Non-surgical endodontic management of dens invaginatus type II in an immature maxillary lateral incisor using a bioceramic apical plug: A 3-year follow-up case report

Dens invaginatus (DI) is a rare developmental dental anomaly characterized by the infolding of enamel and dentin into the pulp cavity. Type II DI poses significant endodontic challenges due to its complex internal morphology and frequent association with pulp necrosis and open apices, particularly in immature teeth. This case report describes the nonsurgical management of a Type II DI in a 10-year-old male patient with an immature maxillary right lateral incisor presenting with pain and swelling. Radiographic examination confirmed the presence of a Type II invagination, apical radiolucency, and a wide-open apex. The case was diagnosed with pulp necrosis with acute apical abscess. The treatment involved conservative ultrasonic removal of the invaginated tissue followed by apexification using a 10-mm bioceramic apical plug. The tooth was restored with composite resin to maintain a proper coronal seal. The patient was followed up for 3 years, during which complete periapical healing and resolution of symptoms were observed, and the tooth remained functional. This case highlights the effectiveness of conservative ultrasonic techniques and bioceramic apical plugs in managing complex anatomical anomalies in immature teeth, leading to predictable healing and long-term clinical success.