Dens invaginatus

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Dens invaginatus
Other namesDens in dente, tooth within a tooth
Specialty Dentistry

Dens invaginatus (DI), also known as tooth within a tooth, is a rare dental malformation where there is an infolding of enamel into dentine. The prevalence of condition is 0.3 - 10%, [1] affecting more males than females. The condition is presented in two forms, coronal and radicular, with the coronal form being more common.

Contents

DI is a malformation of teeth most likely resulting from an infolding of the dental papilla during tooth development or invagination of all layers of the enamel organ in dental papillae. Affected teeth show a deep infolding of enamel and dentine starting from the foramen coecum or even the tip of the cusps and which may extend deep into the root. Teeth most affected are maxillary lateral incisors (80%), [2] followed by maxillary canines (20%). [2] Bilateral occurrence is not uncommon (25%). [2]

Signs and symptoms

Tooth affected by this condition has a higher risk of developing caries and periradicular pathology. [1] The thin layer of the infolding enamel could be chipped off easily, providing entrance for microorganisms into the tooth canal. This can cause abscess formation, displacement of dental structures (i.e. teeth). [3] Preventive measures should be taken.

Cause

Cause of DI is unclear. However, there are several theories:

Diagnosis

During clinical examination, [4] abnormally shaped tooth can be observed. Teeth with this condition can have a conical shape or deep pit on the lingual side or have an exaggerated talon cusp.

Although examination may reveal a fissure on the surface of anterior tooth, radiographic examination is the way. [5] On a periapical radiograph, the invagination lesion will appear as a radiolucent pocket. It is usually seen beneath the cingulum or incisal edge. Larger lesions can appear as fissures. A radio-opaque could be shown. Pulp may be involved and the root canal could have complex anatomy. Two periapical radiographs are often required to make sure that it is not a masked lesion.

Cone beam computed tomography [6] [7] (CBCT) is useful in diagnosing DI. It provides clinicians a detailed 3D image and could aid treatment planning. Feasibility of root canal treatment or apical surgery or other procedures could be assessed.

Oehlers' classification

Oehlers' classification with marked Foramen cecum. Dens invaginatus - Typen nach Oehlers 1957 - Annotation.png
Oehlers' classification with marked Foramen cecum.

Histology

Management

Related Research Articles

<span class="mw-page-title-main">Root canal</span> Hollow part of the root of a tooth

A root canal is the naturally occurring anatomic space within the root of a tooth. It consists of the pulp chamber, the main canal(s), and more intricate anatomical branches that may connect the root canals to each other or to the surface of the root.

<span class="mw-page-title-main">Endodontics</span> Field of dentistry

Endodontics is the dental specialty concerned with the study and treatment of the dental pulp.

<span class="mw-page-title-main">Pulp (tooth)</span> Part in the center of a tooth made up of living connective tissue and cells called odontoblasts

The pulp is the connective tissue, nerves, blood vessels, and odontoblasts that comprise the innermost layer of a tooth. The pulp's activity and signalling processes regulate its behaviour.

<span class="mw-page-title-main">Enamel organ</span> Aggregate of cells involved in tooth development

The enamel organ, also known as the dental organ, is a cellular aggregation seen in a developing tooth and it lies above the dental papilla. The enamel organ which is differentiated from the primitive oral epithelium lining the stomodeum. The enamel organ is responsible for the formation of enamel, initiation of dentine formation, establishment of the shape of a tooth's crown, and establishment of the dentoenamel junction.

A pulp polyp, also known as chronic hyperplastic pulpitis, is a "productive" inflammation of dental pulp in which the development of granulation tissue is seen in response to persistent, low-grade mechanical irritation and bacterial invasion of the pulp.

<span class="mw-page-title-main">Condensing osteitis</span> Medical condition

Condensing osteitis is a periapical inflammatory disease that results from a reaction to a dental related infection. This causes more bone production rather than bone destruction in the area. The lesion appears as a radiopacity in the periapical area hence the sclerotic reaction. The sclerotic reaction results from good patient immunity and a low degree of virulence of the offending bacteria. The associated tooth may be carious or contains a large restoration, and is usually associated with a non-vital tooth. It was described by Dr. Carl Garré in 1893.

Dens evaginatus is a rare odontogenic developmental anomaly that is found in teeth where the outer surface appears to form an extra bump or cusp.

<span class="mw-page-title-main">Dentin dysplasia</span> Medical condition

Dentin dysplasia (DD) is a rare genetic developmental disorder affecting dentine production of the teeth, commonly exhibiting an autosomal dominant inheritance that causes malformation of the root. It affects both primary and permanent dentitions in approximately 1 in every 100,000 patients. It is characterized by the presence of normal enamel but atypical dentin with abnormal pulpal morphology. Witkop in 1972 classified DD into two types which are Type I (DD-1) is the radicular type, and type II (DD-2) is the coronal type. DD-1 has been further divided into 4 different subtypes (DD-1a,1b,1c,1d) based on the radiographic features.

<span class="mw-page-title-main">Dental abscess</span> Medical condition

A dental abscess is a localized collection of pus associated with a tooth. The most common type of dental abscess is a periapical abscess, and the second most common is a periodontal abscess. In a periapical abscess, usually the origin is a bacterial infection that has accumulated in the soft, often dead, pulp of the tooth. This can be caused by tooth decay, broken teeth or extensive periodontal disease. A failed root canal treatment may also create a similar abscess.

<span class="mw-page-title-main">Root canal treatment</span> Dental treatment

Root canal treatment is a treatment sequence for the infected pulp of a tooth which is intended to result in the elimination of infection and the protection of the decontaminated tooth from future microbial invasion. Root canals, and their associated pulp chamber, are the physical hollows within a tooth that are naturally inhabited by nerve tissue, blood vessels and other cellular entities. Together, these items constitute the dental pulp.

Apical periodontitis is typically the body's defense response to the threat of microbial invasion from the root canal. Primary among the members of the host defense mechanism is the polymorphonuclear leukocyte, otherwise known as the neutrophil. The task of the neutrophil is to locate and destroy microbes that intrude into the body – anywhere in the body – and they represent the hallmark of acute inflammation.

<span class="mw-page-title-main">Tooth resorption</span> Medical condition

Resorption of the root of the tooth, or root resorption, is the progressive loss of dentin and cementum by the action of odontoclasts. Root resorption is a normal physiological process that occurs in the exfoliation of the primary dentition. However, pathological root resorption occurs in the permanent or secondary dentition and sometimes in the primary dentition.

Combined periodontic-endodontic lesions are localized, circumscribed areas of bacterial infection originating from either dental pulp, periodontal tissues surrounding the involved tooth or teeth or both.

Pulp necrosis is a clinical diagnostic category indicating the death of cells and tissues in the pulp chamber of a tooth with or without bacterial invasion. It is often the result of many cases of dental trauma, caries and irreversible pulpitis.

A phoenix abscess is an acute exacerbation of a chronic periapical lesion. It is a dental abscess that can occur immediately following root canal treatment. Another cause is due to untreated necrotic pulp. It is also the result of inadequate debridement during the endodontic procedure. Risk of occurrence of a phoenix abscess is minimised by correct identification and instrumentation of the entire root canal, ensuring no missed anatomy.

<span class="mw-page-title-main">Dental trauma</span> Medical condition

Dental trauma refers to trauma (injury) to the teeth and/or periodontium, and nearby soft tissues such as the lips, tongue, etc. The study of dental trauma is called dental traumatology.

<span class="mw-page-title-main">Periapical periodontitis</span> Medical condition

Periapical periodontitis or apical periodontitis (AP) is an acute or chronic inflammatory lesion around the apex of a tooth root, most commonly caused by bacterial invasion of the pulp of the tooth. It is a likely outcome of untreated dental caries, and in such cases it can be considered a sequela in the natural history of tooth decay, irreversible pulpitis and pulpal necrosis. Other causes can include occlusal trauma due to 'high spots' after restoration work, extrusion from the tooth of root filling material, or bacterial invasion and infection from the gums. Periapical periodontitis may develop into a periapical abscess, where a collection of pus forms at the end of the root, the consequence of spread of infection from the tooth pulp, or into a periapical cyst, where an epithelial lined, fluid-filled structure forms.

<span class="mw-page-title-main">Regenerative endodontics</span> Dental specialty

Regenerative endodontic procedures is defined as biologically based procedures designed to replace damaged structures such as dentin, root structures, and cells of the pulp-dentin complex. This new treatment modality aims to promote normal function of the pulp. It has become an alternative to heal apical periodontitis. Regenerative endodontics is the extension of root canal therapy. Conventional root canal therapy cleans and fills the pulp chamber with biologically inert material after destruction of the pulp due to dental caries, congenital deformity or trauma. Regenerative endodontics instead seeks to replace live tissue in the pulp chamber. The ultimate goal of regenerative endodontic procedures is to regenerate the tissues and the normal function of the dentin-pulp complex.

In the dental specialty of endodontics, periradicular surgery is surgery to the external root surface. Examples of periradicular surgery include apicoectomy, root resection, repair of root perforation or resorption defects, removal of broken fragments of the tooth or a filling material, and exploratory surgery to look for root fractures.

Periapical granuloma, also sometimes referred to as a radicular granuloma or apical granuloma, is an inflammation at the tip of a dead (nonvital) tooth. It is a lesion or mass that typically starts out as an epithelial lined cyst, and undergoes an inward curvature that results in inflammation of granulation tissue at the root tips of a dead tooth. This is usually due to dental caries or a bacterial infection of the dental pulp. Periapical granuloma is an infrequent disorder that has an occurrence rate between 9.3 to 87.1 percent. Periapical granuloma is not a true granuloma due to the fact that it does not contain granulomatous inflammation; however, periapical granuloma is a common term used.

References

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  2. 1 2 3 Hakan Çolak, Enes Tan,Bahadır Uğur Aylıkçı, Recep Uzgur, Mustafa Turkal, and Mehmet Mustafa Hamidi (29 June 2012). "Radiographic Study of the Prevalence of Dens Invaginatus in a Sample Set of Turkish Dental Patients". Journal of Clinical Imaging Science. 2: 34. doi: 10.4103/2156-7514.97755 . PMC   3424816 . PMID   22919548.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. 1 2 3 4 5 6 7 8 "What is dens invaginatus or dens in dente?". 3 Feb 2018.
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  5. Radicular Dens Invaginatus: Report of a Rare Case https://www.hindawi.com/journals/crid/2012/871937/
  6. 1 2 Pushpak Narayana, BDS; Gary R Hartwell, DDS, MS; Robert Wallace, DDS, MSc; Umadevi P Nair, DMD, MDS (August 2012). "Endodontic Clinical Management of a Dens Invaginatus Case by Using a Unique Treatment Approach: A Case Report". Journal of Endodontics. 38 (8): 1145–8. doi:10.1016/j.joen.2012.04.020. PMID   22794224.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. Álvaro Zubizarreta Macho, DDS, PhD; Alberto Ferreiroa, DDS, PhD, Cristina Rico-Romano, DDS, PhD; Luis Óscar Alonso-Ezpeleta, DDS, PhD; Jesús Mena-Álvarez, DDS, PhD (April 2015). "Diagnosis and endodontic treatment of type II dens invaginatus by using cone-beam computed tomography and splint guides for cavity access". The Journal of the American Dental Association. 146 (4): 266–70. doi:10.1016/j.adaj.2014.11.021. PMID   25819658.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. 1 2 3 4 Piattelli A, Trisi P (1993). "Dens invaginatus: a histological study of undermineralized material". Dental Traumatology. 9 (5): 191–195. doi:10.1111/j.1600-9657.1993.tb00273.x.
  9. 1 2 Satyaranjan Mishra, Lora Mishra, and Sujit Ranjan Sahoo (Nov 2012). "A Type III Dens Invaginatus with Unusual Helical CT and Histologic Findings: A Case Report". Journal of Clinical and Diagnostic Research.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. Harleen Kumar, BDSc, DCD; Muna Al-Ali, BDSc, MFDS, DCD; Peter Parashos, BDSc, LDS, MDSc, FRACDS, PhD, FICD, FACD; David J Manton, BDSc, MDSc, PhD, FRACDS, FICD, FADI (May 2014). "Management of 2 Teeth Diagnosed with Dens Invaginatus with Regenerative Endodontics and Apexification in the Same Patient: A Case Report and Review". Journal of Endodontics. 40 (5): 725–31. doi:10.1016/j.joen.2013.10.030. PMID   24767572.{{cite journal}}: CS1 maint: multiple names: authors list (link)