Densed tooth invaginatus (DI), also known as Salter’s tooth, is a developmental disorder involving the invagination of enamel and dentin into the interior of the tooth (1, 2). It is caused by the displacement of the enamel-forming organ into the dental papilla before the calcification process of the developing tooth germ (3). It is characterized by high morphological variability. Symptoms suggesting the presence of invagination include: an increased width of the tooth crown compared to the same-named tooth on the opposite side, a deep foramen cecum, a barrel-shaped or conical shape of the crown, a notch on the incisal edge with a groove on the labial surface, a prominent neck on the palatal surface, a claw-like cusp or a dimple on the lingual surface in the neck region (1). An invaginated tooth may also not show clinically noticeable differences in its anatomical structure (1). Radiologically, it is characterized by the penetration of enamel and dentin into the tooth cavity, sometimes extending the entire length of the root, which is surrounded by hard tissues (3). This disorder can affect all tooth groups, including supernumerary teeth (4). It usually occurs in the permanent dentition, although it can also be seen in the primary dentition (5). Cases of dens in dente have been described in the mandible, but these lesions are most often detected in the maxilla and affect the lateral incisors (5-8). Salter’s tooth occurs in 0.04-10% of cases and is more common in males than females (1). It can occur bilaterally (9, 10). Although there are many theories regarding the causes of this disorder, such as infections, trauma, or excessively rapid proliferation of the inner enamel epithelium towards the dental papilla, the etiology of DI remains unclear (11). It has been proven that this trait is inherited in an autosomal dominant manner (1). Parents and siblings of people with DI may also be affected by the disorder.

Three basic types of invaginated teeth were distinguished according to Oehlers, including two subtypes of type III. This division was based on radiological observation of the depth of invaginated teeth (11, 12) (fig. 1, tab. 1).

The choice of DI treatment method is dictated by the Oehlers classification, the location and type of tooth affected by this disorder, the degree of root development, the occurrence of possible external root resorption, the planned orthodontic treatment, as well as the clinical symptoms and the extent of periapical changes.

The paper presents a case of surgical treatment of an invaginated tooth type III according to Oehlers in an 11-year-old patient who is under regular orthodontic care.