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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 11  »  Densinvaginatus type III: report of a case and 10-year radiographic follow-up
Densinvaginatus type III: report of a case and 10-year radiographic follow-up

Goncalves, M. Goncalves, D. P. Oliveira & N. Goncalves
Department of Oral Diagnosis and Dentomaxillofacial Surgery, Division of Dentomaxillofacial Radiology, Araraquara Dental School–UNESP, Brazil.
Department of Endodontics and Department of Oral Diagnosis, Division of Dentomaxillofacial Radiology, Piracicaba Dental School–UNICAMP, Brazil.

‘Dens invaginatus’ is a rare malformation of teeth, probably resulting from an infolding of the dental papilla during tooth development (Ikeda et al. 1995, Hulsmann 1997). However, controversy exists in the dental literature regarding the terminology to be used for this anatomical defect. It has been called ‘dens in dente’ (Thomas 1974), ‘dilated composite odontome’ (Hunter 1951, Hulsmann 1997), and ‘dens invaginatus’ (Oehlers 1957).
The variation in nomenclature has occurred because of a lack of consensus regarding the aetiology of this anomaly. The term ‘dens in dente’ indicates the radiographic appearance of a tooth which has apparently formed within another. ‘Dilated composite odontome’ infers that there is an abnormal dilation of the dental papilla, which then calcifies. ‘Dens invaginatus’ implies a defect which results from invagination of the crown before calcification occurs.
The classification of invaginations proposed by Oehlers (1957) is the most popular classification and the most commonly affected teeth are the maxillary lateral incisors. Type I is an enamel-lined minor invagination occurring within the confines of the crown not extending beyond the amelo-cemental junction. Type II consists of an enamel-lined form, which invades the root but remains as a blind sac; it may or may not communicate with the dental pulp. In type III, the invagination penetrates through the root, perforating the apical area and having a second foramen in the apical or periodontal area. There is no immediate communication with the pulp. The invagination may be completely lined by enamel, but frequently cementum will be found lining the invagination. The reported incidence for ‘dens invaginatus’ ranges from 0.04 to 10% (Hovland & Block 1977).
Although it is not common to find invaginations bilaterally, contra-lateral teeth should be examined clinically and radiographically, whenever one tooth is diagnosed with an invagination, since early discovery may allow preventive treatment to be provided. Classification of invaginations is based on radiographic appearance and it is common to see peg- or barrelshaped teeth.
Clinically, the ‘dens invaginatus’ presents unusual crown morphology, but affected teeth may also show no clinical signs of the malformation. The invagination allows entry of irritants into an area which is separated from pulp tissue by only a thin layer of enamel and dentine. It may predispose to the development of dental caries and ingress of irritants resulting in pulp inflammation. The affected pulp tissue then frequently undergoes necrosis.
If no entrance to the invagination can be detected and no signs of pulp pathosis are visible clinically and radiographically, then no treatment is indicated (Hulsmann 1997). However, the invagination should be sealed before carious destruction occurs. With deep invaginations having a separate apical or lateral foramen, it is likely that conservative root-canal treatment may be required (Szajkis & Kaufman 1993, Schwartz & Schindler 1996). Occasionally, the presence of immature roots necessitates apexification (Fergusson et al. 1980). In extreme cases, surgical procedures may also be necessary (Beltes 1997).
The purpose of this article is to report a case of ‘dens invaginatus’ in a vital permanent mandibular central incisor, which required conservative root-canal treatment.