Endodontic Treatment Of Maxillary Canine With Type IIIa Dens Invaginatus

Dens invaginatus (DI), a developmental anomaly characterized by enamel invagination, poses significant diagnostic and therapeutic challenges. Maxillary canines are exceptionally uncommon sites for DI, with a reported radiographic prevalence of 0.002%. This article reports 1 rare case of maxillary canine Type IIIa dens invaginatus with pulp necrosis and extensive periapical lesions. A 29-year-old female presented with a 7-year history of recurrent swelling and purulent discharge in the right maxillary canine region. Clinical examination revealed an enlarged crown of tooth #13, a labial sinus tract, and negative pulp vitality tests. CBCT imaging confirmed Type IIIa DI with a 16mm×7mm periapical radiolucency. Treatment involved microscopic root canal therapy: mechanical-chemical debridement of both the root canal and invagination tract, followed by obturation using gutta-percha and bioceramic sealer. Three-year follow-up showed complete resolution of symptoms and significant reduction of the periapical lesion. The key factors contributing to the successful treatment of this case were 1) CBCT for precise anatomical evaluation, 2) identification of the infection source and complete elimination of infected tissue through mechano-chemical preparation and 3) application of modern endodontic techniques and biomaterials. In conclusion, non - surgical treatment of maxillary canines with Type IIIa dens invaginatus can be successful with proper diagnosis using advanced imaging, meticulous treatment techniques, and appropriate material selection. This case contributes to the understanding of managing such complex dental anomalies conservatively.