Concurrent occurrence of dens evaginatus and dens invaginatus in maxillary incisors: a case report and review

Dens evaginatus (DE) and dens invaginatus (DI) are developmental anomalies that affect the shape of the teeth. Although they have been found singly and in association with other developmental anomalies in the same patient, it is uncommon to observe these two anomalies in the same tooth. There are only a few published cases of concurrent DI and DE in the same tooth. The patient in the case reported here was a 27-year-old man who exhibited a novel combination of DE and DI in permanent maxillary incisors. Early diagnosis of this anomaly is necessary. The clinician then can take particular care when performing prophylactic odontoplasty for the DE, keeping in mind that the associated DI presents an increased risk of early pulpal involvement. This article focuses on the management aspects of DE and DI.     

A novel combination of dens evaginatus and dens invaginatus in a single tooth--review of the literature and a case report

Dens evaginatus (DE) and dens invaginatus (DI) are rare developmental dental anomalies affecting both the primary and permanent dentitions. Concurrence of DE and DI within the same tooth is extremely rare. We report a case of DE and DI in a maxillary right lateral incisor tooth. Comprehensive clinical and radiographic examinations are essential to identify such defects; the early diagnosis can then result in the appropriate prophylactic treatment being performed, thus preventing undesirable pulpal complications.     

A rare presentation of dens invaginatus in a mandibular lateral incisor occurring concurrently with bilateral maxillary dens invaginatus: case report and review of literature

BACKGROUND: Dens Invaginatus (DI), commonly known as dens in dente, is a developmental malformation of tooth that most commonly affects permanent maxillary lateral incisor teeth. Deciduous teeth are infrequently affected. Presence of DI in mandibular permanent teeth is extremely rare. Further, the presence of DI bilaterally in the maxillary lateral incisors of the same patient is even more unusual. METHODS: In this article, an unusual case of DI affecting a mandibular lateral incisor tooth is described. This malformation was uncovered after a full mouth radiographic examination when the patient presented for dental treatment unrelated to this finding. In addition, the various radiographic appearances of DI as they present within the maxillary and mandibular teeth are described. Essential clinical considerations and treatment options are presented. A review of the pertinent literature is undertaken and a table summarizing previous published findings of mandibular DI is presented. RESULTS: A review of the literature indicates that DI in mandibular teeth is extremely rare with only 10 other cases involving 13 teeth reported previously. CONCLUSIONS: Although this is an extremely rare case, DI is an anomaly that should be familiar to all practising dentists due to the clinical implications of potential sequelae of pulpal involvement.     

A rare case of dens evaginatus and dens invaginatus in the same tooth, with a review of treatment options

Dens evaginatus (DE) and dens invaginatus (DI) are rare developmental anomalies of tooth formation. These variations in odontogenesis have been individually observed and reported in the literature. This report describes the radiographic appearance and management of a 16-year-old boy who came to the clinic with a rare occurrence of both DE and DI in the same tooth and examines the criteria used in identifying and classifying such anomalies. This report also discusses the importance of early identification and efficient management of dental anomalies, which can prevent irreversible pulpal pathology that requires endodontic therapy or tooth loss.     

Diagnosis and clinical significance of dens invaginatus to practicing dentist

Dens invaginatus, commonly known as dens in dente, is a developmental malformation of teeth that most commonly affects permanent maxillary lateral incisors. Deciduous teeth are infrequently affected. Presence of dens invaginatus in mandibular permanent teeth is extremely uncommon. A rare presentation of coronal double dens invaginatus incidentally detected in a mandibular canine tooth on radiographic examination is being reported, along with a discussion of this anomaly. The patient had presented for routine dental treatment unrelated to this finding. In addition, the various radiographic appearances of dens invaginatus, as they present within the maxillary and mandibular teeth, are described. Essential clinical considerations and treatment options are presented. A review of the pertinent literature is undertaken, and tables summarizing previously published reports of mandibular dens invaginatus and double dens invaginatus are presented. A review of the literature indicates that dens invaginatus in mandibular teeth is extremely rare, with only 11 other cases, involving 14 teeth, reported previously. Cases of double dens invaginatus are even more atypical, with only eight previously reported cases. Dens invaginatus is an anomaly that should be familiar to all practicing dentists because of the clinical implications and potential sequelae.     

上颌侧切牙年轻恒牙牙中牙伴根尖周炎的牙髓血运重建治疗1例

牙内陷是由牙发育时期成釉器过度卷叠或局部过度增殖，深入到牙乳头中而导致的牙齿形态异常，因其复杂的解剖结构，给常规的牙髓治疗带来困难和挑战。牙中牙的牙髓治疗为牙内陷最复杂的一种情况，本文报道1例上颌侧切牙年轻恒牙牙中牙伴根尖周炎的牙髓血运重建治疗的病例，结合锥形束CT的辅助诊断，对其治疗及预后进行评估。随访2年，牙根继续发育，根尖周炎症消失。本病例为年轻恒牙牙中牙的牙髓病及根尖周病提供了新的治疗策略。     

Dens invaginatus: a retrospective study of prophylactic invagination treatment

Aim . To evaluate the prognosis for pulp survival in teeth with dens invaginatus (DI) subjected to prophylactic invagination treatment.
Design . A retrospective study by examination of dental records and radiographs.
Sample and methods. The dental records of all patients referred to the Eastman Dental Institute, Stockholm, Sweden, with the diagnosis dens invaginatus between the years 1969–1997 were reviewed. Clinical data was collected from the dental records and the diagnosis DI was confirmed on the radiographs from the time of referral. 95 teeth in 66 patients had been subjected to prophylactic invagination treatment. The retrospective evaluation was based on an examination of the radiographs available from the follow-ups.
Results . 11·3% of the teeth that were followed for 6 months or longer ( n  = 80) were judged as failures, All failures were initially classified as Oehlers type 2.
Conclusion . The findings stress the importance of a follow-up program for teeth subjected to prophylactic invagination treatment in order to avoid serious periradicular complications that could influence the outcome of the endodontic treatment.     

Dens invaginatus on a geminated tooth: a case report

AIM: To present a case of a concomitant occurrence of dens invaginatus (DI) and gemination in a mandibular left lateral incisor. BACKGROUND: DI is a developmental anomaly resulting from the invagination of a portion of a crown in the enamel organ stage of odontogenesis. It is commonly found in the maxillary lateral incisors but also occurs in the central incisors, premolars, canines, and molars in descending order of frequency. The occurrence of DI in the mandible is extremely rare. Gemination results from one tooth bud attempting to split into two. Geminated teeth present with a single root structure and rarely occur in mandibular teeth. REPORT: A 13-year-old girl presented with a chief complaint of spontaneous nocturnal pain in the mandibular left lateral incisor tooth. Intraoral examination revealed the tooth was enlarged with a notch on the incisal edge extending to the coronal 1/3 of the crown. The radiological examination revealed a Type 2 DI in a Type I geminated mandibular left lateral incisor. SUMMARY: DI is clinically significant due to the possibility of the pulpal involvement; pulpitis, necrotic pulps, and chronic periapical lesions are often associated with this anomaly without clinical symptoms. Clinicians should be mindful of the possibility of DI when a tooth presents pulpitis without history of trauma or caries and examine the suspicious tooth and the periodontium radiographically.     

Multiple bilateral dens in dente involving all the premolars. Case report

Dens in dente, also known as dens invaginatus, dilated composite odontoma or deep foramen caecum, is a developmental malformation which usually affects maxillary incisor teeth, particularly lateral incisors. It may occur, however, in teeth anywhere within the jaws but other locations are comparatively rare. It can occur within both the crown and the root, although crown invaginations are more common. In this paper a case of multiple bilateral dens in dente involving maxillary and mandibular premolars is presented.     

Successful management of a case of true radicular dens invaginatus using platelet‐rich fibrin and guided tissue regeneration

A radicular variant of dens invaginatus (DI) is a rare form of dens invaginatus which develops in the root of the tooth after the crown development is completed. This report involves successful management of a case with guided tissue regeneration and describes the cone beam computed tomography (CBCT) characteristics of true radicular DI. A 20‐year‐old woman reported with recurrent swelling and pus discharge associated with her maxillary left central incisor (#21). Cone beam computed tomography (CBCT) of the region revealed #21 had an invagination in the mesial aspect of the coronal third of the root with a para radicular low‐density region perforating both the cortices. A diagnosis of true radicular variant of DI was made by exclusion. The case was managed with Biodentine^®, platelet‐rich fibrin and freeze‐dried demineralised bone graft. A 2‐year review showed that the tooth was functional with normal periodontal parameters and normal response to electric pulp sensibility test.     

Maxillary cyst associated with an invaginated tooth: a case report and literature review.

Dental invagination or dens in dente is a rare malformation with a widely varied morphology. Radiographically, the affected tooth shows an infolding of the enamel and dentin that can extend to within the pulp cavity and the root and sometimes to the root apex. It can occur in both primary and permanent teeth, and its prevalence is reported to be 1.7% to 10%. The dental anomalies observed in association with dental invagination include taurodontia, microdontia, supernumerary teeth, gemination, and dentinogenesis imperfecta. This article presents a clinical case in which a radiographic finding could be compatible with the presence of a nasopalatine or globulomaxillary cyst and a dens in dente. It was decided to extract the invaginated tooth, and by 15 days postextraction, the radiolucid area had completely disappeared. The complex surgery that would have been required to remove the patient's supposed cyst was thus avoided. Clinical and radiographic examination is suggested before making further decisions that could complicate treatment when a lesion is associated with other dental anomalies.     

Multiple dens invaginatus affecting maxillary lateral incisors and a supernumerary tooth

Abstract Dens invaginatus is a developmental variation resulting from an alteration in the normal growth pattern of the dental papilla of a tooth. This anomaly occurs predominantly in maxillary permanent lateral incisors. Multiple occurrence in maxillary incisor teeth in the same patient has frequently been reported, and examination of bilateral teeth for the anomaly is often carried out routinely. This paper reports an unusual case of multiple invaginations, including dens invaginatus affecting maxillary lateral incisors and a supernumerary tooth and minor imaginations of the upper canines. Moreover, the case illustrates the importance of examining all the teeth in patients who present with dens invaginatus and palatal pits in incisors and canines. The possibility that the supernumerary tooth had resulted from gemination of the lateral incisor tooth germ is discussed.     

Unusual dens evaginatus on maxillary premolars: a case report

Dens evaginatus is a developmental anomaly that can be defined as a tubercle from the surface of an affected tooth. It is composed of enamel and dentin usually enclosing pulp tissue. It is a rare dental anomaly commonly seen on premolars. A 12-year-old boy reported for the management of dental caries. He had bilateral occurrence of dens evaginatus on maxillary second premolars. The tubercle on the right side was unusually long without occlusal interference with the opposing primary mandibular second molar. Carious teeth were restored and the tubercle was left untreated. Management of dens evaginatus is determined by various factors which are discussed in decision-support system. Pulpal complication due to caries or fracture of tubercle can occur; hence it should be periodically monitored.     

A review of dens invaginatus (dens in dente) in permanent and primary teeth: report of a case in a microdontic maxillary lateral incisor.

An unusual presentation of dens invaginatus affecting a microdontic permanent lateral incisor in a 19-year-old female patient is reported and pertinent literature reviewed. The patient was referred to the oral and maxillofacial radiology clinic of the authors' institution for radiographic examination of her maxillary teeth. Dens invaginatus was identified on the maxillary right lateral incisor in the anterior periapical radiographs. The tooth was microdontic and clinically simulated a primary tooth. Dens invaginatus occurs rarely in primary dentition although it is fairly common in permanent teeth. Only 4 instances of dens invaginatus affecting the primary dentition have been reported in the literature. The etiology, pathophysiology, association with other dental anomalies, as well as management aspects of this common anomaly, are discussed.     

Combined endodontic and surgical management of a mandibular lateral incisor with a rare type of dens invaginatus

Dens invaginatus is a developmental malformation of teeth that most commonly affects permanent maxillary lateral incisors. Presence of dens invaginatus in mandibular permanent teeth is relatively rare. The purpose of this report is to describe the combined nonsurgical and surgical management of a mandibular lateral incisor associated with a rare type of dens invaginatus. Pulp involvement of the malformed tooth, periapical abscess, and severe periodontal destruction were observed. The signs (sinus tracts) and symptoms ceased after completion of the treatment. Satisfactory healing of the periradicular lesion was observed at the 6-month and 2-year follow-up examinations.     

Dens invaginatus and talon cusp co-occurring in a mandibular central incisor: a case report

Talon cusp and dens invaginatus are tooth shape anomalies that rarely affect mandibular teeth. Their co-occurrence in a single tooth is uncommon. The purpose of this report was to present a rare case of both talon cusp and dens invaginatus in a permanent mandibular central incisor. The diagnosis of dens invaginatus was made from routine radiographs taken to investigate a possible pulpal extension within the taloned cusp. Since the invagination did not communicate with the oral cavity, no treatment was indicated. The talon cusp was slightly grinded and smoothened to eliminate tongue irritation.     

A rare case of dens invaginatus in a mandibular canine

Dens invaginatus (dens in dente) is a common dental anomaly with a reported prevalence of between 0.04% and 10%. It typically affects permanent maxillary lateral incisors, central incisors and premolars. These developmental lesions are less common in mandibular teeth and are extremely rare in canines and molars. This report describes a rare case of dens invaginatus (Oehlers type II) in a permanent mandibular canine. The tooth was mature with a closed apex and showed apical pathosis. The tooth was treated endodontically using a non-surgical technique with hand endodontic files, and then followed up after a period of 8 months. A follow-up radiograph showed some healing of the lesion.     

Retrospective Study of Intentional Replantation for Type IIIb Dens Invaginatus with Periapical Lesions

IntroductionIn recent years, intentional replantation (IR) has received more attention for its high tooth survival rate and wide range of indications. Type IIIb dens invaginatus (DI) is 1 of the most serious types of tooth malformation and is very challenging to treat. When root end surgery is not feasible, IR may be considered as an alternative to extraction. However, there is little information available on the use of IR for type IIIb DI. Therefore, this study investigated the treatment outcomes and clinical procedures used for the treatment of type IIIb DI with IR.MethodsIR was performed to treat 10 patients with type IIIb DI with periapical lesions. Each tooth was examined clinically and radiologically. IR was selected by these patients as their treatment plan after treatment procedures were discussed. An experienced endodontist and an experienced surgeon performed all treatments using the same protocol and surgical technique. Postoperative assessments were composed of clinical and radiographic examinations, tooth survival, and functional status.ResultsThe follow-up period ranged from 4–39 months. After IR, 8 teeth were functioning properly with no clinical or radiologic signs of pathology. The other 2 teeth had complications after IR comprising the recurrence of periapical radiolucency and sinus tract formation in 1 patient and the development of a mucosal fenestration in another. Both of these patients received additional surgery and showed marked improvements.ConclusionsOur study evaluated the most clinical data to date and showed that IR may be a reliable alternative for type IIIb DI with a periapical lesion.     

Double dens invaginatus in an impacted molariform supernumerary tooth: a unique case

Dens invaginatus is a relatively rare developmental anomaly affecting usually the permanent maxillary lateral incisor. Various factors have been put forward regarding its pathogenesis. Involvement of crown/root has been reported as the coronal and radicular variety of dens invaginatus. One of the rarest variant is the Double dens invaginatus and only a few cases have been reported in the literature.This article focuses on a case of double dens invaginatus in an impacted maxillary anterior supernumerary tooth, the associated complications and its management.