PMC6814960_01
(a) Sinus tract with respect to tooth #8. (b) Unusual prominent lingual cusp and a deep lingual pit with respect tooth #7. (c) IOPA showing the sinus tract done by GP cone confirming the lesion on tooth#7. (d) CBCT image of the invaginated structure showing the main apical foramen (red arrow). (e)Axial view of CBCT image showing the invaginated with separate portal exit(green exit). (f) Axial view of CBCT showing the invaginated structure. (g) CBCT 3D reconstruction images demonstrating the invaginated structure.
med-14-767-g001.jpg
PMC6814960_01_med-14-767-g001.jpg
j_med-2019-0089_fig_001
Clinical examination revealed a sinus tract associated with tooth #8 (Fig.1a), while the clinical crown of tooth #7 was unusual with a pronounced lingual cusp and deep lingual pit (Fig. 1b). The CBCT images demonstrated the DI was entirely enclosed in the pulp canal space and had a separate portal exit (Fig.1d). It also revealed that the body of DI was almost a separate entity from the main root canal (Fig.1e and 1f). MeVisLab(MeVis Research, Bremen, Germany) was used for the three-dimensional (3D) reconstruction and analysis of the CBCT images (Fig.1g).
(a) The invaginated structure easily viewed under the DOM after troughing with the ultrasonic tip. (b) H-file used to engage the invaginated structure to remove it from the canal. (c) The removed invaginated structure. (d) IOPA taken after the obturation showing the completely filled canal. (e) Postoperative clinical view of the lingual surface after the restoration. (f) Two- year follow-up IOPA showing the healed lesion.
med-14-767-g002.jpg
PMC6814960_01_med-14-767-g002.jpg
j_med-2019-0089_fig_002
The DI was troughed by using ET20 ultrasonic tip (P5, Satelec, France) carefully to separate the invaginated structure from the pulp canal space (Fig.2a). Once the DI was separated from the dentinal-enamel junction level, it was engaged with an H-file (Dentsply) (Fig 2b) and gently removed (Fig.2c). IOPA was taken after the obturation (Fig.2d). The final coronal restoration was accomplished using composite resin (Filtek Z 350, 3M ESPE, MN, USA) (Fig.2e). At the 2-year follow-up, the tooth was asymptomatic, and the periapical radiograph showed complete healing of periapical radiolucency of tooth #7 (Fig.2f).