(TC47) Clinical Management of Dens Invaginatus through Selective Root Canal Therapy: A Conservative Approach

Dens Invaginatus is a developmental anomaly caused by the infolding of the crown before calcification, often resulting in a "tooth within a tooth" appearance on radiographs, particularly in maxillary lateral incisors. Its prevalence ranges from 0.3% to 10%. Oehlers' classification of dens invaginatus includes three types, with Type I being the mildest form and Type III the most severe, often leading to early pulp necrosis. This condition presents a challenge, particularly in young patients with immature teeth, where preserving pulp vitality is critical for root development.

Treatment strategies range from conservative sealing of the invagination to more extensive interventions like root canal therapy. In cases with necrosis and periapical lesions, selective root canal therapy, which targets only the necrotic tissue, can preserve healthy pulp and maintain tooth integrity.

This case series examines the conservative management of dens invaginatus in four patients of ages 9, 14, 25, and 35 who presented with Type I and Type III invaginatus. Treatment plans were tailored based on the stage of root development and the extent of periapical involvement, ranging from vital pulp therapy to periapical curettage and retro-seal. All patients remained asymptomatic, and periapical healing was observed.

In conclusion, selective root canal therapy for dens invaginatus offers a conservative, effective approach to preserving tooth vitality and structure. Early diagnosis and individualized treatment plans are essential for optimal outcomes and long-term tooth preservation.