Managing Type IIIb Dens Invaginatus With Peri-Invagination Periodontitis

Dens invaginatus is a developmental anomaly that can lead to complex endodontic challenges. This case report presents the management of a 22-year-old female with Oehlers Type IIIB dens invaginatus and peri-invagination periodontitis, emphasizing accurate diagnosis and conservative treatment. A 22-year-old female presented with swelling and pain in the left maxillary anterior region. Clinical examination revealed a conical tooth (22) with a palatal groove and periapical tenderness. Radiographic examination showed an invagination channel extending to the root apex with periapical radiolucency. The diagnosis was Oehlers Type IIIB dens invaginatus with peri-invagination periodontitis. A conservative approach was chosen, involving debridement and sealing of the invagination channel using a custom guide. The procedure included mechanical and chemical preparation, followed by obturation with Iroot BP. The case highlights the importance of precise diagnosis and advanced imaging for treatment planning. The conservative approach aimed to preserve tooth vitality while addressing infection. The use of a custom guide ensured accurate access and minimal damage to surrounding structures. The successful outcome at the 12-month follow-up demonstrates the efficacy of this approach. Conservative management of Oehlers Type IIIB dens invaginatus with peri-invagination periodontitis can effectively preserve tooth vitality and achieve periapical healing. Custom guides and advanced materials like Iroot BP enhance treatment outcomes, emphasizing the importance of tailored treatment plans for complex endodontic cases.