Management of Type II dens invaginatus

Fig. 1

The degree of malformation associated with DI was classified by Oehlers in 1957. According to Oehlers classification, Type I is characterized by enamel lined invagination, which remains confined to the coronal part of the tooth. Type II represents the extension of the invagination in the root extending beyond the cementoenamel junction, which ends in a blind sac. Accordingly, Type IIIa is described as invagination that extends throughout the root and communicates laterally with Periodontal Ligament (PDL) space, and Type IIIb represents invagination extending through the root and communicating the PDL space at the level of the apical foramen.

Fig. 2

A 35 years old male patient was referred from a general Practitioner to my clinic for management of 22 root canal treatment.

After a clinical and radiographic examination, we observe the following : 

Tooth 22 presents Dens invaginatus type II in Oehlers classification, asymptomatic apical periodontitis and physiological probing. 

We decide to perform a non-surgical approach with Mta apical plug   under surgical microscope. The patient was informed of the pros and cons of the treatment and signed the informed consent.

Fig. 3

Preoperative X- Ray

Fig. 4

CBCT Slides

Fig. 5

Preoperative Clinical image, where we can observe the extraoral communication of the dens invaginatus

Fig. 6

In this image we can see the dens in dente and the canal .

Fig. 7

Image after Chemomechanical Preparation where we can see 2 apical foramen.

Fig. 8

Mta Apical plug

Fig. 9

 Back Fill

Fig. 10

Final X-Ray