PMC5852927_01
(a) (Buccal view): Buccal fistula, (b) (palatal view): Accentuated lingual pit of the right maxillary lateral incisor, and (c) intraoral periapical radiograph
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F1
Through intraoral clinical examination, a fistula of the buccal mucosa in correspondence of apex of right maxillary lateral incisor was found (1.2) [Figure 1a]. The 1.2 appeared morphologically normal except for a deep pit on the lingual surface [Figure 1b]. The latter occupied the coronal space and got over the enamel cement junction, enclosing a radiolucent space that communicates with the periodontal space of the middle third of the root [Figure 1c].
(a) The gutta-percha cone inserted in oral fistula and (b) fistulography
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F2
The radiographic diagnosis showed a DI of 1.2 [Figure 2a and b].
(a) Identification of the dens invaginatus invagination orifice, (b) dens invaginatus with a rounded shape surrounded by vital pulp of maxillary lateral incisor, (c) entrance of the dental root canal, and (d) seal of the peri-malformation space and of the canal tract of dental malformation
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F3
After the administration of local anesthesia, under x20, the pulp chamber of 1.2 was opened and the invagination orifice of malformation was localized [Figure 3a]. The DI appeared as a rounded shape malformation into the dental chamber, surrounded by vital and bloody pulp [Figure 3b]. Removal of vital pulp was necessary; thus, a pointed probe was used around the malformation to locate the access of the principal root canal [Figure 3c]. The filling of the canals was realized by mineral trioxide aggregate (MTA) obturation and three-dimensional gutta-percha obturation for DI canal and root canal systems, respectively; then, the vertical compaction technique with System B Heat Source (SybronEndo) and injection of thermoplastic gutta-percha by Obtura III (SybronEndo) were employed for the down packing and backfilling, respectively, to sealing the surrounding malformation space [Figure 3d].
(a) Clinical disappearance of the oral fistula and (b) Composite indirect restoration of the access cavity
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F4
Ten days after the end of the root canal therapy, clinical disappearance of oral fistula was observed [Figure 4a]. Then, the access cavity was restored by a vetroionomeric cement (3M Espe), used as a filling base, and an indirect composite restoration (A2 GandioSO, Voco) [Figure 4b].
(a) Periapical radiography at the end of endodontic treatment and (b) periapical radiography after 6 months of endodontic treatment
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F5
After 6 months, the radiolucent area disappeared as shown by the periapical radiography, differently from the radiography at the end of endodontic treatment [Figure 5a and b].
(a) Cervical gingivoplasty and (b) lithium silicate ceramic veneers on 1.2 and a reductive odontoplasty of the right maxillary central incisor
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F6
A cervical gingivoplasty [Figure 6a] and a lithium silicate ceramic veneers on 1.2 associated with a reductive odontoplasty of central incisor were realized with great satisfaction of the patient [Figure 6b].