(TC28) A Conservative Approach to Manage a Complicated Dens invaginatus Case with Apico-marginal Defect Subjected to Multiple Treatment Failures

Dens invaginatus, also known as dens in dente, results from a deepening or invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues.  Its incidence ranges between 0.04% and 10%, and commonly involves the upper lateral incisors. Though dens invaginatus is a fairly common condition, it can present various endodontic treatment challenges.  The invagination can often present an obstruction to access, clean, and seal the main root canal space. Alternatively, the invagination can be removed to facilitate proper treatment. However, it  is more destructive and can potentially weaken the remaining tooth structure. While non-surgical approaches are often the primary route for endodontic treatment, surgical management as a primary endodontic treatment can present a more conservative approach. This table clinic presents a novel approach to managing a maxillary lateral incisor with Type II Dens invaginatus. The tooth was diagnosed with pulp necrosis with chronic abscess and had been subjected to multiple surgical interventions, resulting in loss of the labial plate and “apico-marginal defect.” To preserve the tooth structure,  the invagination was first managed non-surgically, followed by apical surgery to disinfect and seal the main canal space. The periapical pathology was then excised and guided bone regeneration was attempted to restore the buccal plate. Follow-up clinical evaluation and scan showed evidence of healing and the patient is currently asymptomatic. This clinical approach allowed preservation of the tooth and the supporting structure and was more definitive to control the apical disease.