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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
Case report.



A 10-year-old boy was referred to Piracicaba Dental School for root-canal treatment of the right mandibular central incisor. Clinical signs of morphological alteration were observed with a pronounced ‘dens invaginatus’ on the lingual surface, but no foramen coecum was visible (Fig. 1). The tooth was caries free and no draining sinus was observed. The colour of the tooth did not differ from the adjacent teeth and the total number of teeth in the anterior region was normal (Fig. 2). The tooth responded normally to pulp sensibility testing using ice.
The radiographic examination consisted of one periapical film, which demonstrated a type III invagination extending all the way from the crown to the apex of the root (pseudocanal), with no apparent communication with the main canal (Fig. 3). Although no opening on the lingual surface of the affected tooth could be seen, it was likely that an opening was present since there was a periapical radiolucency.
Since clinical tests suggested a normal pulp, and because there was an invagination extending to the open root end, conservative root-canal treatment of the invagination was initiated as the first course of treatment. It was assumed that the presence of infection in the invaginated canal and the periapical inflammation had delayed root development. The primary purpose of treatment was to remove the infection and allow apical closure of the root.
The tooth was isolated with a rubber dam and access gained to the pulp chamber. The canal was cleaned and shaped prior to placing a calcium hydroxide temporary dressing which was changed on two occasions. Root-canal treatment of the invagination was performed using K-files until a size 30 instrument reached the apex. A 1% sodium hypochlorite solution was used as the irrigant. Gutta-percha and Grossman’s sealer were used to fill the canal with the lateral condensation technique. The pulp continued to provide positive responses to pulp-sensibility testing, which indicated that the pulp in the main root canal had survived. The final restoration of the tooth was completed using amalgam (Fig. 4) and the tooth was reviewed after 1, 2, 5 and 10 years (Fig. 5).

Figure 1. Lingual view of the lower right central incisor showing pronounced dens invaginatus.

Lingual view of the lower right central incisor showing pronounced dens invaginatus

Figure 2. Occlusal radiograph which shows that all teeth in the lower anterior region are present.

Occlusal radiograph which shows that all teeth in the lower anterior region are present

Figure 3. Periapical radiograph which demonstrates the invagination extending all the way from the crown to the apex of the root. Note the periapical radiolucency.

Periapical radiograph which demonstrates the invagination extending all the way from the crown to the apex of the root

Figure 4. Post-operative periapical radiograph taken immediately after completion of the endodontic treatment of the invagination.

Post-operative periapical radiograph taken immediately after completion of the endodontic treatment of the invagination

Figure 5. Periapical radiographs taken at the 1-, 2-, 5- and 10-year follow-up examination.

Periapical radiographs taken at the 1-, 2-, 5- and 10-year follow-up examination