Dens invaginatus is a developmental variation in the formation of a tooth that causes changes in the internal anatomy of the tooth. The presence of double dens invaginatus is extremely rare. Understanding the type, extension, and complex morphology of dens invaginatus is essential. Diagnosis of this condition using conventional radiographic techniques is not easy. Advanced imaging techniques, such as cone beam computed tomography (CBCT) are very helpful in diagnosis of these complex anatomic variations. In the present case report, we demonstrate the use of CBCT in the evaluation and treatment planning of bilateral maxillary dens invaginatus, of which one presented as a case of double dens.
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.
Cone-beam computed tomography for assessment of dens invaginatus in the Polish population