Case Report/Clinical TechniquesManagement of 2 Teeth Diagnosed with Dens Invaginatus with Regenerative Endodontics and Apexification in the Same Patient: A Case Report and Review
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)
- et al.
Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods—a retrospective study
J Endod
(2012) Treatment of the immature tooth with a non-vital pulp and apical periodontitis
Dent Clin North Am
(2010)- et al.
Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol?
J Endod
(2004) - et al.
A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures
J Endod
(2009) Considerations for regeneration procedures
J Endod
(2013)Clinical considerations for regenerative endodontic procedures
Dent Clin North Am
(2012)- et al.
Revascularization: a treatment for permanent teeth with necrotic pulp and incomplete root development
J Endod
(2013) - et al.
Regeneration potential of the young permanent tooth: what does the future hold?
J Endod
(2008) - et al.
Treatment options: biological basis of regenerative endodontic procedures
J Endod
(2013) - et al.
Dentin conditioning codetermines cell fate in regenerative endodontics
J Endod
(2011)
Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure
J Endod
A paradigm shift in endodontic management of immature teeth: conservation of stem cells for regeneration
J Dent
The hidden treasure in apical papilla: the potential role in pulp/dentin regeneration and bioroot engineering
J Endod
Pulp revascularization of immature dog teeth with apical periodontitis
J Endod
Platelet-rich plasma: evidence to support its use
J Oral Maxillofac Surg
Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: a case report
J Endod
Histological findings of revascularized/revitalized immature permanent molar with apical periodontitis using platelet-rich plasma
J Endod
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
Effect of mineral trioxide aggregate on mesenchymal stem cells
J Endod
Effect of proroot mta on pulp cell apoptosis and proliferation in vitro
J Endod
Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift
J Endod
Efficacy of revascularization to induce apexification/apexogensis in infected, nonvital, immature teeth: a pilot clinical study
J Endod
Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial
J Endod
Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis
J Endod
Histologic observation of a human immature permanent tooth with irreversible pulpitis after revascularization/regeneration procedure
J Endod
Challenges in regenerative endodontics: a case series
J Endod
Dilated composite odontome: reports of two cases, one bilateral and one radicular
Oral Surg Oral Med Oral Pathol
The radicular variety of dens invaginatus
Oral Surg Oral Med Oral Pathol
Dens invaginatus (dilated composite odontome): I—variations of the invagination process and associated anterior crown forms
Oral Surg Oral Med Oral Pathol
Nonrecognition and subsequent endodontic treatment of dens invaginatus
J Endod
Nonsurgical endodontic therapy of tooth invagination: report of a case
Oral Surg Oral Med Oral Pathol
A study of dens in dente
Oral Surg Oral Med Oral Pathol
Induction of odontoblast-like cell differentiation in dog dental pulps after in vivo implantation of dentine matrix components
Arch Oral Biol
Angiogenic growth factors in human dentine matrix
Arch Oral Biol
Bactericidal and cytotoxic effects of sodium hypochlorite and sodium dichloroisocyanurate solutions in vitro
J Endod
Expression of mineralization markers in dental pulp cells
J Endod
Formation of odontoblast-like cells from cultured human dental pulp cells on dentin in vitro
J Endod
Mineral trioxide aggregate: a comprehensive literature review—part I: chemical, physical, and antibacterial properties
J Endod
Cited by (40)
Diagnosis of maxillary lateral incisor dens invaginatus and therapeutic approach
2023, Pediatric Dental JournalManagement of teeth with dens invaginatus and apical periodontitis: A case series
2022, Journal of the American Dental AssociationDens Invaginatus: Clinical Implications and Antimicrobial Endodontic Treatment Considerations
2022, Journal of EndodonticsCitation 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 EndodonticsCitation 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.