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A: Periapical radiograph showing a gutta-percha point tracing the sinus tract and enamel like tract which is extended toward the invaginated portion. B: Length determination of the main and invaginated canals. C: Immediate postoperative periapical radiograph taken after final canal obturation and placement of coronal seal. D: 18 months follow-up radiograph demonstrating complete periapical healing.
Source publication
Dens invagination (DI) is a developmental abnormality of teeth which frequently results in a complex internal anatomy of the root canal system. DI type 3 is an anomaly characterized by infolding of enamel and dentin extending into the root apex. This may present difficulties when forming a diagnosis and treatment plan. Many treatment modalities hav...
Contexts in source publication
Context 1
... extended area of radio- lucency adjacent to the mesial aspect of the apex was noted. The radiograph also demonstrated an enamel-like root canal tract that appeared to be separate from the main root canal system (two canals) ( Figure 2A). ...Context 2
... DI was exposed which resulted in drainage from this infected canal. Working lengths for both canals were determined radiographically ( Figure 2B). Gates Glidden drills and hand k-files (Dentsply, Maillefer, USA) were used to clean and shape canals. ...Context 3
... root canal with the closed apex was obturated with gutta-percha (Dentsply, Maillefer, OK, USA) and AH-26 sealer (Dentsply, DeTrey, Konstanz, Germany) by lateral condensation technique. The access cavity was restored with composite resin (Solitaire 2, Heraeus Kulzer, Wehrheim, Germany) ( Figure 2C). ...Similar publications
Background: Calcium hydroxide (Ca(OH)2) is mainly used for intracanal material; it needs to be removed in entirety before obturation. However, complete removal of Ca(OH)2 is very difficult from canal walls resulting in its residues on canal wall which interfere with bonding of sealers and reduce success of root canal treatment. Materials and Method...
Complications may occur during and after endodontic treatment, which may be due to negligence of the operator. The surgical treatment of a case presenting pain and persistent pus discharge and swelling due to the extrusion of the root canal filling to the base of the nasal floor between left maxillary lateral and canine teeth is presented in this r...
To investigate the root canal anatomy of permanent maxillary and mandibular canines in a Turkish subpopulation using cone beam computed tomography (CBCT). Retrospective CBCT data of 300 patients admitted to our clinic between 2016 and 2018 were screened and evaluated. A total of 235 patients, 100 males and 135 females, aged 14-76 years (mean age 37...
Purpose
Post removal may be necessary for many reasons and is inevitable after the re-application of a dental post. The present study investigated the bond strength between root dentin and a re-applied fibre-reinforced composite (FRC) post by a pull-out test.
Materials and methods
After root canal treatments of 30 extracted human maxillary canine...
Statement of Problem: Various factors are involved in causing inflammation following root canal treatment. Controlling these factors may relieve the related pain. One of these factors is extrusion of debris beyond the apex. Although debris extrusion happens in all instrumentation techniques, researchers have declared that in coronal flaring techniq...
Citations
... The latest meta-analysis on this topic revealed a global prevalence of 0.01% for DI in maxillary canines, confirming the rareness of the defect (5). Only fourteen cases have been described so far in the endodontic literature (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). These cases have been endodontically treated either conventionally or both conventionally and surgically (Table 1). in most of the cases, conventional management led to successful treatment overall. ...
... Some studies reported a positive influence of photodynamic therapy (PDT) on decreasing microbial load up to 91-100 % during root canal therapy, This effect was especially against drug-resistance bacteria like Enterococcus faecalis (E. faecalis) which is common in endodontic treatment failures [7][8][9]. ...
Endodontic therapy of dens invaginatus (DI) anomalies is challenging due to difficult access, inadequate cleaning and shaping, and incomplete disinfection of its complicated root canal system. The present case report describes the treatment of tooth #10 with tooth discomfort, intermittent pus discharge, and localized swelling. Sinus tract, mobility, and probing grade 1 were observed. The tooth was tender on palpation and percussion with negative responses to pulp sensibility tests. Radiographic assessments revealed an atypical structure of pulpal anatomy, probably dens invaginatus, associated with a large periapical lesion and severe root curvature. Cone-beam computed tomography confirmed the presence of DI type II. Finally, the diagnosis of pulp necrosis with chronic apical abscess of tooth #10 was made. Combining antimicrobial photodynamic therapy as an adjunctive treatment with different irrigation techniques were effective in nonsurgical endodontic management of the complicated DI type II in a maxillary lateral incisor with a large periradicular lesion and severe root curvature. Six-month and one-year recall radiographic images revealed asymptomatic tooth and progressive osseous healing.
... It commonly occurs in maxilla rather than mandible, and in permanent instead of deciduous teeth [3]. Bilateral appearance is common in maxillary lateral incisors [4]. ...
Dens invagination is a developmental anomaly that requires specific treatment approaches. The invagination is enamel-lined in the crown of the tooth truly negligible, and usually there is no extension on the level of the external amelocemental junction. A well ending surgical root canal treatment of an invaginated tooth with a retrograde filling is presented in this case report. Periapical radiographic examination, after 3 months and 6 years of follow-up, showed periapical healing with osseous formation .
... Finally, some authors have used the lateral condensation of gutta-percha [Steffen and Splieth, 2005;Shadmehr and Farhad, 2011] or vertical [Fayazi et al., 2013], or have used MTA for filling the canal [Demartis al., 2009]; Rotsein et al. [1987] and Nallapati [2004], instead, recommended the injectable thermoplastic method. In the case described in this article, we followed the suggestion of Borkar et al. [2017]: In the presence of very wide canals and very thin root walls, it is advisable to fill the canal with adhesive materials to reinforce the radicular walls and prevent their fracture. ...
Background:
Dens invaginatus is a developmental anomaly that can affect both deciduous and permanent dentition. The anomaly is caused by the invagination of the enamel organ into the dental papilla prior to the calcification of the dental tissues. The treatment option changes according to the classification, from the simple filling of the invaginated enamel area to root canal treatment with or without retrograde surgery, intentional re-implantation, or the extraction of the affected tooth.
Case report:
In this study we report a case of a maxillary lateral incisor invaginatus in a young adult patient. The periapical endoral X-ray showed the presence of a periapical radiolucency in tooth 22, that had a structure similar to a tooth inside it and an immature apex. Cold thermal testing showed that it was not a vital tooth. CBCT confirmed the diagnosis of Oehler Class II dens invaginatus. The treatment plan involved root canal treatment of both the "true" and the "invaginated" canal using calcium hydroxide-based intermediate medication. Then, after removing the hard internal structure with the aid of an operative microscope, MTA was used to close the immature apex. Finally, the large endodontic space was filled with self-etching, self-adhesive, dual curing resin cement. The patient was included in a follow-up programme to monitor and verify the complete healing of the periapical bone of the affected tooth.
Conclusion:
The use of technology and of special materials allowed an adequate management and resolution of the case reported.
... Management of Oehlers' type III lesions is more complex. Peri-invaginatus periodontitis is a condition in which the tissue within an invagination becomes infected [21,25,26]. Treatment of a tooth with peri-invaginatus periodontitis requires root canal treatment of the invagination. ...
... Schwartz and Schindler [22] reported a case in which invagination was treated with a root canal separate from the main canal. Other cases in which invagination had close proximity to the main canal used root canal treatment of the whole root canal system even when the tooth showed a positive response to a vitality test [21,26,27]. ...
The present report presents a case of dens invaginatus (DI) in a patient with 4 maxillary incisors. A 24-year-old female complained of swelling of the maxillary left anterior region and discoloration of the maxillary left anterior tooth. The maxillary left lateral incisor (tooth #22) showed pulp necrosis and a chronic apical abscess, and a periapical X-ray demonstrated DI on bilateral maxillary central and lateral incisors. All teeth responded to a vitality test, except tooth #22. The anatomic form of tooth #22 was similar to that of tooth #12, and both teeth had lingual pits. In addition, panoramic and periapical X-rays demonstrated root canal calcification, such as pulp stones, in the maxillary canines, first and second premolars, and the mandibular incisors, canines, and first premolars bilaterally. The patient underwent root canal treatment of tooth #22 and non-vital tooth bleaching. After a temporary filling material was removed, the invaginated mass was removed using ultrasonic tips under an operating microscope. The working length was established, and the root canal was enlarged up to #50 apical size and obturated with gutta-percha and AH 26 sealer using the continuous wave of condensation technique. Finally, non-vital bleaching was performed, and the access cavity was filled with composite resin.
... Dens invaginatusun etiyolojisi sıklıkla belirsizdir (1,2). Çevre dokudaki anormal basınç sonucunda kısmi büyüme gerilemesi veya ameloblastların apikal proliferasyonu sonucunda, kalsifikasyondan önce kuronun invaginasyonu ve genetik faktörler sonucu oluştuğu ileri sürülmüştür (1,5). ...
... Dens invaginatusun genel popülasyonda sıklığı %0.04-10 arasındadır (5). Kadınlarda erkeklere göre 3 kat daha fazla gözlenir (3,4). ...
... Dİ hem maksilla, hem mandibulada görülür (6). En sık olarak maksiller lateral dişlerde görülen Dİ (1,4,7) sonra sırasıyla santral kesiciler, premolar dişler, kanin ve molar dişlerde görülür (3)(4)(5). Dİ unilateral veya bilateral (8) ve birden fazla dişte görülebilir (9). Bilateral görünüm maksilla yan keser dişlerde yaygındır (5). ...
... • Achieving a clean lumen without any infectious contents and elimination of bacteria from the dentinal tubules connecting the two spaces (central lumen and the surrounding pulp canal) [15,16]. ...
Dens invagination is a developmental anomaly requiring specific treatment approaches. Oehler's Type III dens in dente, extends into the root and perforates at the apical area or lateral surface of the root. In this case endodontic treatment of the invaginated tooth was carried out through the central lumen of the invagination with calcium hydroxide without manipulation of the main pulp canal, thereby leaving the tooth vital. The 18-month follow-up examinations were indicative of treatment success; the periapical lesion resolved completely and the tooth remained vital.
Information about the three dimensional anatomy of the teeth especially those with an abnormality is necessary for a successful treatment.
... Dens invaginatus, diğer adıyla 'dens in dente', diş oluşumunun mineralizasyon safhasından önce, kronda veya kökte mine ile çevrili yüzey invaginasyonları ile karakterize gelişimsel bir dental anomalidir. (1) Bu dental anomalinin etiyolojisi günümüzde hâlâ belirsiz olmakla birlikte, oluşumunda diş germinin bazı bölgelerinde fokal büyümenin erken uyarılmasının veya gecikmesinin, yetersiz kemik gelişiminin, travmaların, enfeksiyonların, genetik faktörlerin bir veya birden fazlasının rol oynayabileceği düşünülmektedir. (2) Süt ve daimi dentisyonda görülebilmekle birlikte, bilateral olarak görülmesi de ender bir bulgu değildir. ...
... (8) Bu dişlerde çürük ve pulpal enfeksiyon riskinin artmış olması dens invaginatusun klinik olarak önemini ortaya koymaktadır. (1) Dens invaginatus'un dişlerde plak birikimini kolaylaştırması çürüklerin hızlı oluşmasına ve ilerlemesine yol açar ve bu durum pulpanın da enfekte olmasıyla pulpal/ periapikal patoloji ile sonuçlanır. (2,5) Dens invaginatus'un doğru teşhisi, tedavi planlamasının doğru yapılabilmesi için oldukça önemlidir. ...
... (4) Kök kanal sisteminin erişilemeyen kısımlarında enfekte pulpa dokularının varlığı olasılığı, dens invaginatuslu dişlerin endodontik tedavisini zorlaştırır. (1) Bu vakada kanalların dezenfeksiyonunu sağlamak amacıyla sodyum hipokloritin antibakteriyel özelliklerinden yararlanılmıştır. ...
... A paucity of cases of successful endodontic treatment involving permanent maxillary canines DI Oehlers type 3 has been reported. A PubMed search, which was restricted to the English language literature from 1970 to 2014, has yielded only 7 documented cases with favorable treatment outcomes, with follow-up assessments as long as 24 months (2,(8)(9)(10)(11)(12)(13). Here we provide the successful case of nonsurgical endodontic therapy on a maxillary canine severely affected with DI type 3. ...
... Four other cases involved the use of gutta-percha cones (2,(9)(10)(11). Singular cases were obturated with gutta-percha in the main canal and a silver point in the DI (8), gutta-percha in the main canal and mineral trioxide aggregate (MTA) in the DI (12), or MTA only within the DI (13). Cases that had appeared in non-peer-reviewed on-line newsletters were excluded from this compilation of successful outcomes. ...
... The preservation of the normal pulp in cases of DI Oehlers type 3 is desirable but often unavoidable because of the proximity of the main canal to the infected invaginated pulp space, as seen in our case with the exuberant root canal system. In fact, 75% (6 of 8) of affected cases (including the featured patient) received endodontic therapy of the entire root canal system (2,8,9,11,12). Interestingly, the attending clinicians were able to preserve the integrity of the normal pulp in the main canal of 2 less severe cases of affected canines with DI type 3 (10, 13). ...
Introduction
The morphogenic complexities of dens invaginatus (DI) Oehlers type 3 in maxillary canines offer significant endodontic challenges.
Methods
A case report is provided of a 14-year-old female patient who presented with an anomalous-looking permanent maxillary canine associated with a sinus tract. Pulp testing revealed a normal response on the distal aspect of the tooth, whereas the mesial segment tested nonresponsive. A radiolucent lesion was seen on the mesiolateral radicular area adjacent to the severely distended pulp chamber. A gutta-percha point inserted into the sinus tract traced to this same region. The diagnosis was normal pulp coincident with DI Oehlers type 3 with pulp necrosis and chronic apical abscess.
Results
Despite a concerted effort to limit the root canal therapy to only the necrotic canal, its proximity to the normal canal obviated this possibility, entailing endodontic treatment of the entire root canal system. The necrotic pulp space was subjected to sustained irrigation with 5.25% sodium hypochlorite and then completed with 17% ethylenediaminetetraacetic acid. A bolus of gutta-percha was used to create an apical barrier, and then the remainder of the enlarged pulp space was obturated with injectable thermoplasticized gutta-percha. At a 4.5-year recall, there was no clinical and radiographic evidence of infection.
Conclusions
Endodontic success was accomplished with meticulous efforts of disinfection. Thermoplasticized gutta-percha can offer utility for obturation of anatomically complicated pulp spaces. The use of the dental operating microscope is an invaluable aid for discernment of the intricacies of teeth affected with DI type 3 variant and can enhance clinical outcomes.
... Resin-based sealers have other advantages, including setting in the presence of moisture, insolubility in tissue fluids, good setting time and antibacterial effects. [9] MTA cement has a great sealing ability and has been used widely in endodontic treatments for sealing perforation areas, [10,11] internal and external root resorptions, [12] creating an artificial barrier for non-vital open-apex teeth, [13] root-end filling [14,15] and pulp capping. [16] Recently, researchers have tried to use MTA cement as a sealer. ...
Sealing ability is one of the most important features of endodontic sealers. The purpose of this in vitro study was to compare the sealing ability of a resin-based sealer with a mineral trioxide aggregate-based sealer.
A total of 60 single-rooted extracted human teeth were randomly divided into two experimental groups (n = 25) and two control groups (n = 5). After canal preparation and smear layer removal, both groups were obturated with gutta-percha and sealer. Resin-based AH26 sealer was used in the first group and Fillapex(®) sealer in the second group. Two layers of nail varnish were applied on tooth surfaces except for the apical 2 mm. In the negative control group, nail varnish was applied on the entire surface. The teeth were mounted according to Lima et al. study and then sterilized by ethylene oxide gas. The samples were evaluated for bacterial microleakage using Enterococcus faecalis (ATCC 29212) for 90 days. Data were analyzed by survival test (P < 0.05).
Control groups had either immediate leakage or no leakage. The Fillapex(®) showed significantly higher amounts of microleakage compared with AH26 sealer (P < 0.05) and both groups exhibited significant differences in comparison with control groups.
Both sealers had bacterial leakage. Sealing ability of AH26 was significantly higher than that of Fillapex(®).
