Dens invaginatus. Part 2: clinical, radiographic features and management options

By Bishop K, & Alani A

Date: 11/2008
Journal: JOE

Summary: 

•Purpose: To describe the clinical and radiographic features of dens invaginatus, review previous treatment and options of  management based on the classification of the problem.


Clinical presentation :

In deciduous teeth, invagination located on the incisal edge of the tooth while permanent incisors and other anterior teeth palatally w/a great variation (conical morphology ,and incisal notching  that locate by magnification and methylene blue dye).

•Increased labio-lingual or mesio-distal diameter or incisal notching in association with a labial groove.

•Ridell et al. (2001) reported 91 patients w/dens invaginatus.

•Evidence of reported malformations, syndromes, pulpal disease and a symmetrical pattern  of contra-lateral tooth  associated w/ dens invaginatus

Radiographic image include: shape of the invagination may appear as radiolucent pocket , complex pulpal morphology, pseudo-canal or alteration in pulpal outline in proximity to the invagination.

Treatment recommendation :

•Generally, if  no pulpal disease (prophylactic treatment), with  pulp disease and caries (root canal treatment) regardless the type of invaginatus. If severely extensive  infection and can not be instrumented and cleaned then (extraction).

•In necrotic  pulp treat the canal and invagination separately if applicable. •Necrotic pulps in immature teeth :retain the tooth w/orthodontists until the occlusion is fully then treat as type II ,III with filling using MTA