Dens Invaginatus : Case Series’ Clinical and Therapeutic Features
Objectives: To present clinical and therapeutic features of dens invaginatus (DI) case series.
Methods: Six patients were referred for endodontic treatments of DI. Clinical and radiological investigations were performed. Treatments were conducted under magnification using a rubber dam. Mechanical preparation with copious NaOCL/EDTA irrigation was used. Elimination of the invaginated tissue was done with endosonic instruments.
Results: Patients’ ages varied from 13 to 26 years old. An overall number of 8 teeth presented DI. In one patient, 3 teeth were involved #12, 22 and 44. The other patients presented each, one DI in tooth 12 (n=2), 11 (n=1) and 22 (n=2). Pulp necrosis was seen in 5 cases. A draining fistula was present in 4 cases. DI types and apical periodontitis (AP) were investigated using retroalveolar radiographs and CBCT. DI type III was seen in 6 teeth, while type I and II were recorded in one case each. AP (PAI from 3 to 5) was present in all cases. In 4 patients, CBCT showed 3D details of the topography of the invagination as well as the extension of the AP when present. Root canal filling was performed using warm or cold thermoplasticized gutta percha. In 4 cases surgical resection of the periapical lesion was performed. Coronal sealing was achieved using composite resin. Complete healing was recorded in 4 teeth after 4 years.
Conclusions: DI can effectively be managed by non surgical endodontic treatment. Microsurgery is indicated when the apical lesion is persistent.