© Borgis - Nowa Stomatologia 3/2003, s. 107-110
L.J. Pypeć, A. Bruzda-Zwiech
Dens invaginatus as endodontic problem – case report*
Department of Paediatric Dentistry, Institute of Dentistry,
Medical University of Lodz
The developmental anomaly known as dens in dente, dens invaginatus, dens Saltersi occurs as an indentation of hard tissues of the tooth into the pulp chamber or into the root canal (1, 2). This condition is most probably caused by an invagination of the inner enamel epithelium into the dental papilla prior to calcification (3, 4, 5). Pindborg, except of dislocation of the enamel organ relation to the dental papilla, mentions several other hypotheses, which have been put forward with regard to the aetiology and pathogenesis of the invaginations:
– abnormal pressure from the surrounding tissue during tooth formation,
– defects in the enamel organ occupied by connective tissue which, as tooth formation progresses, retard local development (6).
Dens invaginatus is a fairly common condition in maxillary lateral incisors, but any type of tooth may be seat of an invagination (4, 5, 6, 9, 10). The anomaly is very rare in the mandible, and only few cases were reported among primary dentition (7). Supernumerary teeth quite often present invaginations (5, 8). The prevalence of dens invaginatus ranges from 0,25-6,8%. Poyton and Morgan (11) stated the prevalence of 0,25%, Amos (12) – 5,1%, and Backman (13) reported the prevalence of this anomaly of 6,8%. The opening to the invagination is located on the palatal surface of the tooth, under the dental cusp, in normally shaped teeth and on the top of incisor´s edge in peg-shape teeth (10). Very rarely a radicular invagination is observed. The invaginations may vary from slightly accentuated cingulum (foramen coecum) to deep infolding reaching the apical foramen (6). Classifications of this anomaly include: extent of the invagination (shallow, deep, deep with deformation of the crown), localization (crown, root), and defects in the bottom of the invagination (1, 6). The deeper the invagination the weaker mineralization of enamel and dentine in the bottom of the invagination is. That may cause a direct communication between the bottom of the invagination and the pulp (6, 14). The communication may consist of one or more small canal. In some cases of „dens in dente” the enamel lining the invagination is almost absent over a small area at the deepest part. The unprotected dentine may give bacteria access to the underlying pulp (4, 15). Food debris and microorganisms may become packed into the defect, leading to early carious destruction and to pulp pathosis (3, 5, 6). Because of this risk, the opening of the defect should be sealed as soon as possible (16). Prophylactic invagination treatment helps to avoid serious periapical complication that could influence the outcome of endodontic treatment (16). Therapeutic treatment of pulp and periapical pathosis in dentes invaginatus, have better prognosis in teeth with the completed development of the root (1). Endodontic treatment can be successful even in the cases with very deep infolding, which extends to 1/3 apical part of root (17, 18).
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