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Freire AM, Guedes OA, de Deus LB, Mafra PE, Chaves GS, Matias KK, Miguel JG, Freire EEJ, Decurcio DDA. Endoaesthetic Management of Type II Dens Invaginatus Associated With Root Perforation and Apical Abscess: A Case Report. Case Rep Dent 2025; 2025:2909252. [PMID: 40330900 PMCID: PMC12052460 DOI: 10.1155/crid/2909252] [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: 11/25/2024] [Accepted: 04/03/2025] [Indexed: 05/08/2025] Open
Abstract
Dens invaginatus (DI) is a developmental anomaly that affects teeth. This case report demonstrates the successful endoaesthetic management of a Type II DI in the maxillary right lateral incisor (Tooth 12). A 12-year-old female patient presented with pain and swelling in Tooth 12, which had previously been diagnosed with DI and accessed endodontically. The patient was also concerned about the aesthetic appearance of her anterior teeth. Clinical, radiographic, and tomographic findings confirmed Oehler's type II DI, with root perforation and an apical abscess in Tooth 12, as well as pulp necrosis in Tooth 13. Nonsurgical root canal treatment was recommended for both teeth, with additional root perforation repair for Tooth 12. Multiple visits were required for nonsurgical endodontic therapy. During the initial visit, the perforation was identified and sealed, followed by chemomechanical preparation and placement of calcium hydroxide paste. Ten months later, the root canals were filled. After endodontic treatment, the patient underwent in-office bleaching, followed by composite resin veneers on the upper anterior teeth, using the preformed metal matrix technique. This resulted in excellent aesthetic outcomes. At the 2-year follow-up examination, the patient remained asymptomatic, and radiographic assessment showed complete resolution of the periapical lesion. This case highlights the importance of multidisciplinary collaboration, precise treatment planning, and patient-centered care in achieving optimal endoaesthetic results in complex cases.
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Affiliation(s)
| | | | - Lara Borges de Deus
- Department of Stomatology, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Gustavo Silva Chaves
- Department of Oral Biology, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Karolina Kellen Matias
- Department of Oral Biology, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | | | | | - Daniel de Almeida Decurcio
- Department of Endodontics, Evangelical University of Goiás, Anápolis, Goiás, Brazil
- Department of Stomatology, Federal University of Goiás, Goiânia, Goiás, Brazil
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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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ÇAKICI EB, ÇAKICI F. Periapikal sağlık üzerine koronal restorasyonun kalitesine karşı kök kanal tedavisinin kalitesinin etkisi: sistematik derleme ve meta-analiz. ACTA ODONTOLOGICA TURCICA 2022. [DOI: 10.17214/gaziaot.837948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Coria-Bello M, Morales-González FJ. [ Dens invaginatus or dilated odontoma, a definition controversy.]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e061. [PMID: 38465271 PMCID: PMC10919797 DOI: 10.21142/2523-2754-0902-2021-057] [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: 01/31/2021] [Accepted: 03/12/2021] [Indexed: 03/12/2024] Open
Abstract
The invaginate tooth (IT) is an alteration in the development of the dental organ, which occurs as a consequence of invagination of the internal epithelium of the enamel organ. IT is also known as "dens in dente", among other denominations, and presents a series of clinical, histological and imaging characteristics. The most extreme variant of IT has a very complex configuration, and the magnitude of the intussusception has led to it also being called dilated odontoma, being a term that generates confusion in some professionals.While the term odontoma has been reported as a synonym for both IT as well as a new variant of odontomas, there is a difference betweene the two types: one is a developmental anomaly and the other is a growth with a hamartomatous appearance. However, the literature continues to use both terms to define IT, and thus, it is important to know the origin and be aware that the controversy is based on historical and customary references.
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Affiliation(s)
- Mayra Coria-Bello
- Facultad de Odontología, Universidad Nacional Autónoma de México. Ciudad de México, México. Universidad Nacional Autónoma de México Facultad de Odontología Universidad Nacional Autónoma de México Ciudad de México Mexico
| | - Francisco Javier Morales-González
- Facultad de Odontología, Universidad Michoacana de San Nicolás de Hidalgo. Michoacán, México. Universidad Michoacana de San Nicolás Hidalgo Facultad de Odontología Universidad Michoacana de San Nicolás de Hidalgo Michoacán Mexico
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Ma L, Fei B. Comprehensive review of surgical microscopes: technology development and medical applications. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200292VRR. [PMID: 33398948 PMCID: PMC7780882 DOI: 10.1117/1.jbo.26.1.010901] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/04/2020] [Indexed: 05/06/2023]
Abstract
SIGNIFICANCE Surgical microscopes provide adjustable magnification, bright illumination, and clear visualization of the surgical field and have been increasingly used in operating rooms. State-of-the-art surgical microscopes are integrated with various imaging modalities, such as optical coherence tomography (OCT), fluorescence imaging, and augmented reality (AR) for image-guided surgery. AIM This comprehensive review is based on the literature of over 500 papers that cover the technology development and applications of surgical microscopy over the past century. The aim of this review is threefold: (i) providing a comprehensive technical overview of surgical microscopes, (ii) providing critical references for microscope selection and system development, and (iii) providing an overview of various medical applications. APPROACH More than 500 references were collected and reviewed. A timeline of important milestones during the evolution of surgical microscope is provided in this study. An in-depth technical overview of the optical system, mechanical system, illumination, visualization, and integration with advanced imaging modalities is provided. Various medical applications of surgical microscopes in neurosurgery and spine surgery, ophthalmic surgery, ear-nose-throat (ENT) surgery, endodontics, and plastic and reconstructive surgery are described. RESULTS Surgical microscopy has been significantly advanced in the technical aspects of high-end optics, bright and shadow-free illumination, stable and flexible mechanical design, and versatile visualization. New imaging modalities, such as hyperspectral imaging, OCT, fluorescence imaging, photoacoustic microscopy, and laser speckle contrast imaging, are being integrated with surgical microscopes. Advanced visualization and AR are being added to surgical microscopes as new features that are changing clinical practices in the operating room. CONCLUSIONS The combination of new imaging technologies and surgical microscopy will enable surgeons to perform challenging procedures and improve surgical outcomes. With advanced visualization and improved ergonomics, the surgical microscope has become a powerful tool in neurosurgery, spinal, ENT, ophthalmic, plastic and reconstructive surgeries.
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Affiliation(s)
- Ling Ma
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
| | - Baowei Fei
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
- University of Texas Southwestern Medical Center, Department of Radiology, Dallas, Texas, United States
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Lee JK, Hwang JJ, Kim HC. Treatment of peri-invagination lesion and vitality preservation in an immature type III dens invaginatus: a case report. BMC Oral Health 2020; 20:29. [PMID: 32000767 PMCID: PMC6993444 DOI: 10.1186/s12903-020-1008-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report a case of type III dens invaginatus associated with peri-invagination periodontitis in an immature permanent mandibular central incisor with open apex, in which only the invagination area was treated and vitality was preserved. CASE PRESENTATION A 9-year-old boy was referred complaining of pain in the mandibular left central incisor. After radiographic examination, an invagination into the pulp chamber of the tooth associated with periapical radiolucency was detected. Endodontic access was performed and the orifice was identified under a dental operating microscope. The invagination area was chemo-mechanically cleaned. After 1 week, the invagination was obturated with mineral trioxide aggregate. During the 2-year follow up period, the tooth was asymptomatic. Radiographic examination revealed significant progression of periapical healing and root development in the main root canal of the tooth. CONCLUSION Non-surgical root canal treatment of the invagination may preserve pulp vitality, and continuous root development of the tooth.
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Affiliation(s)
- Ju-Kyung Lee
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Geumo-ro 20, Mulgeum, Yangsan, Gyeongnam, 50612, Korea
| | - Jae Joon Hwang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Geumo-ro 20, Mulgeum, Yangsan, Gyeongnam, 50612, Korea.
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Kato H, Kamio T. Diagnosis and Endodontic Management of Fused Mandibular Second Molar and Paramolar with Concrescent Supernumerary Tooth Using Cone-beam CT and 3-D Printing Technology: A Case Report. THE BULLETIN OF TOKYO DENTAL COLLEGE 2018; 56:177-84. [PMID: 26370578 DOI: 10.2209/tdcpublication.56.177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Supernumerary teeth in the molar area are classified as paramolars or distomolars based on location. They occur frequently in the maxilla, but only rarely in the mandible. These teeth are frequently fused with adjacent teeth. When this occurs, the pulp cavities may also be connected. This makes diagnosis and planning of endodontic treatment extremely difficult. Here we report a case of a mandibular second molar fused with a paramolar, necessitating dental pulp treatment. Intraoral and panoramic radiographs were obtained for an evaluation and diagnosis. Although the images revealed a supernumerary tooth-like structure between the posterior area of the mandibular second molar and mandibular third molar, it was difficult to confirm the morphology of the tooth root apical area. Subsequent cone-beam computed tomography (CBCT) revealed that the supernumerary tooth-like structure was concrescent with the root apical area of the mandibular second molar. Based on these findings, the diagnosis was a fused mandibular second molar and paramolar with a concrescent supernumerary tooth. A 3-dimensional (3-D) printer was used to produce models based on the CBCT data to aid in treatment planning and explanation of the proposed procedures to the patient. These models allowed the complicated morphology involved to be clearly viewed, which facilitated a more precise diagnosis and better treatment planning than would otherwise have been possible. These technologies were useful in obtaining informed consent from the patient, promoting 3-D morphological understanding, and facilitating simulation of endodontic treatment.
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Affiliation(s)
- Hiroshi Kato
- Department of Endodontics and Clinical Cariology, Tokyo Dental College
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Zhu J, Wang X, Fang Y, Von den Hoff JW, Meng L. An update on the diagnosis and treatment of dens invaginatus. Aust Dent J 2017; 62:261-275. [PMID: 28306163 DOI: 10.1111/adj.12513] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 12/15/2022]
Affiliation(s)
- J Zhu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
- Affiliated Zhongshan Hospital; Sun Yat-sen University; Zhongshan China
| | - X Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - Y Fang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - JW Von den Hoff
- Department of Orthodontics and Craniofacial Biology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - L Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
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Okoro C, Vartanian A, Toussaint, KC. Development of a handheld smart dental instrument for root canal imaging. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:114002. [PMID: 27851855 PMCID: PMC8357325 DOI: 10.1117/1.jbo.21.11.114002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/27/2016] [Indexed: 06/06/2023]
Abstract
Ergonomics and ease of visualization play a major role in the effectiveness of endodontic therapy. Using only commercial off-the-shelf components, we present the pulpascope—a prototype of a compact, handheld, wireless dental instrument for pulp cavity imaging. This instrument addresses the current limitations of occupational injuries, size, and cost that exist with current endodontic microscopes used for root canal procedures. Utilizing a 15,000 coherent, imaging fiber bundle along with an integrated illumination source and wireless CMOS sensor, we demonstrate images of various teeth with resolution of ?48???m and angular field-of-view of 70 deg.
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Affiliation(s)
- Chukwuemeka Okoro
- University of Illinois at Urbana–Champaign, PROBE Lab, Department of Electrical and Computer Engineering, Urbana, Illinois 61801, United States
| | - Albert Vartanian
- Moon Ark Inc. Los Angeles, Moon Ark Inc., 12340 Rochester Avenue 102, Los Angeles, California 90025, United States
| | - Kimani C. Toussaint,
- University of Illinois at Urbana–Champaign, PROBE Lab, Department of Mechanical Science and Engineering, Urbana, Illinois 61801, United States
- University of Illinois at Urbana–Champaign, PROBE Lab, Department of Electrical and Computer Engineering and Bioengineering, Urbana, Illinois 61801, United States
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Management of Oehler's Type III Dens Invaginatus Using Cone Beam Computed Tomography. Case Rep Dent 2016; 2016:3573612. [PMID: 27069697 PMCID: PMC4812223 DOI: 10.1155/2016/3573612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/18/2016] [Indexed: 11/17/2022] Open
Abstract
Dens Invaginatus is a dental malformation that poses diagnostic difficulties in the clinical context. This anomaly may increase the risk of pulp disease and can potentially complicate endodontic procedure due to the aberrant root canal anatomy. Compared to conventional radiographs, three-dimensional images obtained with Cone Beam Computed Tomography (CBCT) are invaluable in the diagnosis of the extent of this anomaly and in the appropriate treatment planning. Oehler's classification (1957) for Dens Invaginatus (DI) into three types depending on the depth of the invagination has been used for treatment planning. Of the three types Type III DI is characterized by infolding of the enamel into the tooth up to the root apex and is considered as the most severe variant of DI and hence the most challenging to treat endodontically, due to the morphological complexities. This report describes a case of Oehler's Type III DI in a necrotic permanent maxillary lateral incisor in which CBCT images played a key role in diagnosis and treatment planning. The case was managed successfully by a combination of nonsurgical and surgical endodontic therapy with orthograde and retrograde thermoplastic gutta percha obturation.
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Forghani M, Moghim Farooji E, Abuchenari J, Bidar M, Eslami N. Conservative Treatment of an Invaginated Maxillary Lateral Incisor with a C-shaped Canal Using Cone-Beam Computed Tomography. IRANIAN ENDODONTIC JOURNAL 2015; 10:281-3. [PMID: 26576164 PMCID: PMC4609669 DOI: 10.7508/iej.2015.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This report describes the non-surgical treatment of an invaginated maxillary lateral incisor with two fused roots. The mesial root had a C-shaped canal, while the distal one had a type III dens invagination. Cone-beam computed tomography (CBCT) was used to help with the diagnosis and treatment decision making. Clinical and radiographic follow-up revealed satisfactory periapical repair and absence of symptoms after 15 months.
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Affiliation(s)
- Maryam Forghani
- Dental Materials Research Center, Department of Endodontics, Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elaheh Moghim Farooji
- Dental Materials Research Center, Department of Endodontics, Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Maryam Bidar
- Dental Research Center, Department of Endodontics, Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Eslami
- Dental Research Center, Department of Orthodontics, Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
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Sharma D, Kaur R, Monga S, Kaur S, Kundra R. Diagnostic imaging: Morphological and eruptive disturbances in the permanent teeth. World J Stomatol 2015; 4:72-80. [DOI: 10.5321/wjs.v4.i2.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/04/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
This paper reviewed the literature on newer three-dimensional imaging techniques and their applications in diagnosis and treatment planning of various dental anomalies. Developmental anomalies can occur during any of the developmental stages and are manifested clinically after the tooth is fully formed. These dental anomalies may involve a single tooth, a group of teeth, or the entire dentition. Two-dimensional diagnostic imaging, including periapical, occlusal, panoramic, or cephalometric radiographs are essential in localization and management of morphological and eruptive disorders. However, due to their inherent limitations such as insufficient precision because of unusual projection errors and lack of information about spatial relationships, these methods are considered unreliable. Thus, the use of newer image acquisition techniques that allow comprehensive three dimensional imaging and visualization of dental abnormalities is highly recommended for making a confirmatory diagnosis. The significance of accurate endodontic, surgical and orthodontic treatment planning in dental abnormalities cannot be overstated as it pertains to critical anatomic landmarks such as proximity to adjacent teeth or the mandibular canal. The precise information on spatial relationships provided by multiplanar imaging helps the dental surgeon to establish more accurate diagnosis, management strategies and also increases the patient safety. This review highlights the use of high-end diagnostic imaging modalities in diagnosis of the various morphologic and eruptive dental abnormalities.
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Regenerative endodontic treatment of an infected immature dens invaginatus with the aid of cone-beam computed tomography. Case Rep Dent 2014; 2014:403045. [PMID: 25530890 PMCID: PMC4229997 DOI: 10.1155/2014/403045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/18/2014] [Indexed: 01/27/2023] Open
Abstract
Dens invaginatus is a developmental anomaly that results in an enamel-lined cavity intruding into the crown or root before the mineralization phase. This report presents regenerative endodontic treatment of a necrotic immature tooth with Oehler's type III dens invaginatus of a nine-year-old female patient. A diagnosis of dens invaginatus (Oehler's type III) and a large periapical lesion was established with the aid of cone-beam computed tomography (CBCT). In the presented case contrary to the classic revascularization protocol, mechanical instrumentation was performed which apparently did not interfere with the regeneration process. After mechanical instrumentation of the invaginated canal by manual K-files, the invaginated canal space was disinfected by triple antibiotic paste followed by blood clot induction from the periapical tissues and the placement of mineral trioxide aggregate. At one-year follow-up, the tooth remained clinically asymptomatic. Radiographic examination revealed complete healing of the periapical lesion. At the 20-month follow-up, the radiographic examination also showed that the open apex was closed and the walls of the root canal were thickened.
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Successful Nonsurgical Endodontic Outcome of a Severely Affected Permanent Maxillary Canine with Dens Invaginatus Oehlers Type 3. J Endod 2014; 40:1702-7. [DOI: 10.1016/j.joen.2014.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/09/2014] [Accepted: 06/18/2014] [Indexed: 11/19/2022]
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