Management of type IIIb dens invaginatus using a combination of root canal treatment, intentional replantation, and surgical therapy: A case report

Figure 1 Preoperative photograph of the left upper anterior teeth. A: Labial view showing an intact left lateral incisor with a sinus on the distobuccal aspect; B: Palatal view showing tooth 22 with an access cavity; C: Radiograph showing the presence of dens invaginatus (DI) associated with a large periapical lesion; D-F: Cone-beam computed tomography images: Transverse view showing radiolucency surrounding tooth 22 (D), coronal view showing a DI extending to the apex of the root (E), and sagittal sections showing DI with a large periapical radiolucency (F); G: Three-dimensional reconstruction indicating loss of labial cortical plate.

Figure 2 Canal disinfection and intentional replantation. A: Radiographic image showing that tooth 22 was placed with hydroxide paste; B: Radiographic image of tooth 22 at the 2-wk recall; C: Tooth 22 was extracted, and the apex of the tooth was resected; D: Obturation of root canal space and retroseal of the apex with iRoot BP; E: Replantation of tooth 22 with a composite resin splint; F: Radiographic image of the replantation of tooth 22 (red arrow indicates the boundaries of the lesion).

Figure 3 Intraoral examination after 6 mo and surgical treatment. A: Labial view showing the left lateral incisor with a sinus on the mesiobuccal aspect; B: Radiograph image showing enlargement of a large periapical radiolucency (red arrow) around the mid-root of tooth 22; C: A gutta percha was placed into the sinus of tooth 22; D: Radiograph of tooth 22 with a gutta percha point in the sinus tract; E: Surgical confirmation of the L-shaped pit on the mid-root surface (black arrow); F: Postoperative radiograph.

Figure 4 Follow-up photographs and radiograph. A: Three-year recall labial view; B: Three-year recall palatal view; C: Three-year recall radiograph. The obturated lateral canal was visualized; D: Sagittal sections showing bony healing; E: Three-dimensional reconstruction indicating continuous bony plates.