Overview
Dens invaginatus, also known as tooth-within-a-tooth, is an enamel developmental anomaly characterized by invagination of enamel into the tooth pulp, often leading to complex pulpal and periapical pathology 1.Diagnosis
Radiographic identification showing enamel invagination and potential internal resorption 1.
Clinical symptoms may include pain, swelling, and signs of infection 1.
Pulp vitality testing can reveal non-vital responses in affected teeth 1.Management
First-line treatments:
- Apexification with mineral trioxide aggregate for necrotic pulps 1.
- Canal debridement and dressing under general anesthesia for infected but vital pulps 1.
Adjunctive treatments:
- Regenerative endodontic procedures for immature teeth with potential for continued root development 1.
- Monitoring for progressive sclerosis and root maturation 1.Special Populations
Pediatrics: Treatment must consider dental anxiety and immature tooth development, often requiring general anesthesia 1.
Comorbidities: Management should account for systemic conditions like supraventricular tachycardia, potentially influencing treatment approach and timing 1.Key Recommendations
For immature teeth with dens invaginatus and pulpal involvement, consider regenerative endodontic approaches alongside conventional apexification to promote root development and healing 1 (Evidence: Moderate).
In cases of infected dens invaginatus, initial canal debridement and appropriate dressing under general anesthesia can be effective, especially in pediatric patients 1 (Evidence: Weak).
Regular follow-up is essential to monitor for periapical healing and root maturation, particularly noting signs of progressive sclerosis 1 (Evidence: Expert opinion).References
1 Kumar H, Al-Ali M, Parashos P, Manton DJ. Management of 2 teeth diagnosed with dens invaginatus with regenerative endodontics and apexification in the same patient: a case report and review. Journal of endodontics 2014. link