Multiple dens invaginatus affecting maxillary lateral incisors and a supernumerary tooth

Treatment opinions for dens invaginatus: A case series

Dens invaginatus (DI) is a rare congenital dental malformation characterized by enamel or cementum folded into dentine. Such teeth are susceptible to caries, pulp infection or necrosis and periradicular lesion. The complex anatomy of this disease results in difficult treatment and a high rate of therapeutic failure. Therapeutic options, such as debriding and filling invagination, root canal treatment (RCT) and intentional replantation, vary according to the morphology and infection of the involved tooth. The present study reports five cases of DI with chronic apical periodontitis. The treatment strategies and procedures, including RCT, removing the invagination, intentional replantation and surgical treatment, are discussed according to the classification and the condition of pulp and periapical tissue. The study also reports the prognosis: All patients were followed up for ≥12 months and all teeth demonstrated periapical healing and clinical asymptomatic. In summary, appropriate treatment is based on accurate analysis of the anatomical variation in different types of DI and intentional replantation is a reliable and viable treatment to preserve the tooth.

Prevalence, classification and dental treatment requirements of dens invaginatus by cone-beam computed tomography

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.

Management of 'labial' type of dens invaginatus: A rare case report

Dens invaginatus is a developmental anomaly resulting in an infolding of the enamel organ into the dental papilla prior to calcification of the dental tissues. The invagination predisposes the tooth for the development of dental caries. Conventional radiographs do not provide detailed information concerning the three-dimensional image, which would help the clinician in making a confirmatory diagnosis and planning the treatment before undertaking the actual treatment. This report describes a case where Oehlers type II dens invaginatus was diagnosed with the help of spiral computed tomography. The locations of the primary root canal and the invagination were assessed from spiral computed tomography scan images. Usually, the invagination is present on palatal/lingual side. However, in this case, the invagination was unusually located on labial side, which has yet not been reported. The tooth also showed certain unusual morphological features.

A retrospective study of the prevalence and characteristics of dens invaginatus in a sample of the Turkish population

OBJECTIVE

The purpose of this study was to assess the prevalence of dens invaginatus and to classify the types of dens invaginatus in a sample of the Turkish population.

STUDY DESIGN

A retrospective study was performed using periapical and panoramic radiographs of 5355 patients who presented to the Department of Oral Diagnosis and Radiology at the Ondokuz Mayis University Dentistry Faculty between January 2009 and December 2010. Maxillary and mandibular anterior teeth were evaluated for the presence and characteristics of dens invaginatus. Statistical evaluation of the presence of dens invaginatus related to gender was performed by the Pearson chi-squared test.

RESULTS

Dens invaginatus was observed in 116 of 4556 subjects, with a frequency of 2.5%. There was only one periapical lesion in teeth with type I dens invaginatus, but 8.1% of patients with type II and 87.5% of patients with type III dens invaginatus had apical periodontitis at the time of referral. There were 116 (72%) females and 32 (27%) males with dens invaginatus.

CONCLUSION

This data represents the only study carried out in a large population in Turkey, and no dens invaginatus was found in mandibular teeth. The most commonly observed type of dens invaginatus was type I (69.8%).

Radiographic study of the prevalence of dens invaginatus in a sample set of Turkish dental patients

Aim:

The aim of this study was to determine the prevalence of dens invaginatus in a sample of Turkish dental patients.

Materials and Methods:

The sample included 6, 912 panoramic radiographs from different Turkish dental patients. The ages of the patients ranged from 18 to 50 years. A tooth was considered having dens invaginatus if an infolding of a radiopaque ribbon-like structure equal in density to enamel was seen extending from the cingulum into the root canal. Maxillary and mandibular teeth were evaluated on panoramic radiographs to determine the type of dens invaginatus using Oehlers’ classification.

Results:

The overall incidence of patients with dens invaginatus was 0.17%. Dens invaginatus were detected in 15 teeth of a total of 192 150 teeth to give a tooth prevalence of 0.008%. Maxillary lateral incisors were most commonly affected teeth in the mouth (80% of cases), followed by maxillary canine teeth (20% of cases). The bilateral incidence of a symmetrical distribution was 25%.

Conclusion:

The occurrence of dens invaginatus among this Turkish population was rare. Attention should be paid to the presence of dens invaginatus and the treatment problems associated with it.

The prevalence of anterior teeth with dens invaginatus in the western Mediterranean region of Turkey

AIM

To assess the prevalence and type of dens invaginatus in anterior teeth of a selected population and to report associated dental complications.

METHODOLOGY

The records of patients examined in the Department of Paedodontics, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey between 1999 and 2006 were screened and a total of 2477 patients who had complete records with satisfactory radiographs were selected. The type of dens invaginatus and the presence of apical pathosis was determined from radiographs. Other dental abnormalities, syndromes and systemic diseases were noted. Variations in crown shape were also recorded.

RESULTS

Dens invaginatus was detected in 300 out of 2477 patients, with a prevalence of 12%; 82% of affected patients had dens invaginatus bilaterally. Maxillary lateral incisors were the most affected teeth. The majority of the teeth had normal crown morphology (95%). The most commonly seen type of dens invaginatus was type I (94%). Overall 33% of the patients with type III dens invaginatus and 4% of the patients with type II dens invaginatus had apical pathosis. No associations with other systemic diseases and syndromes and some limited association with hypodontia and dens evaginatus were detected.

CONCLUSION

A careful oral examination, radiographs, a suitable treatment plan and follow-up programme are crucial for early diagnosis and treatment for teeth with dens invaginatus.

Dens invaginatus. Part 1: classification, prevalence and aetiology

AIM

To review and discuss the aetiology, prevalence and classification of this dental anomaly together with the morphology of an invagination and the most appropriate nomenclature.

SUMMARY

This review considers the different possible nomenclatures and concludes that dens invaginatus is the most appropriate description. The paper highlights the different reported prevalence figures and concludes that the problem is probably one of the most common of the dental developmental abnormalities with maxillary lateral incisors most commonly affected. The paper suggests that the classification system described by Oehlers (1957a) is probably the most clinically relevant and that the morphological features associated with this problem may increase the risk of pulpal pathology developing and complicate any possible endodontic treatment.

KEY LEARNING POINTS

* The aetiology of dens invaginatus is still unknown, although there is some evidence that it may be genetic in origin. * The problem is probably more prevalent than most clinicians are aware of and this is because of the diagnostic difficulties associated with the anomaly. * The nature of the problem may increase the risk of pulp disease and complicate any root canal treatment.

Dens invaginatus in an immature maxillary lateral incisor: a case report of complex endodontic treatment

This case report presents the surgical endodontic treatment of an Oehlers Class II invaginated immature tooth. In this case, communication between the invagination and the pulp caused pulp necrosis, periapical inflammation, and cessation of root formation. The initial treatment goal was to achieve apexification and then fill both the root canal and the canal of the invagination. After a 6-month treatment with calcium hydroxide dressings, there was no healing radiographically and no sign of a hard tissue barrier in the apex. Periapical surgery with the placement of mineral trioxide aggregate (MTA) root-end filling was deemed successful at the 1-year recall. To treat dens invaginatus, both conventional and surgical endodontic treatment techniques should be considered. In dens invaginatus, conventional endodontic treatment modalities may be unsuccessful because of inadequate debridement and disinfection; however, subsequent periapical surgery and retrofilling with MTA may promote healing.

Non-surgical root canal treatment of Dens invaginatus: reports of three cases

Dens invaginatus is a rare developmental malformation of teeth showing a deep infolding of enamel and dentine which may extend deep into the root. To date, conventional root canal therapy, endodontic surgery and extraction have been reported as treatment modalities, when the pulpo-dentinal complex of such teeth is affected. In the present report, non-surgical endodontic treatment of three maxillary lateral incisors with invaginatus (DI) is discussed. The Tri Auto ZX rotary system was used for shaping the root canals of two affected teeth and the Profile system was used in the third. Teeth with periradicular lesions received calcium hydroxide as an interim therapy. Two teeth were obturated with gutta percha points and AH Plus sealer using cold lateral compaction. In the third case, obturation was accomplished using a coated carrier system (Thermafil) due to the specific shape of the root canal system. Twelve months postoperatively all teeth were asymptomatic with resolution of the periapical radiolucency on two affected teeth, as confirmed radiographically. Healing was achieved without any need for further surgical intervention.

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

AIM

To describe the conservative endodontic treatment and the 1-year follow-up of a permanent maxillary lateral incisor with dens invaginatus.

SUMMARY

Frequently, the root canal treatment of invaginated teeth is challenging because of problems associated with gaining access to the root canals and with variations of canal morphology associated with this type of malformation. The present case describes the complex root canal treatment of dens invaginatus in a maxillary lateral incisor with three root canals (Oehler type III), incomplete apex formation, necrotic pulp and abscess formation. After gaining access to two root canals and the invagination with the help of a dental operating-microscope, the canals and the invagination were instrumented and calcium hydroxide dressing was applied for 6 months. Apexification and osseous bone repair were achieved, and the canals were filled with gutta-percha. A follow-up after 1 year showed that the tooth was free of any clinical symptoms and the periapical condition was normal.

KEY LEARNING POINTS

The present case demonstrated that conservative root canal treatment can be performed successfully even in sever cases of dens invaginatus. The use of a dental operating microscope can help in the management of complicated cases of invaginated teeth through conventional root canal treatment.

Talon cusp causing occlusal trauma and acute apical periodontitis: report of a case

- The talon cusp, or dens evaginatus of anterior teeth, is a relatively rare dental developmental anomaly characterized by the presence of an accessory cusp-like structure projecting from the cingulum area or cemento-enamel junction. This occurs in either maxillary or mandibular anterior teeth in both the primary and permanent dentition. One of the main problems caused by accessory cusps are occlusal interferences. The anomalous cusp even can generate occlusal trauma and reversible acute apical periodontitis of the opposing tooth. This article reports a case of talon cusp affecting the permanent maxillary left lateral incisor that caused clinical problems related to occlusal trauma and apical periodontitis caused by a premature contact. The treatment of the occlusal interference produced by the taloned tooth is described.

Multiple dental anomalies in a young patient: a case report

This case illustrates the management of multiple dental anomalies in a young patient, which included anomalies of number and morphology. Although individually these anomalies are not uncommon, the combination is unusual and highlights the importance of careful clinical and radiographic examination of patients with dental anomalies.

Talon cusp affecting permanent maxillary lateral incisors in 2 family members

The term talon cusp refers to a relatively rare dental anomaly in which an accessory cusplike structure projects from the cingulum area or cement-enamel junction. The condition can occur in either maxillary or mandibular anterior teeth in both the primary and permanent dentitions. This article reports 2 cases of talon cusp affecting consanguineous first cousins: a case of bilateral talon cusps on the permanent maxillary lateral incisors of a 16-year-old girl, and a case of talon cusp on the maxillary permanent lateral incisor of an 11-year-old boy. The talon cusps caused clinical problems that were related to caries or occlusal interferences. The presence of the dental anomaly in 2 members of the same family suggests that genetic inheritance may be a causative (related) factor. Examination of relatives could facilitate early diagnosis of the talon cusp and aid in preventing carious and occlusal problems.

Concomitant hypohyperdontia: simultaneous occurrence of a mesiodens and agenesis of a maxillary lateral incisor

A 13-year-old boy appeared for evaluation with a missing maxillary left lateral incisor. He also had an abnormally shaped tooth in the midline between his maxillary central incisors. This mesiodens had an incompletely developed root. The unusual association of these 2 anomalies is discussed as a possible transposition of the lateral incisor to the mesiodens position.

A case of combined dental development abnormalities: importance of a thorough examination

This report describes a case of combined dental development abnormalities. A patient with a previous ectopically erupted supernumerary maxillary canine presented a new ectopically erupted supernumerary premaxillary tooth with dens invaginatus (Oehlers' type 2) and an aberrant coronal morphology, including a pit in the distal portion of the palatal surface. This tooth would have been diagnosed earlier if a panoramic radiograph had been taken at the first visit 5 months before. This case represents a good example of combined dental development abnormalities, i.e., a numerical anomaly (the supernumerary tooth), an alteration of dental position (the ectopic eruption), an alteration of dental morphology (the aberrant coronal shape), and the invagination. This case highlights the importance of a thorough examination, including complementary radiography, of patients with a dental anomaly.