2006 Volume 49 Issue 5 Pages 607-616
Dens in dente, or dens invaginatus, is a developmental anomaly of the hard tissues of teeth. Endodontic treatment of a dens in dente in which the invagination communicates with the periodontal ligament is very difficuls. Therefore, most clinicians recommend extraction. Here, we present a case of successful conservative endodontic therapy by apexification of an immature permanent tooth with dens in dente. An 11-year-old girl was referred for endodontic treatment of a right mandibular lateral incisor with dens in dente. Radiographic observation revealed that the invagination communicated with the periodontal ligament (Type III, according to Oehlers' classification). Computed tomography (CT) was used to further examine the anatomical form of the root canal. The imaging information from CT was helpful for endodontic treatment. Two root canals including a main root canal, and the invaginated root canal of the incomplete root were observed. Pulpectomy was performed in the main root canal, and apexification was attempted after the invaginated root canal was treated endodontically. An apical hard tissue barrier was formed 14 months after treatment, after which the root canal was obturated by gutta-percha. At the 1-year recall examination, the tooth remained asymptomatic and reduction of the lesion was evident in the radiograph.
