Case Report
Conservative management of Dens Invaginatus with an open apex and vital pulp: A case report
Raul De Alba Valdivia, DDS 1
David Masuoka Ito DDS, PhD 1
Eunice Liset Ascencio Sandoval, DDS 1
Santíago Andaracua Garcia DDS, MS 2
Sugeyn Rodríguez Castillo, DDS 2
Jorge Vera DDS, MS 3
Itzel Athziry Carre Espinoza, DDS 2
Daniela Reyes Pedraza, DDS 2
https://doi.org/10.71347/fr59e2pz
1 Departamento de Estomatología, Universidad Autónoma de Aguascalientes, Mexico
2 Departamento de Endodoncia, Universidad Autónoma de Querétaro, Mexico
3 Advanced Education Program in Endodontics, Department of Periodontics and Endodontics, University at
Buffalo, School of Dental Medicine, USA
Corresponding author:
Jorge Vera DDS, MS, Director of the Advanced Education Program in Endodontics, Department of
Periodontics and Endodontics, University at Buffalo School of Dental Medicine Squire Hall - University at
Buffalo, State University at Buffalo South Campus, 3435 Main St, Buffalo, NY 14215
e-mail: jveraro@yahoo.com.mx
Key words: Dens invaginatus, Immature apex, Cone Beam Computed Tomography (CBCT), Mineral
Trioxide Aggregate (MTA)
Acknowledgements: The authors deny any conflict of interest related to this study.
The patient’s guardian provided informed consent.
Abstract
Background: Dens invaginatus (DI) is a developmental anomaly characterized by a deepening or invagination of the enamel organ into the dental papilla before calcification of dental tissues.
Case description: A 9-year-old female Hispanic patient was referred for evaluation of the upper left central incisor, due to swelling of the attached gingiva. Clinical examination revealed a talon cusp on the palatal surface, a draining sinus tract tracing to the apical area of tooth #9, and radiographically, a possible radiolucency. The cone beam computed tomography (CBCT) scan revealed a hypodense area involving the buccal and mesial cortical bone. The tooth was classified as Oehlers’ Type IIIB dens invaginatus. Root canal treatment of the invagination was performed using an MTA apical plug. At the one-year follow-up examination, the tooth exhibited negative responses to percussion and palpation. CBCT and radiographic examinations showed bone healing and continuous root development, indicating successful treatment outcome.
Conclusion: This case demonstrates that, in select cases of Type IIIB dens invaginatus with an open apex and a vital pulp, conservative treatment limited to the invagination canal can be successful when supported by accurate CBCT evaluation and appropriate material selection.
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