Case Report/Clinical Techniques
Management of 2 Teeth Diagnosed with Dens Invaginatus with Regenerative Endodontics and Apexification in the Same Patient: A Case Report and Review

https://doi.org/10.1016/j.joen.2013.10.030Get rights and content

Abstract

Introduction

This review and case report present the treatment of a 10-year-old boy with both permanent maxillary lateral incisors demonstrating Oehlers type II dens invaginatus and pulpal involvement. Treatment was complicated by dental anxiety, supraventricular tachycardia, immature tooth development, and facial cellulitis.

Methods

An infected necrotic pulp of the permanent maxillary left lateral incisor was treated by apexification and endodontic treatment with mineral trioxide aggregate. The necrotic pulp of the permanent maxillary right lateral incisor was treated with canal debridement and dressing under general anesthesia.

Results

Periapical healing of both teeth occurred, with the right lateral incisor showing continued root growth, thickening of the dentinal root walls, and completed apex formation. This tooth responded normally to pulp testing. Twenty-eight months after initial treatment, the right lateral incisor displayed progressive sclerosis of the canal.

Conclusions

This case demonstrates possible pulpal regeneration of an infected maxillary right lateral incisor with dens invaginatus and an immature apex after minimal canal debridement.

Section snippets

Case Report

A 10-year-old boy was referred by a private general dental practitioner to the endodontic unit of the Royal Dental Hospital of Melbourne, Australia for evaluation and management of persistent infection arising from the permanent maxillary left lateral incisor with a history of recurrent pain and parulis formation. Three courses of amoxicillin (Amoxil; GlaxoSmithKline, Victoria, Australia) were prescribed during a 2-month period by the local general medical practitioner, with no resolution of

Discussion

The described case demonstrated possible pulpal regeneration of an infected maxillary right lateral incisor with DI and an immature apex after minimal canal debridement and dressing with an antibiotic/corticosteroid paste (Odontopaste). To the authors' knowledge, there are no similar reports. The possibility of Hertwig's root sheath and pulpal and apical papilla stem cells surviving the destructive effect of the acute infection has been proposed (19). Their survival would have allowed for

Conclusion

Pulpal regeneration techniques are an emerging approach to management of infected necrotic immature teeth. This article has reported 2 different treatment outcomes of permanent lateral incisors with type II Oehlers DI and apical abscesses. This report introduces the possibility of the use of Odontopaste in endodontic regeneration procedures and highlights the need for regular reviews of teeth with open apices and caution when treating a patient with SVT under local anesthesia or GA.

Acknowledgments

The authors acknowledge Emeritus Professors Louise Brearley-Messer and Harold Messer, both at Melbourne Dental School, University of Melbourne, Australia; Clinical Associate Professor Kerrod Hallett, director of dentistry at The Royal Children's Hospital, Melbourne, Australia; and Dr Justin Wong, pediatric dentist, for their contributions to this case report.

The authors deny any conflicts of interest related to this study.

References (77)

  • T.W. Lovelace et al.

    Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure

    J Endod

    (2011)
  • G.T. Huang

    A paradigm shift in endodontic management of immature teeth: conservation of stem cells for regeneration

    J Dent

    (2008)
  • G.T. Huang et al.

    The hidden treasure in apical papilla: the potential role in pulp/dentin regeneration and bioroot engineering

    J Endod

    (2008)
  • B. Thibodeau et al.

    Pulp revascularization of immature dog teeth with apical periodontitis

    J Endod

    (2007)
  • R.E. Marx

    Platelet-rich plasma: evidence to support its use

    J Oral Maxillofac Surg

    (2004)
  • M. Torabinejad et al.

    Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: a case report

    J Endod

    (2011)
  • G. Martin et al.

    Histological findings of revascularized/revitalized immature permanent molar with apical periodontitis using platelet-rich plasma

    J Endod

    (2013)
  • R.S. Prescott et al.

    In vivo generation of dental pulp-like tissue by using dental pulp stem cells, a collagen scaffold, and dentin matrix protein 1 after subcutaneous transplantation in mice

    J Endod

    (2008)
  • V. D'Antò et al.

    Effect of mineral trioxide aggregate on mesenchymal stem cells

    J Endod

    (2010)
  • S. Moghaddame-Jafari et al.

    Effect of proroot mta on pulp cell apoptosis and proliferation in vitro

    J Endod

    (2005)
  • L.H. Chueh et al.

    Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift

    J Endod

    (2006)
  • N. Shah et al.

    Efficacy of revascularization to induce apexification/apexogensis in infected, nonvital, immature teeth: a pilot clinical study

    J Endod

    (2008)
  • A. Nosrat et al.

    Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial

    J Endod

    (2011)
  • X. Wang et al.

    Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis

    J Endod

    (2010)
  • E. Shimizu et al.

    Histologic observation of a human immature permanent tooth with irreversible pulpitis after revascularization/regeneration procedure

    J Endod

    (2012)
  • J.A. Petrino et al.

    Challenges in regenerative endodontics: a case series

    J Endod

    (2010)
  • H.A. Hunter

    Dilated composite odontome: reports of two cases, one bilateral and one radicular

    Oral Surg Oral Med Oral Pathol

    (1951)
  • F.A. Oehlers

    The radicular variety of dens invaginatus

    Oral Surg Oral Med Oral Pathol

    (1958)
  • F.A. Oehlers

    Dens invaginatus (dilated composite odontome): I—variations of the invagination process and associated anterior crown forms

    Oral Surg Oral Med Oral Pathol

    (1957)
  • E.J. Hovland et al.

    Nonrecognition and subsequent endodontic treatment of dens invaginatus

    J Endod

    (1977)
  • M. Tagger

    Nonsurgical endodontic therapy of tooth invagination: report of a case

    Oral Surg Oral Med Oral Pathol

    (1977)
  • J.G. Thomas

    A study of dens in dente

    Oral Surg Oral Med Oral Pathol

    (1974)
  • D. Tziafas et al.

    Induction of odontoblast-like cell differentiation in dog dental pulps after in vivo implantation of dentine matrix components

    Arch Oral Biol

    (1995)
  • D.J. Roberts-Clark et al.

    Angiogenic growth factors in human dentine matrix

    Arch Oral Biol

    (2000)
  • I. Heling et al.

    Bactericidal and cytotoxic effects of sodium hypochlorite and sodium dichloroisocyanurate solutions in vitro

    J Endod

    (2001)
  • X. Wei et al.

    Expression of mineralization markers in dental pulp cells

    J Endod

    (2007)
  • G.T.J. Huang et al.

    Formation of odontoblast-like cells from cultured human dental pulp cells on dentin in vitro

    J Endod

    (2006)
  • M. Parirokh et al.

    Mineral trioxide aggregate: a comprehensive literature review—part I: chemical, physical, and antibacterial properties

    J Endod

    (2010)
  • Cited by (40)

    • Dens Invaginatus: Clinical Implications and Antimicrobial Endodontic Treatment Considerations

      2022, Journal of Endodontics
      Citation Excerpt :

      Immature teeth at stage 4, which show nearly completed root formation with an open apex, can be managed with either regenerative endodontics or apexification50. There have been reports of dens invaginatus types II and III in immature teeth treated by regenerative procedures51,52. According to the American Association of Endodontists, the main criteria to consider regenerative endodontic procedures as successful involve eliminating symptoms, evidence of bone healing, and increased root wall thickness and/or increased root length53.

    • Allogeneic Cellular Therapy in a Mature Tooth with Apical Periodontitis and Accidental Root Perforation: A Case Report

      2020, Journal of Endodontics
      Citation Excerpt :

      Although this treatment has a high success rate and can prolong tooth survival, the loss of the vital pulp and hard tooth structure, because of the nature of the therapy, may still accelerate tooth loss16. The use of tissue engineering to regenerate the pulp-dentin complex overcomes the disadvantages of nonsurgical root canal therapy because it recovers the sensory, immune, and dentinal apposition roles lost in the tooth17. A preliminary clinical trial in young patients using REPs with the bleeding technique demonstrated the potential use of this treatment as an option for mature teeth18.

    View all citing articles on Scopus
    View full text