I. Introduction
Dens invaginatusor dens in dente, is a developmental anomaly resulting from invagination of the tooth crown or root before calcification has occurred. It shows multiple morphological variations of crown and root formation. The complex anatomy of dens invaginatus may compromise instrumentation, disinfection, and obturation of the root canals. This case report presents an conservative treatment of dens invaginatus with large periapical lesion.
II. Clinical case
1. Sex/Age: F / 14
2. Chief Complaint (C.C): My gingiva and face has swollen (Referred from local clinic)
3. Past Dental History (PDH): 2 times of root canal treatment at local clinic within last 2 weeks
4. Present Illness (P.I): Dens invaginatus, periapicallesion(+), per(+), mob(++),
Gingival and facialswelling(+), open access cavity
5. Impression: Previously initiated treatment with acute apical abscess on tooth #22
6. Tx. plan: Incision & drainage, non-surgical root canal treatment on #22
III. Conclusion
Because of the complex anatomy of dens invaginatus, conservative endodontic treatment is difficult and usually complicated. The complete removal of the anomalous structure can cause thinning of root and weakening of tooth. In order to reduce unnecessary loss of tooth structure, conservative technic should be considered as first treatment option. This case illustrates that conservative root canal treatment of dens invaginatus, not removing all of the internal structure, can result in satisfactory healing.
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