Abstract
Dens invaginatus (DI), which often occurs in the maxillary lateral incisor, is an
important issue in endodontics because the treatment complexity increases depending
on the degree of invagination and the vitality or nonvitality of the pulp. An 11-year-old
female patient with a sinus tract in the gingiva of the maxillary lateral incisors
showed peri-invagination periodontitis and double DI on radiography. Cone-beam computed
tomographic imaging was used to examine the structure in the root canal in detail,
and Oehlers type IIIA and IIIB DI was found. It was also shown that the patient’s
bone defect was caused by type IIIA. Because a healthy reaction was observed in the
pulp test, the final diagnosis was peri-invagination periodontitis associated with
type IIIA of the double DI with vital pulp. We expected the lesion to heal by treating
only the type IIIA invaginated pseudo–root canal while preserving the healthy pulp.
The invaginated root canal was cleaned under a microscope using ultrasonic instruments
and nickel-titanium files to minimize irritation to the pulp. Because the lesion shrinkage
was confirmed by cone-beam computed tomographic imaging taken 3 months after the start
of treatment, vertical compaction of the warm gutta-percha technique was performed.
At the 6-month postoperative recall, the pulp was normal, and the lesions were further
improved. Treatment of the main root canal of double DI is complicated. However, proper
diagnosis and careful cleaning of the invaginated root canal are essential for healing
while preserving the pulp.
Key Words
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Article info
Publication history
Published online: June 05, 2021
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© 2021 American Association of Endodontists.
