PMC10329757_01
Preoperative photos and radiographs of the dens invaginatus in maxillary left and right lateral incisors; A) The gumboil on attached gingiva related to left lateral incisor (white arrow), the right lateral incisor was not erupted yet; B) The frontal view of CBCT showed left lateral incisor with dens in dent anomaly that associated with a peri-apical lesion (white arrow); also the right lateral incisor had this anomaly (yellow arrow)
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F1
A 9-year-old boy with no relevant medical history was referred to the dental clinic at Shahid Beheshti University, with the chief complaint of having big gumboil on the gingiva of the left maxillary lateral permanent incisor for the past 2 weeks (Figure 1A). The Intra-oral examination revealed conic-shape permanent lateral incisors, without any caries, restorations, or color alteration (Figure 1A). An evaluation of the panoramic radiograph revealed the presence of DI (Figure 1B) in the LLI (Oehlers' type IIIa) and RLI (Oehlers' type II). The invagination extended through the root and associated with lateral radiolucent lesion around the root (Figure 1B).
A) Axial view of CBCT showed both maxillary lateral incisors with dens invaginatus (white arrows), the left lateral associated with a large lesion which perforated buccal cortical plate (yellow arrow); B) Axial view of the left lateral incisor with three pseudo canals; C) Sagittal view of the left and right lateral incisors; D) Axial view of maxillary arch
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F2
Cone-beam computed tomography (CBCT) (NewTom Vgi; Quantitative Radiology, Verona, Italy) was used to scan the affected tooth at 110 kVp, 100 micron voxel size, and a field of view of 6 cmx6 cm to get more precise anatomical information and a diagnosis (Figure 2A). CBCT image indicated that type IIIa invaginatus was present and showed a C-shaped orifice making 3 pseudo canals (Figure 2B); mesiobuccal (MB), mid buccal (midB) and distobuccal (DB). CBCT also revealed a 6.3 mm periapical radiolucency associated with the LLI which had perforated the labial cortical plate (Figure 2C).
Peri-apical radiographs (PA) after treatment; A) immediate after RCT of pseudo canals LLI, The main root was immature with open apex; B) 6 months after treatment, the lesion was going to be heal and main root was developed;. C-D) One year follow-up, a lesion was appeared at the apex of the main root; E) RLI was sealed with resin composite after eruption
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F3
The pseudo canals were obturated with MTA cement (AGM, Tehran, Iran) (Figure 3A). Radiographic assessment revealed root formation, thickening of the root canal walls and significant osseous healing of the preoperative lesion (Figure 3B). Radiographic evaluation showed an osseous lesion forming around the main apical foramen affirming the main canal had become necrotic after one year (Figure 3C).
Post-operative photo and radiographs of the dens invaginatus in maxillary left and right lateral incisors; A) esthetic treatment for LLI and RLI; B) The panoramic image showed the lesion of LLI was healed and the root of RLI was completely developed after 3 years; C) PA radiograph after retreatment of the left lateral incisor; D-E) PA radiograph and CBCT image after 3 years follow up (LLI); F-G) PA radiograph and CBCT images after 3 years follow up (RLI)
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F4
Depth of probing was normal, in periapical radiography healing of the lesion of the left lateral was found (Figure 4). It had erupted completely and esthetic restoration was performed due to patient demand (Figure 4).