4.4 Article

Management of teeth with dens invaginatus and apical periodontitis A case series

Journal

JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
Volume 153, Issue 5, Pages 470-478

Publisher

AMER DENTAL ASSOC
DOI: 10.1016/j.adaj.2021.10.009

Keywords

Apical periodontitis; dens invaginatus; root canal treatment; root canal infection

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This study evaluated the treatment approaches for 6 maxillary incisors with dens invaginatus and apical periodontitis. Cone-beam computed tomography was used for diagnosis and treatment planning, and sodium hypochlorite irrigation and thermoplasticized gutta-percha obturation were the key methods used. The results showed favorable clinical and radiographic outcomes.
Background. Dens invaginatus is a dental anomaly that can predispose the tooth to pulp and periapical pathology. Case Description. Different endodontists treated 6 maxillary incisors with dens invaginatus associated with apical periodontitis. Cone-beam computed tomography was used to help with diagnosis and treatment planning in most patients. Four patients received diagnoses of Oehlers type II dens invaginatus and the other 2 as type III. In some patients with type II, the invagination had to be perforated to permit access to the apical part of the true root canal. Both the true canal and the invagination (pseudocanal) were treated in all cases using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation and supplementary disinfection approaches. Calcium hydroxide medication was used in all but 1 case. The root canal and invag-ination were often filled using thermoplasticized gutta-percha techniques, sometimes using an apical plug with a bioceramic material in teeth with large apical openings. All treated patients had favorable clinical and radiographic outcomes. Practical Implications. Regardless of the complex anatomic variations, common strategic thera-peutic approaches were identified that might serve as recommendations for proper management of teeth with dens invaginatus and apical periodontitis. These approaches include cone-beam computed tomographic planning, aggressive disinfection using sodium hypochlorite ultrasonic or sonic activation and calcium hydroxide intracanal medication, and thermoplasticized gutta-percha obturation of both the root canal and invagination.

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