Endodontic management of a talon cusp and dens invaginatus in a mandibular lateral incisor: A case report

Anomalies in tooth development represent deviations from normal morphogenesis and may arise due to disturbances in epithelial–mesenchymal interactions during odontogenesis. These disturbances can manifest as variations in the number, shape, size, or morphology of teeth. Talon cusp and dens invaginatus are rare developmental anomalies that present unique diagnostic and therapeutic challenges, particularly when coexisting in a single tooth. This case report describes the endodontic management of a 12-year-old male who presented with a dentoalveolar abscess in the lower anterior region, although the affected mandibular lateral incisor (tooth 42) appeared clinically intact and non-carious. Intraoral examination revealed a prominent talon cusp with a lingual pit on tooth 42, which also exhibited grade I mobility and tenderness on percussion. Radiographic and cone-beam computed tomography (CBCT) analyses revealed a Type II dens invaginatus with mesiobuccal deviation of the primary canal and a centrally located accessory invaginated canal. Access cavity preparation under rubber dam isolation revealed two distinct canal orifices. Endodontic treatment included negotiation and shaping of both canals, followed by intracanal medication with calcium hydroxide and obturation using the lateral condensation technique. The unique internal morphology necessitated tailored endodontic protocols supported by CBCT guidance. This report underscores the importance of recognizing rare morphological anomalies in pediatric patients and adopting a comprehensive diagnostic approach to ensure effective and conservative management of complex endodontic cases