(TC45) Dens invaginatus- Type III A

Rationale: Dens invaginatus is a dental anomaly that results in the invagination of an amelodental structure within the pulp. Its etiology remains unclear and different treatment options are available depending on the tooth's morphology and the infection's severity. 

Objective:  To present a case report of dens invaginatus in a canine and its management. Technique description: A 37-year-old female patient presented at Eastman Institute of Oral Health, University of Rochester, with a discolored right maxillary canine. The tooth was not sensitive to percussion and palpation and did not respond to a cold thermal test. An intraoral radiograph revealed a radiopaque coronal projection embedded into the root canal with an associated apical radiolucency. Cone beam computerized tomography (CBCT) confirmed a single type III A dens invaginatus. Based on the clinical and radiographic examination, pulpal necrosis/asymptomatic apical periodontitis was diagnosed. Initial access preparation showed two orifices that were confirmed with a microscope. Chemomechanical preparation of both the invagination and the true canal was performed. Hand filing was used in the invagination canal and a combination of hand files and rotatory instrumentation in the true canal. The canals were intermittently irrigated with 5% sodium hypochlorite and calcium hydroxide dressing was placed between visits. Both main canals were obturated with vertical condensation technique. 

Conclusion: Dens invaginatus cases require a different approach and course of action for endodontic treatment. Early diagnosis is essential to prevent complications. The use of magnification and CBCT can enhance treatment planning and the prognosis for this complex anatomical variation.