Successful nonsurgical management of Oehler's type III dens invaginatus in maxillary lateral incisor: A case report as per CARE guidelines

Abstract

Rationale: Dens invaginatus (DI) is a rare condition with a prevalence of only 0.3% to 10% mainly affecting the maxillary lateral incisors. In the present case, we describe management of the rarest variant of DI, that is, Oehler type III DI.

Patient concerns: Patient complained of severe pain in upper left front teeth since 1 month which aggravated on taking hot liquids. Patient had visited a general dentist who did emergency access opening on #9 and #10 and referred the patient.

Diagnoses: Oehler type III DI with apical periodontitis w.r.t.#10 (maxillary left lateral incisor).

Interventions: Nonsurgical root canal treatment of the main canal and apexification of pseudo canal with mineral trioxide aggregate.

Outcomes: At 6 months follow-up, the patient was asymptomatic, and the clinical evaluation revealed no sensitivity to percussion or palpation on tooth #10 and mobility within normal limits. The radiograph examination displayed significant periapical healing.

Lessons: The unusual morphological appearance of the crown in the maxillary lateral incisor or the radiographic appearance should alert the dentist to the possibility of DI. Knowledge of tooth anatomy and its variations, correct diagnosis, and use of magnification and advanced materials like mineral trioxide aggregate can help in managing rare variations.

Keywords: MTA; apexification; apical periodontitis; dens invaginatus; endodontic treatment; type III dens invaginatus.

Figure 1.

(A) Periapical radiograph of tooth #10 displaying DI Oehler type III, along with wider dimension mesiodistally compared to tooth #9, complex internal anatomy, and periapical radiolucency along with previous access cavities in teeth #9, #10. (B) Periapical radiograph of tooth #10 to confirm the working of the regular root canal on the distal side and the pseudo canal on the mesial side. (C) Inter-appointment application of calcium hydroxide paste in the canals with some overflow on the mesial side of tooth #10. DI = dens invaginatus.

Figure 2.

(A) Obturation of regular root canal and removal of intertwining invaginated tissue between the root canal and the pseudo canal in tooth #10. (B) Apexification of the pseudo canal by creating a 4 to 5 mm apical plug using mineral trioxide aggregate in tooth #10. (C) Middle and coronal third of the canal obturated with warm vertical condensation technique using the Obtura III Max in tooth #10. (D) Periapical radiograph of teeth #9, #10 at 6 months recall displaying significant periapical healing.