Cone-Beam Computed Tomography (CBCT)-Guided Non-surgical Management of Type II Dens Invaginatus in Maxillary Lateral Incisors Using Calcium Silicate-Based Materials: A Case Series

Dens invaginatus (DI) is a developmental anomaly that may create complex internal anatomy, predisposing affected teeth to early pulp necrosis and extensive periapical pathology, particularly in maxillary lateral incisors. Successful management depends on accurate diagnosis, 3D assessment of the invagination, and the use of materials capable of sealing irregular canal spaces and managing open apices or perforations. This report describes the non-surgical endodontic management of two maxillary lateral incisors with Oehlers type II DI associated with necrotic pulp and perforation in the first case and a large periapical lesion in the second case. In both cases, cone-beam computed tomography (CBCT) was used to delineate the extent of the invagination, identify perforations, and evaluate lesion size and proximity to adjacent structures. After careful removal of the invaginated mass and thorough chemomechanical debridement with adjunctive calcium hydroxide medication, treatment strategies were tailored to the root morphology and pathology. In the first case, a coronal perforation was repaired with Biodentine, and the canal was obturated with a calcium silicate-based sealer and gutta-percha. In the second case, an immature tooth with an open apex and extensive periapical lesion was obturated completely with Biodentine. Follow-up periods of 6 and 24 months, respectively, demonstrated satisfactory periapical healing and maintained function, supporting CBCT-guided, bioactive material-based conservative management of complex DI cases.