Endodontic treatment of a central incisor with dens invaginatus





Root canal; Dens in dente; Endodontics.


Dens invaginatus (DI) is a developmental dental anomaly where there is an invagination of the enamel organ in the dental papilla, before calcification is complete. These anomalies are clinically relevant, as bacteria from the oral cavity can contaminate and propagate within these malformations, leading to the development of early caries and, consequently, pulp death. The definitive cause of these anomalies is still uncertain. The reported frequency is 0,04-10%. And the permanent lateral incisors are the most affected, followed by the central incisors, premolars, canines and molars, in descending order. ID is usually diagnosed on a routine radiograph, however reconstructed CBCT images are useful in assessing the true nature of the invagination-root canal relationship. The objective of this case report was to present an endodontic technique for the treatment of a compromised DI. Recognition of root canal developmental anomalies and complexities is essential for long-term success in endodontic therapy. Modification of the conventional treatment procedure is often necessary for unusual canal anatomy. For this reason, referral to an endodontic specialist is always indicated.


Agrawal, P. K., Wankhade, J., & Warhadpande, M. (2016). A rare case of type III dens invaginatus in a mandibular second premolar and its nonsurgical endodontic management by using cone-beam computed tomography: a case report. Journal of Endodontics, 42(4), 669-672.

Ahmed, H. M. A., & Dummer, P. M. (2018). A new system for classifying tooth, root and canal anomalies. International endodontic journal, 51(4), 389-404.

Alani, A., & Bishop, K. (2008). Dens invaginatus. Part 1: classification, prevalence and aetiology. International endodontic journal, 41(12), 1123-1136.

de Oliveira, N. G., da Silveira, M. T., Batista, S. M., Veloso, S. R. M., de Vasconcelos Carvalho, M., & Travassos, R. M. C. (2018). Endodontic treatment of complex dens invaginatus teeth with long term follow-up periods. Iranian endodontic journal, 13(2), 263.

Gallacher, A., Ali, R., & Bhakta, S. (2016). Dens invaginatus: diagnosis and management strategies. British Dental Journal, 221(7), 383-387.

Gharechahi, M., & Ghoddusi, J. (2012). A nonsurgical endodontic treatment in open-apex and immature teeth affected by dens invaginatus: using a collagen membrane as an apical barrier. The Journal of the American Dental Association, 143(2), 144-148.

Heydari, A., & Rahmani, M. (2015). Treatment of dens invagination in a maxillary lateral incisor: a case report. Iranian endodontic journal, 10(3), 207.

Ishida, A. L., Endo, M. S., Queiroz, A. F., Jacomacci, W. P., Ferreira, G. Z., Bisol, F. C. T., & Iwaki Filho, L. (2016). Treatment of extensive cystic lesion in the maxilla associated with dens in dente. Brazilian Dental Science, 19(3), 117-123.

Jain, P., Balasubramanian, S., Sundaramurthy, J., & Natanasabapathy, V. (2017). A cone beam computed tomography of the root canal morphology of maxillary anterior teeth in an institutional-based study in Chennai urban population: an in vitro study. Journal of International Society of Preventive & Community Dentistry, 7(Suppl 2), S68.

Siqueira, J. F., Jr, Rôças, I. N., Hernández, S. R., Brisson-Suárez, K., Baasch, A. C., Pérez, A. R., & Alves, F. R. F. (2022). Dens Invaginatus: Clinical Implications and Antimicrobial Endodontic Treatment Considerations. Journal of endodontics, 48(2), 161–170.

Kaneko, T., Sakaue, H., Okiji, T., & Suda, H. (2011). Clinical management of dens invaginatus in a maxillary lateral incisor with the aid of cone‐beam computed tomography–a case report. Dental Traumatology, 27(6), 478-483.

Lee, J. K., Hwang, J. J., & Kim, H. C. (2020). Treatment of peri-invagination lesion and vitality preservation in an immature type III dens invaginatus: a case report. BMC Oral Health, 20(1), 1-6.

Martins, J. N., da Costa, R. P., Anderson, C., Quaresma, S. A., Corte-Real, L. S., & Monroe, A. D. (2016). Endodontic management of dens invaginatus Type IIIb: Case series. European Journal of Dentistry, 10(04), 561-565.

Narayana, P., Hartwell, G. R., Wallace, R., & Nair, U. P. (2012). Endodontic clinical management of a dens invaginatus case by using a unique treatment approach: a case report. Journal of endodontics, 38(8), 1145-1148.

Ohelers, F. A. C. (1957). Dens invaginatus (dilated composite odontome). Oral Surg Oral Med Oral Pathol, 10, 1204-18.

Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da pesquisa científica.

Pradeep, K., Charlie, M., Kuttappa, M. A., & Rao, P. K. (2012). Conservative management of type III dens in dente using cone beam computed tomography. Journal of clinical imaging science, 2.

Ranganathan, J., Rangarajan Sundaresan, M. K., & Ramasamy, S. (2016). Management of oehler’s type III dens invaginatus using cone beam computed tomography. Case reports in dentistry, 2016.

Zhang, J., Wang, Y., Xu, L., Wu, Z., & Tu, Y. (2022). Treatment of type III dens invaginatus in bilateral immature mandibular central incisors: a case report. BMC Oral Health, 22(1), 1-6.

Zhang, P., & Wei, X. (2017). Combined therapy for a rare case of type III dens invaginatus in a mandibular central incisor with a periapical lesion: a case report. Journal of endodontics, 43(8), 1378-1382.

Zhu, J., Wang, X., Fang, Y., Von den Hoff, J. W., & Meng, L. (2017). An update on the diagnosis and treatment of dens invaginatus. Australian Dental Journal, 62(3), 261-275.

Zoya, A., Ali, S., Alam, S., Tewari, R. K., Mishra, S. K., Kumar, A., & Andrabi, S. M. U. N. (2015). Double dens invaginatus with multiple canals in a maxillary central incisor: retreatment and managing complications. Journal of Endodontics, 41(11), 1927-1932.



How to Cite

LOPES, R. S. .; OLIVEIRA, C. E. G. de .; ARAÚJO, C. S. A. .; NASCIMENTO, V. R. do .; PEREIRA, K. F. S. .; BASTOS, H. J. S. .; TOMAZINHO, L. F. Endodontic treatment of a central incisor with dens invaginatus. Research, Society and Development, [S. l.], v. 12, n. 4, p. e0312440807, 2023. DOI: 10.33448/rsd-v12i4.40807. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/40807. Acesso em: 1 dec. 2023.



Health Sciences