Fig. 1

35 years old patient with 1.2 with a typical aspect of dens invaginatus with an anatomical malformation in the crown.

The tooth responded negatively to vitality tests and it was also discromic.

Fig. 2

Radiograph evaluation confirmed the presence of dens invaginatus and a periapical radiolucent lesion.

Radiography has an important role in the diagnosis and assessment of the irregular morphology of the root canal system, but conventional planar radiography only provides a two-dimensional representation of the complex anatomy 

Cone beam computed tomography (CBCT) provides three-dimensional (3D) images of the maxillofacial skeleton, including the teeth and their surrounding tissues,

Fig. 3

The scanned volume derived from the CBCT software may allow generation of images in three planes that can be continuously scrolled through, thus allowing a three- dimensional understanding of the structure involved. They can also be converted into additional types of files. 

the new types of files that can be derived from the CBCT scans is the stereo litography (STL) file. An STL file is a format used by stereoli- thography software to generate information needed to produce 3D plastic models using stereolithography machines or printers

Fig. 4

Thanks to CBCT is also possible measure properly length an diameter of root canal anatomy

The CBCT data were used to produce precise 3D plastic models of the tooth. These models facilitated the treatment planning process and the trial of treatment approaches. 

First visit: access cavity with a proper location in order to treat only the anatomy accessible with a conventional orthograde approach.

WL 19mm

Shaping:F2 gold

Filling: Warm vertical technique

Fig. 5

Xray of RCT

Second visit: surgical approach. 

Cavity preparation with Spartan Obtura tips

Retrofilling with bioceramic putty

Res Membrane

Fig. 6

Post op X-ray 

Fig. 7

After 4 days seiches removal

Fig. 8

Bone healing process after one month

Fig. 9

5 months recall x-ray


Root canal treatment in teeth with dens invaginatus associated with apical pathosis often involves complicated procedures that require precise diagnosis, appropriate treatment planning and adequate implementation.
The printing of a transparent 3D plastic model of this tooth, with its complex invagination, provided an effective means for defining the correct approach, surgical and not surgical.
In complex cases, 3D models can facilitate treatment planning and is also useful for education purposes.


Management of a Type III Dens Invaginatus using a Combination Surgical and Non-surgical Endodontic Therapy: A Case Report
The journal of contemporary dental practice 10(5):E081-7 · September 2009

The diagnosis and conservative treatment of a complex type 3 dens invaginatus using cone beam computed tomography (CBCT) and 3D plastic models
A. Kfir, Y. Telishevsky-Strauss, A. Leitner & Z. Metzger