Supplemental Classification And Management Of Dens Invaginatus

This study evaluates the clinical outcomes of 144 maxillary anterior teeth with dens invaginatus (Coronal Dens Invaginatus of Oehlers classification and Palatogingival groove) treated between 2015–2025. A 98% retention rate was achieved for coronal Dens Invaginatus. Crown/coronal cases showed predictable outcomes with basic interventions. Mid-root cases required meticulous invaginatus removal but maintained resistance. Advanced root involvement necessitated tailored surgical strategies, yet achieved high success.We propose a modified classification and management protocol based on root involvement depth. All cases were personally managed with long-term follow-up. Treatment modalities included Preventive filling,direct pulp capping, root canal therapy, apical barrier techniques, microscopic apical surgery, and combined periodontal-endodontic interventions. Cases were stratified into three categories: 1. Crown/Coronal third: Simplified treatments (Preventive filling /direct capping/ root canal therapy,). 2. Middle root third: Preventive filling /direct capping/ Complete invaginatus removal via minimally invasive approaches. 3. Beyond mid-root: Complex individualized therapy (e.g., apical surgery). Traditional classifications inadequately address root-level complexity. Our depth-based stratification optimizes treatment planning: The treatment of superficial invaginatus is simple, while deep invaginatus demand advanced techniques. The high retention rate underscores the importance of case-specific approaches and early intervention to prevent complications. Supplementing existing classifications with root-depth criteria enhances clinical decision-making. Conservative management suffices for coronal invaginatus, whereas mid-to-deep root involvement requires targeted interventions. This framework improves prognosis and reduces morbidity in complex dens invaginatus cases. Further validation in multicenter studies is recommended.