Non-surgical root canal treatment of dens invaginatus type 2 in a maxillary lateral incisor

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Report A 10-year-old girl was referred by her general dental practitioner because of pain and swelling from her maxillary right lateral incisor. The patient described an episode of recent severe throbbing pain over the past 2 days; there was no previous history of any signs or symptoms. The medical history was non-contributory. Clinical examination revealed that there was a swelling buccal to the lateral incisor (Fig. 1). The tooth was caries free but had an enamel projection in the centre of its lingual surface (Fig. 2). The gingival probing depths were within normal limits. The tooth was sensitive to percussion and failed to respond to electric pulp sensitivity testing. The adjacent teeth all responded within normal limits to percussion and sensitivity testing. A periapical radiograph demonstrated a radiolucent lesion in the mesial aspect of the apical third of the right lateral incisor (Fig. 3). A clinical diagnosis was established of dens invaginatus (Oehlers Type 2), necrotic pulp and acute apical abscess. Following isolation of the tooth with a rubber dam, the pulp chamber was opened and the invagination orifice located. When the invagination orifice was enlarged, the primary root canal was discovered in a more lingual position (Fig. 4). A radiograph with files in the root canals was obtained (Fig. 5). Non-surgical root canal treatment of dens invaginatus type 2 in a maxillary lateral incisor Report. 0 A 10-year-old girl was referred by her general dental practitioner because of pain and swelling from her maxillary right lateral incisor. The patient described an episode of recent severe throbbing pain over the past 2 days; there was no previous history of any signs or symptoms. The medical history was non-contributory. Clinical examination revealed that there was a swelling buccal to the lateral incisor (Fig. 1). The tooth was caries free but had an enamel projection in the centre of its lingual surface (Fig. 2). The gingival probing depths were within normal limits. The tooth was sensitive to percussion and failed to respond to electric pulp sensitivity testing. The adjacent teeth all responded within normal limits to percussion and sensitivity testing. A periapical radiograph demonstrated a radiolucent lesion in the mesial aspect of the apical third of the right lateral incisor (Fig. 3). A clinical diagnosis was established of dens invaginatus (Oehlers Type 2), necrotic pulp and acute apical abscess. Following isolation of the tooth with a rubber dam, the pulp chamber was opened and the invagination orifice located. When the invagination orifice was enlarged, the primary root canal was discovered in a more lingual position (Fig. 4). A radiograph with files in the root canals was obtained (Fig. 5).

 

 

Preoperative view of maxillary lateral incisor showing localized swelling
Figure 1. Preoperative view of maxillary lateral incisor showing localized swelling.

Preoperative palatal view of maxillary lateral incisor. Note the large enamel projection
Figure 2. Preoperative palatal view of maxillary lateral incisor. Note the large enamel projection.

Preoperative radiograph of maxillary lateral incisor showing dens invaginatus with periapical radiolucency
Figure 3. Preoperative radiograph of maxillary lateral incisor showing dens invaginatus with periapical radiolucency.

Access opening demonstrating two distinct canal orifices
Figure 4. Access opening demonstrating two distinct canal orifices.

K-files in both canals
Figure 5. K-files in both canals.

Radiograph immediately after obturation of primary root canal. No communication with invagination is evident
Figure 6. Radiograph immediately after obturation of primary root canal. No communication with invagination is evident.

Two-year follow-up radiograph of maxillary lateral incisor. Radiograph reveals a reduction in size of the radiolucent area
Figure 7. Two-year follow-up radiograph of maxillary lateral incisor. Radiograph reveals a reduction in size of the radiolucent area.