Treatment Plan Making For Tooth With Dens Invaginatus

Dens invaginatus remains concealed and often be detected when it progresses to pulpitis or periapical periodontitis. Due to its complex anatomical structure, RCT becomes significantly more challenging and may even lead to failure. Therefore, early detection, accurate diagnosis, and standardized treatment of dens invaginatus are crucial. The patient was referred to our hospital due to pus discharge at the apical region of tooth 22. Upon opening the pulp chamber at an external clinic, a variation in root canal anatomy was discovered. A CBCT scan revealed that tooth 22 exhibited an Oehlers type II dens invaginatus accompanied by apical periodontitis. The treatment plan was performing RCT first. During the procedure, the invaginated structure was removed. While attempting to negotiate the apical region, instrument separation occurred. The root canal was prepared and obturated to the maximum negotiable working length, then followed by microscopic apical surgery. The invagination structure was removed using ultrasonic devices to achieve infection control and hermetic sealing. While attempting to negotiate the calcified fine apical region, a K-file separated. It was hard to retrieve the fractured instrument or establish a bypass. Therefore, a microscopic apical surgery was performed and resected the unprepared apical portion, followed by retrograde preparation and filling. The management plan for dens invaginatus requires comprehensive consideration of the degree of invagination, the condition of the pulp and periapical tissues, the developmental stage of the root, and associated pathological conditions. Clinicians should develop an appropriate treatment strategy based on the specific conditions of the affected tooth.