An Operating Microscope-Assisted Therapy For Type II Dens Invaginatus

Dens invaginatus is a developmental anomaly resulting from the invagination of the enamel organ into the dental papilla during odontogenesis, driven by multiple etiological factors. This report presents a clinical case of pulp preservation treatment in a maxillary lateral incisor with Oehlers’ Type II dens invaginatus, utilizing bioactive ceramic materials under microscopic visualization. A 23-year-old female patient presented with a one-year history of discoloration on the lingual surface of tooth #12. Clinical examination revealed vital pulp vitality, while CBCT (Cone Beam Computed Tomography) imaging demonstrated a well-defined, droplet-shaped dens invaginatus on the lingual side of tooth#12. The invagination extended into the pulp chamber but did not reach the root apex. Based on these findings, the patient was diagnosed with Oehlers’ Type II dens invaginatus complicated by incipient caries. The patient opted for conservative filling therapy. Postoperative follow-up showed no symptoms or discomfort. The invagination is lined with enamel on its inner surface, surrounded by hyperplastic pulp horns, posing two critical challenges. Therefore, a non-conventional approach—combining root canal-like instrumentation with chemical irrigation—was adopted to achieve thorough infection control while minimizing excessive destruction of the narrow invagination area. Additionally, bioactive ceramic materials were utilized to reduce pulpal irritation, enabling successful cavity sealing under optimal pulp protection. The synergistic application of precise management strategies for narrow anatomical structures under microscopy and biomaterials offers a replicable technical pathway for the clinical treatment of complex dens invaginatus.