revealed that the wall of the root canal was thickened and the open apex was closed. Conclusion: For young permanent teeth with type III Dens invaginatus, it is particularly important to keep pulp vitality, which could maintain root development and allow a good long-term prognosis. [ABSTRACT FROM AUTHOR]

Dens invaginatus or dens in dente is a developmental dental anomaly resulting from an invagination of the enamel organ into the dental papilla during odontogenesis. Radiographically, it is usually seen as a radiolucent invagination surrounded by a radiopaque area (enamel) limited to the tooth crown or extending into the root. Because the invagination is opened to the oral cavity, it can retain saliva, food remnants, and bacteria. In conditions where the enamel lining of the invagination is naturally absent or lost because of caries, bacterial cells and products can diffuse from the invagination through the dentin tubules to reach the pulp and cause disease. Management of teeth with dens invaginatus includes preventive sealing or filling of the invagination, or if the pulp is affected, therapeutic options include vital pulp therapy, nonsurgical root canal treatment, apexification or regenerative endodontic procedures, periradicular surgery, intentional replantation, or extraction. It is recommended that the invagination be always approached, regardless of the type of dens invaginatus. The root canal should be treated whenever the pulp is irreversibly inflamed or necrotic. Endodontic management of teeth with dens invaginatus is often tricky because of its anatomic complexity, and special and customized strategies should be devised. This review discusses the endodontic implications of this anomaly and the current treatment recommendations based on anatomic, pathological, and technologic considerations. [ABSTRACT FROM AUTHOR]

This case report elaborates on the clinical and histopathological features of dens invaginatus in a supernumerary tooth. A 12-year-old female patient had a swelling in the upper jaw associated with mild pain and pus discharge. Intraorally, bony hard and non-tender swelling on the hard palate was present w.r.t., palatally displaced supernumerary tooth. Orthopantomogram revealed tooth-like structure superimposed with mesiodistally inclined 23. Ground and decalcified sections confirmed the diagnosis of dens invaginatus type 2. This study highlights the importance of comprehensive histopathological investigation of such cases along with history and clinical examination, the neglect of which could hamper successful treatment outcomes. [ABSTRACT FROM AUTHOR]

Dens invaginatus (DI) is one of the most common developmental anomalies observed in maxillary lateral incisors. An early diagnosis requires thorough clinical knowledge, advanced radiographic evaluation as well as the use of cone beam computed tomography (CBCT) and dental operating microscope (DOM), dictates the successful endodontic management of such teeth. A total of 7 cases with (DI) in maxillary lateral incisors were collected from dental practitioners worldwide, analysed and reported in the present case series. Our aim was to analyse and understand the various morphological patterns of DI in maxillary lateral incisors with their varied treatment protocols employed worldwide. This article illustrates the aberrant morphological patterns and the diverse treatment protocols followed by the clinicians worldwide. The use of biomaterials enhances post-operative healing. Further, a modification in the existing classification has been proposed in this report which would enable the clinicians to easily diagnose, categorise and effectively manage DI. The different treatment protocols employed for the management of DI has been discussed and the use of CBCT and DOM in identifying and managing the anatomical variation of DI were emphasised. [ABSTRACT FROM AUTHOR]