Aim: The aim of this case report is to give a detailed review about the etiology, prevalence, clinical features, radiographic features and treatment of dens in dente along with the presentation of a case report.
Background: Dental anomaly is a complex interaction between genetic and environmental factors during the process of dental development. One such commonly seen anomaly is dens in dente which represents as an exaggeration or accentuation of a lingual pit. It is a developmental malformation where the etiology is the alteration in the normal growth pattern of the dental papilla during tooth development, resulting in invagination of the surface of the crown or root before calcification.
Case description: A 10-year-old female patient presented to the department, for the routine dental check-up. There was a coincidental diagnosis of a dental anomaly following which a preventive protocol was followed to rescue the teeth from further damage.
Conclusion: Early diagnosis and preventive intervention are important to save the teeth from the further carious lesion.
Clinical significance: As a pediatric dentist, the knowledge about the malformations and making the right decision for management is important.
Neville BW. Abnormalities of teeth. In: Neville B, Damm DD, Allen CM, Bouquot J Oral and Maxillofac Pathol. 2nd ed. Philadelphia: W.B. Saunders; 2002. pg. 80-82.
Hartsfield JK, Cameron AC. Acquired and Developmental Disturbances of the Teeth and Associated Oral Structures. In McDonald and Avery's Dentistry for the Child and Adolescent. Tenth Edition. 2016; pp. 39-79.
Hulsmann M. Dens invaginatus: aetiology, classification, prevalence, diagnosis and treatment considerations. Int Endod J 1997;30:79-90.
Hegde V, Morawala A, et al. Dens in Dente: A Minimally Invasive Nonsurgical Approach! J Conserv Dent 2016;19(5):487- 489.
Tsurumachi T, Hayashi M, et al. Non-surgical root canal treatment of dens invaginatus type 2 in a maxillary lateral incisor. Int Endod J 2002;35(1):68-72.
Atkinson SR. The permanent maxillary lateral incisor. Am J Orthodont 1943;29:685-698.
Rushton MA. A collection of dilated composite odontomes. Br Dent J 1937;63:65-85.
Oehlers FAC. Dens invaginatus. Part I: variations of the invagination process and association with anterior crown forms. Oral Surg Oral Med Oral Pathol 1957;10:1204-1218.
Nagaveni NB, Umashanikara KV, et al. Permanent mandibular incisor with multiple anomalies-report of a rare clinical case. Braz Dent J 2011;22(4):346-350.
Brill WA, Phillips JE. Double dens invaginatus. Oral Surg Oral Med Oral Pathol Oral Radio 1974; 37(1):139-140.
Munir B, Tirmazi SM, et al. Dens invaginatus: aetiology, classification, prevalence, diagnosis and treatment considerations. Pak Oral Dent J 2011;31(1).
Gustafson G, Sundberg S. Dens in dente. Br Dent J 1950; 88:83-88,111-122,144-146.
Kettunen P, Laurikkala J, et al. Associations of FGF-3 and FGF-10 with signaling networks regulating tooth morphogenesis. Dev Dyn 2000; 219(3):322-332. Hovland EJ, Block RM. Non recognition and subsequent endodontic treatment of dens invaginatus. J Endod 1977;3(9):360- 362.
Senia ES, Regezi JA. Dens evaginatus in the etiology of bilateral periapical pathologic involvement in caries-free premolars: case report. Oral Surg Oral Med Oral Pathol 1974;38(3):465-468.
Everett FG, Kramer GM. The disto-lingual groove in the maxillary lateral incisor; a periodontal hazard. J Periodontol 1972;43(6):352-361.
Conklin WW. Double bilateral dens invaginatus in the maxillary incisor region. Oral Surg Oral Med Oral Pathol 1975;39(6):949-952.
Ferguson FS, Friedman S, et al. Successful apexification technique in an immature tooth with dens in dente. Oral Surg Oral Med Oral Pathol Oral Radio 1980;49(4):356-359.
Bóveda C, Fajardo M, et al. Root canal treatment of an invaginated maxillary lateral incisor with a C-shaped canal. Quintessence Int 1999;30:707-711.
Girsch WJ, Mc Clammy TV. Microscopic removal of dens invaginatus. J Endod 2002;28:336-339.
Nallapati S. Clinical management of a maxillary lateral incisor with vital pulp and type 3 dens invaginatus: a case report. J Endod 2004;30(10):726-731.
Steffen H, Splieth C. Conventional treatment of dens invaginatus in maxillary lateral incisor with sinus tract: one year follow-up. J Endod 2005;31:130-133.
Sübay RK, Kayataþ M. Dens invaginatus in an immature maxillary lateral incisor: a case report of complex endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radio Endod 2006;102(2):e37-e41.
Jiménez-Rubio A, Segura JJ, et al. Multiple dens invaginatus affecting maxillary lateral incisors and a supernumerary tooth. Dent Traumatol 1997;13(4):196-198.
Sauveur G, Roth F, et al. Surgical treatment of a periradicular lesion on an invaginated maxillary lateral incisor (dens in dente). Int Endod J 2007;30(2):145-149.
Zengin AZ, Sumer AP, et al. Double dens invaginatus: report of three cases. Eur J Dent 2009;3(1):67.
Keleþ A, Çakýcý F. Endodontic treatment of a maxillary lateral incisor with vital pulp, periradicular lesion and type III dens invaginatus: a case report. Int Endod J 2010;43(7):608-614.
Kottoor J, Murugesan R, et al. A maxillary lateral incisor with four root canals. Int Endod J 2012 Apr;45(4):393-397.
Yang J, Zhao Y, et al. Pulp revascularization of immature dens invaginatus with periapical periodontitis. J Endod. 2013;39(2):288-292.
Izaz S, Bolla N, et al. Endodontic Management of Calcified Oehler's Type IIIb Dens Invaginatus in Permanent Maxillary Lateral Incisor Using Cone Beam Computed Tomography. J Dent 2015;19(3):243.
Zoya A, Ali S, et al. Double dens invaginatus with multiple canals in a maxillary central incisor: retreatment and managing complications. J Endod 2015;41(11):1927-1932.
Heydari A, Rahmani M. Treatment of dens invagination in a maxillary lateral incisor: A case report. Iran Endod J 2015;10(3):207.
Nagaveni NB, Pathak S, et al. An Overview of Dens Invaginatus with Report of 2 Cases. J Clin Exp Pathol 2015;5(238):2161- 2681.
Tripathi P, Singh AR, et al. Nonsurgical endodontic management of maxillary lateral incisor with dens invaginatus and periradicular lesion. Int J Pedod Rehab 2017;2(2):81.
Norouzi N, Kazem M, et al. Nonsurgical management of an immature maxillary central incisor with type iii dens invaginatus using MTA plug: A Case Report. Iran Endod J 2017;12(4):521.
Izaz S, Bolla N, et al. Endodontic Management of Calcified Oehler's Type IIIb Dens Invaginatus in Permanent Maxillary Lateral Incisor Using Cone Beam Computed Tomography. J Dent 2018;19(3):243.
Afkar M, Gholamshahi M, et al. Nonsurgical Treatment of type ii dens invaginatus in a maxillary lateral incisor using cone-beam computed tomography. Iran Endod J 2018; 13(1):132.
Alani A, Bishop K. Dens invaginatus. Part 1: classification, prevalence, aetiology. Int Endod J 2008;41(12):1123-1136.
Hitchin AD, Mchugh WD. Three coronal invaginations in a dilated composite odontome. Brit Dent J 1954;97:90-92.
Green Field RS, Cambruzzi JV. Complexities of endodontic treatment of maxillary lateral incisors with anomalous root formation. Oral Surg Oral Med and Oral Pathol 1986;62:82-88. 66.
Fujiki Y, Tamaki N, et al. Clinical and radiographic observations of dens invaginatus. J Dento Maxillofacial Radio 19743:343-348.
Aguiar CM, Ferreira JP, et al. Type 2 dens invaginatus in a maxillary lateral incisor: a case report of a conventional endodontic treatment. J Clin Pediatric Dent 2008;33(2):103-106.
Ortiz P, Weisleder R, et al. Combined therapy in the treatment of dens invaginatus: case report. J Endod 2004;30:672-674.