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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Non-surgical management of dens invaginatus type IIIB in maxillary lateral incisor with three root canals and 6-year follow-up: A case report and review of literature
Suraj Arora, Gurdeep Singh Gill, Shahabe Abullais Saquib, Priyanka Saluja, Suheel M Baba, Shafait Ullah Khateeb, Anshad M Abdulla, Shashit Shetty Bavabeedu, Ahmed Babiker Mohamed Ali, Mohamed Fadul A Elagib
Suraj Arora, Suheel M Baba, Shafait Ullah Khateeb, Shashit Shetty Bavabeedu, Ahmed Babiker Mohamed Ali, Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia
Gurdeep Singh Gill, Priyanka Saluja, Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa 125055, India
Shahabe Abullais Saquib, Mohamed Fadul A Elagib, Department of Periodontics and Community Dental Sciences, King Khalid University, Abha 61421, Saudi Arabia
Anshad M Abdulla, Department of Pediatric Dentistry and Orthodontic Sciences, King Khalid University, Abha 61421, Saudi Arabia
Author contributions: Arora S was the patient’s endodontic specialist, reviewed the literature and contributed to manuscript drafting; Gill GS and Saluja P reviewed the literature and contributed to manuscript drafting; Saquib SA, Baba SM, Abdulla AM, Bavabeedu SS, Khateeb SU, Ali ABM and Elagib MFA revised the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by Deanship of Scientific Research at King Khalid University, Abha, Saudi Arabia through the Small Groups Project, No. RGP. 1/351/43.
Informed consent statement: Informed written consent was obtained from the patient’s parents for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Suraj Arora, MDS, Assistant Professor, Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia. surajarorasgrd@yahoo.co.in
Received: March 23, 2022
Peer-review started: March 23, 2022
First decision: May 30, 2022
Revised: June 12, 2022
Accepted: October 17, 2022
Article in press: October 17, 2022
Published online: November 26, 2022
BACKGROUND
The presence of dens invaginatus (DI) complicates treatment of any tooth, from diagnosis to access cavity and biomechanical preparation and obturation. Reports of successful non-surgical management of DI type IIIB in maxillary lateral incisor are rare. Here, we report such a case, with three root canals and a long follow-up.
CASE SUMMARY
A 13-year-old female patient presented with mild pain in the maxillary right lateral incisor (#7) for 10-15 d. On examination, the tooth was slightly rotated, with slight tenderness on percussion and grade I mobility but with no caries, pockets or restorations and non-vital pulp (via vitality tests). Radiographic examination revealed unusual configuration of the tooth’s root canals, with an enamel-lined invagination extending to the apex, suggesting the possibility of DI Oehler’s type IIIB and a periapical radiolucency. Widening the access cavity lingually revealed one distinct buccal orifice and two distinct palatal orifices; under higher magnification of a dental operating microscope (DOM), the mesio-palatal and disto-palatal orifices were observed as connected by a C-shaped groove. The root canals were prepared with hand K-files following a step-back technique, and obturated using a combination technique of lateral condensation and vertical compaction. At the 6-year follow-up, the patient was asymptomatic, and the periapical radiography displayed significant healing around the apical end of the root.
CONCLUSION
Proper knowledge of unusual root canal anatomy is required in treating DI. Conventional methods of root canal treatment can successfully resolve such complex cases, facilitated by DOM and cone-beam computed tomography.
Core Tip: This case report describes the successful non-surgical management of dens invaginatus type IIIB in a maxillary lateral incisor with three root canals. Access cavity preparation revealed one distinct buccal orifice and two palatal orifices (mesio-palatal and disto-palatal) connected by a C-shaped groove, observed under a dental operating microscope. The root canals were prepared with hand K-files following the step-back technique and obturated using a combination technique of lateral condensation and vertical compaction. At the 6-year follow-up, the patient was asymptomatic and the periapical radiography displayed excellent healing around the apical end of the root.
