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Jia J, Cheng M, Shi S, Qiao Y. Three-year follow-up case report: root canal treatment combined with intentional replantation for treating type III palatogingival groove in a maxillary lateral incisor. FRONTIERS IN ORAL HEALTH 2025; 5:1467327. [PMID: 39897021 PMCID: PMC11782284 DOI: 10.3389/froh.2024.1467327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 12/26/2024] [Indexed: 02/04/2025] Open
Abstract
Palatogingival groove is a developmental anomaly that can lead to significant periodontal and periapical diseases, particularly in Type III, which extends to the apex and communicates with the periodontal membrane through the apical foramen. This case report details the management of a Type III palatogingival groove in a maxillary lateral incisor, combining root canal treatment and intentional replantation, followed by a 3-year follow-up to assess the mid-term efficacy of this approach. The patient presented with a narrow and deep periodontal pocket on the palatal side, destruction of the palatal root surface and labial bone plate, and a persistent sinus tract. Initial treatment involved controlling the intracanal infection using root canal treatment under a dental microscope. One week later, the tooth was extracted for ex vivo preparation, including apical retrofilling and segmented filling of the root surface groove, before replantation and stabilization with elastic fixation on the labial side. At the 2-month follow-up, the labial sinus tract had completely healed. The palatal area, which initially exhibited a probing depth of 10 mm, demonstrated an 8-mm gain in clinical attachment. Probing revealed no signs of bleeding or pus discharge. Radiographic examinations showed the disappearance of periapical radiolucency. Regular follow-ups at 12, 24, and 36 months indicated no discomfort, with radiographic evidence of new bone formation at the apex and gradual recovery of the periodontal membrane, achieving new periodontal attachment. This case demonstrates that root canal treatment combined with intentional replantation, with a focus on infection control, is an effective treatment method for managing Type III palatogingival groove in maxillary lateral incisors.
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Affiliation(s)
| | | | | | - Yanchun Qiao
- Department of Stomatology, Aerospace Center Hospital, School of Aerospace Clinical Medicine, Peking University, Beijing, China
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Rahman A, Alam S, Zia A, Tiwari RK, Andrabi SMUN, Mahmood M. Non-surgical and guided-bone-regeneration surgical management of Type-3b dens invaginatus with an apico-marginal defect: A case report. Clin Adv Periodontics 2024; 14:276-283. [PMID: 38491757 DOI: 10.1002/cap.10283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND 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). METHODS AND RESULTS 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. CONCLUSIONS 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. KEY POINTS 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.
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Affiliation(s)
- Aaliya Rahman
- Department of Conservative Dentistry & Endodontics, Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - Sharique Alam
- Department of Conservative Dentistry & Endodontics, Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - Afaf Zia
- Department of Periodontics and Community Dentistry, Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - R K Tiwari
- Department of Conservative Dentistry & Endodontics, Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - S Mukhtar Un Nisar Andrabi
- Department of Conservative Dentistry & Endodontics, Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - Maahin Mahmood
- Kothiwal Dental College and Research Centre, Moradabad, India
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Kaya S, Koc A. Radiologic evaluation of associated symptoms and fractal analysis of unilateral dens invaginatus cases. Oral Radiol 2024; 40:484-491. [PMID: 38748387 DOI: 10.1007/s11282-024-00756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/27/2024] [Indexed: 07/07/2024]
Abstract
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.
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Affiliation(s)
- Sema Kaya
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Van Yuzuncu Yil University, Van, Turkey.
| | - Alaettin Koc
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Van Yuzuncu Yil University, Van, Turkey
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Bolhari B, Ghabraei S, Noori F, Hashemi N. Dens evagination and complete invagination in the same tooth with extraoral fistula: A rare case report. Clin Case Rep 2024; 12:e9247. [PMID: 39119030 PMCID: PMC11306110 DOI: 10.1002/ccr3.9247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/21/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
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.
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Affiliation(s)
- Behnam Bolhari
- Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
| | - Sholeh Ghabraei
- Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
| | - Faranak Noori
- Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
| | - Nasim Hashemi
- Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
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Wang J, Niu C, Zhang P, Ran S, Huang Z. Endodontic management considerations for Type III dens invaginatus based on anatomical characteristics: A case series. AUST ENDOD J 2024; 50:377-387. [PMID: 38651624 DOI: 10.1111/aej.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/18/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
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.
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Affiliation(s)
- Jia Wang
- 1. Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chenguang Niu
- 1. Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Pengfei Zhang
- 1. Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shujun Ran
- 1. Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhengwei Huang
- 1. Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
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Li M, Wang G, Zhu F, Jiang H, Yang Y, Cheng R, Hu T, Zhang R. Application of personalized templates in minimally invasive management of coronal dens invaginatus: a report of two cases. BMC Oral Health 2024; 24:592. [PMID: 38778368 PMCID: PMC11110288 DOI: 10.1186/s12903-024-04377-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Treating the coronal dens invaginatus (CDI) with pulp infection commonly involves the removal of invagination, which increases the risk of perforation and fracture, and compromises the tooth structure. Minimally invasive endodontic management of CDI is highly recommended. This report describes two cases of type II CDI with the application of personalized templates. CASE PRESENTATION Two cases of type II CDI, affecting the main root canal in a maxillary canine and a lateral incisor, were diagnosed. A guided endodontics (GE) approach was applied. Cone-beam computed tomography and intraoral scans were imported and aligned in a virtual planning software to design debridement routes and templates. The MICRO principle (which involves the aspects of Mechanical (M) debridement, Irrigation (I), Access cavities (C), Rectilinear routes (R), and Obstruction (O)) was proposed for designing optimal debridement routes for future applications. The templates were innovatively personalized and designed to preserve the tooth structure maximally while effectively debriding the root canal. Root canal treatment with supplementary disinfection was then performed. The follow-up of the two patients revealed favorable clinical and radiographic outcomes. CONCLUSIONS The GE approach could be a feasible method for preserving healthy dental structure while effectively debriding the root canal, thereby achieving successful and minimally invasive endodontic treatment for CDI.
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Affiliation(s)
- Mingming Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Guosong Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Fangzhi Zhu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Han Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yingming Yang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ran Cheng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Tao Hu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - Ru Zhang
- Department of Endodontics, School of Stomatology, Capital Medical University, Beijing, P. R. China.
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LaLonde L, Askar M, Paurazas S. A Novel Diagnostic and Treatment Approach to an Unusual Case of Dens Invaginatus in a Mandibular Lateral Incisor Using CBCT and 3D Printing Technology. Dent J (Basel) 2024; 12:107. [PMID: 38668019 PMCID: PMC11048744 DOI: 10.3390/dj12040107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
| | | | - Susan Paurazas
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (L.L.); (M.A.)
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Wei C, Wang D, Shen L, Lu P, Meng Z, Zhou R. Treatment opinions for dens invaginatus: A case series. Exp Ther Med 2024; 27:138. [PMID: 38476914 PMCID: PMC10928843 DOI: 10.3892/etm.2024.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
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.
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Affiliation(s)
- Chengshi Wei
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Dong Wang
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Lili Shen
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Ping Lu
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Zhen Meng
- Biomedical Laboratory, Medical School of Liaocheng University, Liaocheng, Shandong 252000, P.R. China
| | - Rongjing Zhou
- Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
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Ríos-Osorio N, Quijano-Guauque S, Briñez-Rodríguez S, Velasco-Flechas G, Muñoz-Solís A, Chávez C, Fernandez-Grisales R. Cone-beam computed tomography in endodontics: from the specific technical considerations of acquisition parameters and interpretation to advanced clinical applications. Restor Dent Endod 2024; 49:e1. [PMID: 38449497 PMCID: PMC10912545 DOI: 10.5395/rde.2024.49.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 03/08/2024] Open
Abstract
The implementation of imaging methods that enable sensitive and specific observation of anatomical structures has been a constant in the evolution of endodontic therapy. Cone-beam computed tomography (CBCT) enables 3-dimensional (3D) spatial anatomical navigation in the 3 volumetric planes (sagittal, coronal and axial) which translates into great accuracy for the identification of endodontic pathologies/conditions. CBCT interpretation consists of 2 main components: (i) the generation of specific tasks of the image and (ii) the subsequent interpretation report. A systematic and reproducible method to review CBCT scans can improve the accuracy of the interpretation process, translating into greater precision in terms of diagnosis and planning of endodontic clinical procedures. MEDLINE (PubMed), Web of Science, Google Scholar, Embase and Scopus were searched from inception to March 2023. This narrative review addresses the theoretical concepts, elements of interpretation and applications of the CBCT scan in endodontics. In addition, the contents and rationale for reporting 3D endodontic imaging are discussed.
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Affiliation(s)
- Néstor Ríos-Osorio
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | - Sara Quijano-Guauque
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | - Sandra Briñez-Rodríguez
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | - Gustavo Velasco-Flechas
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | | | - Carlos Chávez
- Postgraduate Endodontics Department, IMED, Guadalajara, México
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Agarwal NS, Singh S, Chandrasekhar P, Kulkarni G, Podar R. Conservative Nonsurgical Approach for Management of a Case of Type II Dens in Dente. Case Rep Dent 2024; 2024:8843758. [PMID: 38204753 PMCID: PMC10776186 DOI: 10.1155/2024/8843758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/07/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Dens in dente is a developmental dental anomaly which poses a challenge for the endodontist due to its complex pulpal anatomy. In this case report, a class 2 dens in dente was managed nonsurgically. A 32-year-old female reported with a palatal swelling and pain in the upper front region of the jaw. On examination, #7 was observed to be malformed and showed a negative pulpal sensibility test. Radiographic and CBCT analysis revealed Ohler's type 2 dens in dente with a periapical radiolucency. In the first visit, invagination was removed using diamond-coated ultrasonic tips, the canal was minimally instrumented, and premixed calcium hydroxide was injected in the canal which accidentally extruded periapically. After two weeks, a draining sinus was observed on the palatal side which when traced, lead to #7. Intracanal dressing was replaced with a mix of powdered calcium hydroxide and saline. The dressing was replaced every two weeks, and radiographs were taken, which revealed the resorption of extruded calcium hydroxide and reduction in the osseous defect. Biodentine was used to obturate the entire canal space. Subsequent follow-up radiographs till 24 months showed significant periapical healing and resorption of extruded calcium hydroxide.
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Affiliation(s)
- Navin S. Agarwal
- Department of Conservative Dentistry and Endodontics, TPCT's Terna Dental College, Nerul, Navi Mumbai, India
| | - Shishir Singh
- Department of Conservative Dentistry and Endodontics, TPCT's Terna Dental College, Nerul, Navi Mumbai, India
| | - Padmini Chandrasekhar
- Department of Conservative Dentistry and Endodontics, TPCT's Terna Dental College, Nerul, Navi Mumbai, India
| | - Gaurav Kulkarni
- Department of Conservative Dentistry and Endodontics, TPCT's Terna Dental College, Nerul, Navi Mumbai, India
| | - Rajesh Podar
- Department of Conservative Dentistry and Endodontics, TPCT's Terna Dental College, Nerul, Navi Mumbai, India
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Ahmad S, Alam S, Andrabi SMUN, Kumar A. Combined surgical and conservative endodontic management of Oehler's type 3b dens invaginatus aided by guided tissue regeneration. BMJ Case Rep 2023; 16:e255546. [PMID: 37758663 PMCID: PMC10537856 DOI: 10.1136/bcr-2023-255546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
The present case describes the successful healing of a periapical lesion associated with the left maxillary lateral incisor (# 22, Federation Dentaire Internationale) having a type 3b dens invaginatus tooth morphology. The treatment was complicated by the presence of blunderbuss root apex and large periapical lesion (>10 mm) with through and through bone defect (Bucco palatal cortical bone perforation, Von Arx Type 1b). An adolescent boy reported palatal swelling and pus discharge in relation to tooth #22. A thorough clinical and radiographic examination revealed tooth #22 as having a type 3b dens invaginatus with an open apex and a diagnosis of pulp necrosis and acute apical abscess. The case was managed by non-surgical root canal treatment followed by endodontic surgery using principles of guided tissue regeneration. A 5-year recall revealed an asymptomatic functional tooth with complete healing.
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Affiliation(s)
- Sarah Ahmad
- Conservative Dentistry and Endodontics, Dr Z.A Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, India
| | - Sharique Alam
- Conservative Dentistry and Endodontics, Dr Z.A Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, India
| | - Syed Mukhtar-Un-Nisar Andrabi
- Conservative Dentistry and Endodontics, Dr Z.A Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, India
| | - Ashok Kumar
- Conservative Dentistry and Endodontics, Dr Z.A Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, India
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Kalogeropoulos K, Solomonidou S, Xiropotamou A, Eyuboglu TF. Endodontic management of a double-type IIIB dens invaginatus in a vital maxillary central incisor aided by CBCT: A case report. AUST ENDOD J 2023; 49:365-372. [PMID: 35770932 DOI: 10.1111/aej.12651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
Abstract
Type IIIB dens invaginatus presents with diagnostic and treatment related challenges when in need of endodontic management as a consequence of its complex anatomy, especially when presented in a vital tooth with a periapical lesion. Apical periodontitis associated with two type IIIB invaginations in a central maxillary incisor of a 10-year-old patient was diagnosed. A cone-beam computed tomography (CBCT) scan provided essential diagnostic information and steered the treatment plan. The two invaginations were separate, with no communication between them and the pulp. The pulp appeared vital and non-inflamed. Endodontic treatment of the invaginations was carried out without intervention in the pulp. A 4-month follow-up periapical radiograph showed significant shrinkage of the lesion and a 2-year follow-up CBCT scan confirmed its complete healing. The pulp remains vital, responding normally to sensitivity tests. This outcome indicates that preserving the pulp's vitality is achievable through timely diagnosis.
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Affiliation(s)
| | | | | | - Tan Firat Eyuboglu
- Department of Endodontics, School of Dentistry, Istanbul Medipol University, Istanbul, Turkey
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13
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Ghandi M, Jadidi S. Endodontic management of type IIIb dens invaginatus in central incisor: A case report. Clin Case Rep 2023; 11:e7679. [PMID: 37465240 PMCID: PMC10350666 DOI: 10.1002/ccr3.7679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
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.
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Affiliation(s)
- Mostafa Ghandi
- Department of Endodontics, School of DentistryArak University of Medical SciencesArakIran
| | - Soheila Jadidi
- School of DentistryArak University of Medical SciencesArakIran
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14
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Alves Dos Santos GN, Sousa-Neto MD, Assis HC, Lopes-Olhê FC, Faria-E-Silva AL, Oliveira ML, Mazzi-Chaves JF, Candemil AP. Prevalence and morphological analysis of dens invaginatus in anterior teeth using cone beam computed tomography: A systematic review and meta-analysis. Arch Oral Biol 2023; 151:105715. [PMID: 37146389 DOI: 10.1016/j.archoralbio.2023.105715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/29/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To evaluate the prevalence and morphological characteristics of DI using CBCT. METHODS A literature search was performed in PubMed, Embase, Scopus, and Web of Science. Inclusion criteria were randomized clinical trials, cross-sectional studies, and prospective and retrospective cohort studies evaluating the morphological characteristics of DI in anterior teeth using CBCT. Three reviewer authors independently screened the studies, applied the eligibility criteria, assessed the risk of bias, and extracted until September (2022). The risk of bias was evaluated using the Joanna Briggs Institute criteria. Meta-analyses of proportions were used for estimate the prevalence DI according to factors at participant and tooth levels. RESULTS Six studies were included in the meta-analysis. Among 7373 individuals, a prevalence of 7.45 % of DI was observed (n = 258; τ2 = 0.0096; CI of 4.51-11.3; p < 0.05), with no significant influence of sex. Regarding laterality, unilateral DI showed higher mean prevalence (4.30 %; CI of 2.03-7.33). Among the 382 anterior teeth with DI (0.72 %), the most affected tooth was the upper lateral incisor (5.12 %; n = 329; CI of 2.35-8.86; p < 0.001), type I was the most prevalent (0.59 %; CI of 0.24-1.08) and the presence of open apex and periradicular pathology ranged from 4.3 % to 22.72 % and 3.5-77.92 %, respectively. CONCLUSIONS The prevalence of individuals with dens invaginatus was 7.45 %, the most affect tooth was the upper lateral incisor with a prevalence of 5.12 % unilaterally and type I was the most prevalent morphology.
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Affiliation(s)
- Guilherme Nilson Alves Dos Santos
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Helena Cristina Assis
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Fabiane Carneiro Lopes-Olhê
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | | | - Matheus L Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Jardel Francisco Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Amanda Pelegrin Candemil
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
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15
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Yalcin TY, Bektaş Kayhan K, Yilmaz A, Göksel S, Ozcan İ, Helvacioglu Yigit D. Prevalence, classification and dental treatment requirements of dens invaginatus by cone-beam computed tomography. PeerJ 2022; 10:e14450. [PMID: 36523480 PMCID: PMC9745910 DOI: 10.7717/peerj.14450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Turgut Yagmur Yalcin
- Department of Endodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Kıvanç Bektaş Kayhan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Ayca Yilmaz
- Department of Endodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Sevde Göksel
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - İlknur Ozcan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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16
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Tan D, Li ST, Feng H, Wang ZC, Wen C, Nie MH. Intentional replantation combined root resection therapy for the treatment of type III radicular groove with two roots: A case report. World J Clin Cases 2022; 10:6991-6998. [PMID: 36051153 PMCID: PMC9297402 DOI: 10.12998/wjcc.v10.i20.6991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/29/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A radicular groove is an anatomic malformation that usually initiates at the central fossa, extending along the root at varying lengths and depths and predisposes the involved tooth to a severe periodontal defect. Severe grooves that extend to the root apex often lead to complex combined periodontal-endodontic lesions. They are a serious challenge for doctors to diagnose and treat.
CASE SUMMARY In this report, we described a patient with a maxillary lateral incisor with a deep palatogingival groove with two roots, which led to complex combined periodontal-endodontic lesions. Suggested treatment modalities included curettage of the affected tissues, elimination of the groove by grinding and/or sealing with a variety of filling materials, and surgical procedures. In this case, a combination of endodontic therapy, intentional replantation, and root resection were used, which resulted in periodontal/periradicular healing after 12 mo.
CONCLUSION Intentional replantation and root resection offer a predictable procedure and should be considered a viable treatment modality for the management of palatogingival grooves, especially for two-rooted teeth.
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Affiliation(s)
- Dan Tan
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Shi-Ting Li
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Hao Feng
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Zhong-Chao Wang
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Cai Wen
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Min-Hai Nie
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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17
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Radicular variant of dens in dente (RDinD) in a patient undergoing radioisotope therapy. J Taibah Univ Med Sci 2022; 17:1094-1098. [PMID: 36212590 PMCID: PMC9519356 DOI: 10.1016/j.jtumed.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/29/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Dense in dente is a developmental anomaly frequently encountered in permanent maxillary incisors, with a prevalence rate of 0.25–10%. Our review of the scientific literature on a radicular variant of dens in dente (RDinD) in permanent molar teeth identified only two reported cases with a confirmed diagnosis. Here, we report the third case of RDinD, in a 37-year-old woman presenting with nocturnal pain in the left maxillary second molar for 1 week. The patient had a medical history of surgery for papillary thyroid carcinoma followed by radioactive iodine therapy. We established a diagnosis of RDinD with an osteolytic lesion and transverse fracture line along the palatal root of the tooth by using cone beam computed tomography (CBCT). Extraction and periapical curettage of the lesion were performed, and the patient was followed up. In summary, we observed a rare clinical presentation of RDinD in the left maxillary second molar of a 37-year-old female patient.
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18
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Zhang J, Wang Y, Xu L, Wu Z, Tu Y. Treatment of type III dens invaginatus in bilateral immature mandibular central incisors: a case report. BMC Oral Health 2022; 22:28. [PMID: 35120475 PMCID: PMC8815253 DOI: 10.1186/s12903-022-02059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/25/2022] [Indexed: 12/03/2022] Open
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.
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Affiliation(s)
- Jie Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Yuan Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Lei Xu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Zhifang Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China.
| | - Yan Tu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China.
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19
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Retrospective Study of Intentional Replantation for Type Ⅲb Dens Invaginatus with Periapical Lesions. J Endod 2022; 48:329-336. [PMID: 34999093 DOI: 10.1016/j.joen.2021.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION 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 one 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 treatment of type IIIb DI with IR. METHODS 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 comprised of clinical and radiographic examinations, tooth survival and functional status. RESULTS The follow-up period ranged from 4 to 39 months. After IR, eight teeth were functioning properly with no clinical and radiological signs of pathology. The other two teeth had complications after IR comprising recurrence of periapical radiolucency and sinus tract formation in one patient, and development of a mucosal fenestration in another. Both of these patients received additional surgery and showed marked improvements. CONCLUSION 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.
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20
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Wu Q, Li Z, Zhang Y, Peng X, Zhou X. Dental caries and periodontitis risk factors in cleft lip and palate patients. Front Pediatr 2022; 10:1092809. [PMID: 36683789 PMCID: PMC9846248 DOI: 10.3389/fped.2022.1092809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Cleft lip and palate (CLP) is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. Risk factors contributing to CLP may conclude as genetic factors and environmental factors. The anatomical and morphological abnormalities related to CLP are favorable for dental plaque accumulation on the tooth surface. Therefore, patients with CLP undergo poorer oral hygiene and higher susceptibility to dental caries and periodontitis. In this review, we aim to conclude and update probable causes underlying the association between CLP and poor oral health and provide novel ideas of targeted early prevention for such oral diseases.
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Affiliation(s)
- Qinrui Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhengyi Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yixin Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xian Peng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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21
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Siqueira JF, Rôças IN, Hernández SR, Brisson-Suárez K, Baasch AC, Pérez AR, Alves FRF. Dens invaginatus: clinical implications and antimicrobial endodontic treatment considerations. J Endod 2021; 48:161-170. [PMID: 34902355 DOI: 10.1016/j.joen.2021.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023]
Abstract
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 that the enamel lining of the invagination is naturally absent or lost due to 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 include preventive sealing or filling of the invagination, or, if the pulp is affected, therapeutical 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 anatomical 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, pathologic, and technologic considerations.
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Affiliation(s)
- José F Siqueira
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil
| | - Isabela N Rôças
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil
| | - Sandra R Hernández
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil; Department of Endodontics, Francisco Marroquín University, Guatemala City, Guatemala
| | - Karen Brisson-Suárez
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil
| | - Alessandra C Baasch
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil; Department of Endodontics, Santa María University, Caracas, Venezuela
| | - Alejandro R Pérez
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Endochat research group, Rio de Janeiro, RJ, Brazil; Department of Endodontics, University Rey Juan Carlos. Madrid, Spain
| | - Flávio R F Alves
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil.
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22
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Alkadi M, Almohareb R, Mansour S, Mehanny M, Alsadhan R. Assessment of dens invaginatus and its characteristics in maxillary anterior teeth using cone-beam computed tomography. Sci Rep 2021; 11:19727. [PMID: 34611255 PMCID: PMC8492853 DOI: 10.1038/s41598-021-99258-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/22/2021] [Indexed: 01/01/2023] Open
Abstract
This cone-beam computed tomographic (CBCT) study aimed to evaluate the prevalence of dens invaginatus (DI) and its characteristics in maxillary anterior teeth in a Saudi population. A total of 505 CBCT scans were evaluated, including a total of 2790 maxillary anterior teeth. The patients' demographic data, including age and sex, were recorded. The presence of DI and the related characteristics including bilateral occurrence; DI type according to Oehlers classification; and presence of periapical radiolucency, open apex, and/or nearby impacted teeth were analyzed. The associations between DI and the other factors were analyzed using the chi-square and fisher exact tests. DI was detected in 7.3% of the patients and 1.6% of the teeth examined. Most of the DI-affected teeth were maxillary lateral incisors (76.1%), followed by mesiodens (19.6%) and maxillary central incisors (4.3%), while no DI was observed in the maxillary canines. Bilateral DI was found in 24.3% of the affected patients. Oehlers type I DI was the most frequent (80%). Periapical radiolucencies, open apices, and nearby impacted teeth were observed in 10.9%, 4.3%, and 30% of the invaginated teeth, respectively. DI was significantly associated with tooth type (P < 0.0001) but not with sex (P > 0.05). Although most of the DI cases are limited to the crown, CBCT imaging is essential for DI evaluation and management.
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Affiliation(s)
- Manal Alkadi
- Division of Endodontics, Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Rahaf Almohareb
- Division of Endodontics, Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Soad Mansour
- Department of Basic Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohamed Mehanny
- Department of Basic Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Raed Alsadhan
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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The use of antimicrobial photodynamic therapy in the successful management of a nonsurgical complex type II Dens Invaginatus. Photodiagnosis Photodyn Ther 2021; 36:102540. [PMID: 34555534 DOI: 10.1016/j.pdpdt.2021.102540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022]
Abstract
Because of its complex root canal morphology, dens invaginatus (DI) is a developmental anomaly that represents an endodontic challenge to complete cleaning, shaping, and disinfecting the root canal system. The present case report describes the use of antimicrobial photodynamic therapy as an adjunctive treatment in the successful management of nonsurgical complex type II DI in a left maxillary lateral incisor with thin and fragile dentin walls associated with periradicular lesion.
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Print and Try Technique: 3D-Printing of Teeth with Complex Anatomy a Novel Endodontic Approach. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11041511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The purpose of this report is to evaluate the applicability of a novel Print and Try technique in the presence of aberrant endodontic anatomies and to achieve a predictable treatment with improved outcome. According to guidelines, cone beam computed tomography (CBCT) is recommended in the presence of complex anatomies. The volumes were utilized to produce a stereo lithographic (STL) file, from which a 3D-plastic tooth model including a hollow root canal system was obtained. The 3D-patient-specific model facilitates the treatment planning and the trial of therapeutic approaches. Using a transparent material, all the treatment steps could be directly visualized. Subsequently, endodontic therapy could be performed in vivo with reduced operating time and with a better overview. Clinicians benefit from the Print and Try technique when facing a complicated root canal system with reduced stress and higher chances of success. In aberrant endodontic anatomies, the use of a transparent 3D plastic model, derived from the CBCT dicom, provides an exact preview of clinical challenges that will be met intra-operatively. A patient centered tailored approach to shaping, cleaning, and filling strategies can be applied.
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Leinonen S, Rice D, Leikola J, Heliövaara A. Dental Age, Agenesis, and Morphology in Patients With Operated Single-Suture Craniosynostoses. Cleft Palate Craniofac J 2020; 58:290-298. [PMID: 32815397 DOI: 10.1177/1055665620950145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the dental age, agenesis, and morphology of children with surgically operated single-suture craniosynostoses from orthopantomographs. DESIGN A single-centered cross-sectional observational archival study. PATIENTS A sample of 196 Finnish patients with single-suture craniosynostosis without additional birth defects or syndromes (excluding Muenke syndrome) was included in this study. MAIN OUTCOME MEASURES Dental age was assessed using the method developed by Demirjian et al. and modified by Nyström et al. for the Finnish population. Methods described by Tulensalo et al. and Oehlers et al. were used to study taurodontism and dens invaginatus, respectively. RESULTS The study sample of 149 patients was divided into 3 groups: patients with sagittal synostosis (n = 103), coronal synostosis (n = 25), and metopic synostosis (n = 21). Orthopantomographs taken on average at ages 8.20 to 8.33 were used. The dental ages in different groups were on average 0.37, 0.60, and 0.66 years ahead of normative values, for sagittal, coronal, and metopic groups, respectively. Tooth agenesis, taurodontism, and invaginated teeth were found in all groups with invaginations having a high prevalence. Peg-shaped upper lateral incisors and one geminated lower lateral incisor were also found. CONCLUSIONS These descriptive data may help improve dental care in patients with single-suture craniosynostosis.
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Affiliation(s)
- Sami Leinonen
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| | - David Rice
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Junnu Leikola
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| | - Arja Heliövaara
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
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Assunção GSM, Ocarino NM, Sofal LC, Serakides R. A Rare Case of Radicular Dens Invaginatus (Dens in Dente) in a Dog. J Comp Pathol 2020; 178:46-49. [PMID: 32800108 DOI: 10.1016/j.jcpa.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/28/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
A rare case of radicular dens invaginatus (dens in dente) was found during dental cleaning of a 5-year-old male Rottweiler dog. Radiographic examination revealed intense radiopacity, which extended from the crown to the apical root region of the affected tooth. Macroscopically, the crown of the left maxillary first molar tooth (209) had irregular and deformed buccal and lingual surfaces. Microscopic examination revealed dentine invagination in the pulp cavity in of the crown and root and pulp necrosis. Based on the gross, radiographic and histological findings, a diagnosis of radicular dens invaginatus was made.
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Affiliation(s)
- G S M Assunção
- Laboratório de Patologia do Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária da Universidade Federal de Minas Gerais, Brazil
| | - N M Ocarino
- Laboratório de Patologia do Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária da Universidade Federal de Minas Gerais, Brazil
| | - L C Sofal
- Zoodonto Odontologia Veterinária, Belo Horizonte, Minas Gerais, Brazil
| | - R Serakides
- Laboratório de Patologia do Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária da Universidade Federal de Minas Gerais, Brazil.
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Yan H, Xu N, Wang H, Yu Q. Intentional Replantation with a 2-segment Restoration Method to Treat Severe Palatogingival Grooves in the Maxillary Lateral Incisor: A Report of 3 Cases. J Endod 2019; 45:1543-1549. [PMID: 31676043 DOI: 10.1016/j.joen.2019.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022]
Abstract
The palatogingival groove is a developmental anomaly that typically starts near the cingulum of the maxillary incisors and extends along the roots at varying lengths and depths. Severe grooves that extend to the root apex often lead to complex combined periodontal-endodontic lesions. There are various therapeutic options available for these cases; however, the prognosis is unfavorable. Here, we report the successful surgical treatment of 3 cases of maxillary lateral incisors with severe palatogingival grooves using intentional replantation with a 2-segment restoration method. The teeth were gently extracted, resulting in minimal damage to the periodontal ligament. Under a dental operating microscope, 3 mm of the root end was resected. The palatogingival groove was removed, and root-end preparation was performed with a #700 fissure bur. The groove cavity was connected with root-end cavity to form a class II cavity. The cavity was then filled using a 2-segment restoration method (ie, dividing the cavity into 2 parts by the cementoenamel junction, the coronal portion was filled with a flowable composite while the radicular portion, including the root-end cavity, was filled with bioceramics). The tooth was then replanted into its alveolar bone and splinted with a flexible splint for 7 days. The sinus tract was closed at the 1-week postoperative visit. During subsequent recalls, the teeth showed almost complete periapical healing. In summary, intentional replantation with a 2-segment restoration method is a viable treatment modality for single-rooted teeth with a severe palatogingival groove that extends to the root apex.
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Affiliation(s)
- Hao Yan
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Ning Xu
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Hanguo Wang
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
| | - Qing Yu
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
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Plascencia H, Díaz M, Moldauer BI, Uribe M, Skidmore E. Non-Surgical Endodontic Management of Type II Dens Invaginatus with Closed and Open Apex. IRANIAN ENDODONTIC JOURNAL 2017; 12:534-539. [PMID: 29225655 DOI: 10.22037/iej.v12i3.10861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Dens invaginatus (DI) is a developmental anomaly that poses a significant challenge to the clinician if endodontic treatment is required. The type II (as per Oehlers) form exhibits complex internal anatomy and is frequently associated with incomplete root and apex formation. The purpose of this study is to present two cases of type II DI in the maxillary lateral incisors. In the first case, non-surgical endodontic therapy was performed utilizing calcium hydroxide as an intracanal dressing, showing significant periapical healing of the apical radiolucent area at the six month follow-up. In the second case, the development of the root and apex were affected by pulp necrosis, and the revascularization procedure was performed. Complete resolution of the pre-existing apical radiolucency, apical closure, thickening of the root canal walls, and increase in root length, after 32 months was observed. Early detection of teeth with DI type II and proper exploration of their internal anatomy are key factors for their successful management. As demonstrated in this report, conservative non-surgical endodontic treatment should be the first line of treatment for these cases. The use of revascularization protocols in teeth that develop pulp necrosis and exhibit early stage of root development could be a better alternative than traditional apexification techniques.
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Affiliation(s)
- Hugo Plascencia
- Endodontic Postgraduate Program, CUCS-CUAltos, University of Guadalajara, México
| | - Mariana Díaz
- Endodontic Postgraduate Program, CUCS-CUAltos, University of Guadalajara, México
| | - Bertram Ivan Moldauer
- Adjunct Assistant Professor in Endodontics and Surgical Course Co-Director, Nova Southeastern University, College of Dental Medicine, Fort Lauderdale, Florida, USA
| | - Mario Uribe
- Endodontic Postgraduate Program, CUCS, University of Guadalajara, México
| | - Eddy Skidmore
- Department of Endodontics, Nova Southeastern Universitiy College of Dental Medicine, Fort Lauderdale, Florida, USA
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Ahmed HMA, Dummer PMH. A new system for classifying tooth, root and canal anomalies. Int Endod J 2017; 51:389-404. [DOI: 10.1111/iej.12867] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/09/2017] [Indexed: 01/30/2023]
Affiliation(s)
- H. M. A. Ahmed
- Department of Restorative Dentistry; Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
| | - P. M. H. Dummer
- School of Dentistry; College of Biomedical and Life Sciences; Cardiff University; Cardiff UK
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