J Korean Academy of Advanced General Dentistry 2014;3:29-33 ABSTRACT Endodontic Treatment of 2 Maxillary Lateral Incisors with Dens Invaginatus; 2 Case Reports Jaemin Lee, Kee-Deog Kim, Bock-Young Jung, Wonse Park, Kang-Hee Lee, Hye-Jeong Park, Nan-Sim Pang Department of Advanced General Dentistry, College of Dentistry, Yonsei University Dens invaginatus is a developmental variation resulting from the infolding of the dental papilla before calcification of the dental tissue. Permanent maxillary lateral incisors are most commonly affected. The most widely used classification system for dens invaginatus was described by Oehlers. The purpose of this paper was to describe treatments of 2 cases on Type II dens invaginatus with open apex. In the first case, the invaginated barrier was removed, apexification and nonsurgical endodontic treatment was performed. At the 8-month follow-up, no clinical symptoms or radiographic apical lesion were observed. In the second case, because of the morphologic variation, it was unable to clean and shape the root canal system. Thus, apical surgery was performed. After 5 months, no signs of sinus tract or radiographic apical lesion was observed. In these cases, satisfactory clinical and radiographic outcomes were observed. It is important to know about root canal anatomy for successful endodontic treatment of dens invaginatus. Key words : Dens invaginatus, Endodontic treatment, Maxillary lateral incisor.. (enamel organ),,,, Correspondence : Prof. Nan-Sim Pang Department of Advanced General Dentistry, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea Tel: +82-2-2228-8982, fax: +82-2-2227-8906, E-mail: pangns@yuhs.ac Received: January 22, 2014; Revised: February 11, 2014; Accepted: February 28, 2014 1,2. 1% 10% 3.,,,, 4, 43% 5. Oehlers, 6. Type I -. Type II -, (blind sac).. Type III 29
JOURNAL OF KOREAN ACADEMY OF ADVANCED GENERAL DENTISTRY.. Type III (peri-invagination periodontitis) (Fig 1). Type I 79%, Type II 15%, Type III 5% 7. Oehlers 8.,,, 1,2,9.... 2. Cone beam computed tomography (CBCT) 3 10,11.. CBCT. 1. 1 Type I Type II Type III Figure 1. Classification of invaginated teeth by Oehlers (1957). 12. (sinus tract). CBCT Oehlers Type II (Fig 2). open apex. Figure 2. A periapical and CBCT radiograph of maxillary left lateral incisor from the initial visit. 30
Lee et al. Endodontic treatment of dens invaginatus Figure 3. Periapical radiographs of root canal filling after 16 month from initial treatment, and 8 month follow up.. (Junsei Chemical, Tokyo, Japan),. 16, gutta-percha., (Fig 3). 2. 2 11. (sinus tract). CBCT Oehlers Type II (Fig 4).. 3 gutta-percha IRM Figure 4. A periapical radiograph and CBCT radiographs of maxillary right lateral incisor from the initial visit.. 1, (Fig 5).. CBCT.,, 3,, 31
JOURNAL OF KOREAN ACADEMY OF ADVANCED GENERAL DENTISTRY Figure 5. Periapical radiographs of working length determination, root canal filling, apicoectomy and 12 months follow-up visit. 12.,,, 1. 13. Oehlers Type II.. Tyep I, II 14., apical constriction 13.,. 16 gutta-percha. Oehlers Type II... 3 (sinus tract), 10.,. gutta-percha, IRM. 12,. CBCT 3.,,. 1. Sousa SMG, Bramante CM. Dens invaginatus: treatment choices. Endodontics and dental traumatology 1998;14:152-8. 2. Hulsmann M. Dens invaginatus. Aetiology, classification, prevalence, diagnosis, and treatment considerations. Int Endod J 1997;30:79-90. 3. Hovland EJ, Block RM. Nonrecognition and subsequent endodontic treatment of dens invaginatus. J Endod 1977;3:360-2. 4. Kronfeld R. Dens in dente. J Dent Res 1934;14:49-66. 5. Granhen H, Lindhal B, Omnell K. Dens invaginatus I. A clinical roentgenological and genetical study of permanent upper lateral incisors. Odontol Revy 1959;10:115-37. 6. Oehlers FA. Dens invaginatus (dilated composite odontome). I. 32
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