Guided Intentional Replantation of a Mandibular Premolar with Type IIIb Dens Invaginatus Associated with Peri-invagination Periodontitis without Root Canal Treatment: A Case Report.

Abstract

This report highlights successful management of a rare case of a mandibular premolar with Oehler's Type IIIb Dens Invaginatus (DI) and peri-invagination periodontitis with guided intentional replantation without root canal treatment. A 22-year-old female patient reported with discomfort and a sinus tract associated with tooth number 21. Clinical examination and cone beam computed tomography revealed tooth number 21 had an Oehler's Type IIIb DI with peri-invagination periodontitis. The patient had partially healed sockets in the number 19 and number 30 regions. Thus, guided intentional replantation for tooth number 21 and guided double autotransplantation in the position of teeth number 19 and number 30 in a single visit was planned. Three-dimensional replicas of the donor teeth (numbers 16 and 32) as well as number 21 with type IIIb DI were printed based on intraoral scanning and cone beam computed tomography images. Tooth number 21 was extracted with its buccal cortical plate and root-end resection followed by root-end filling with mineral trioxide aggregate was performed. The tooth was replanted into the modified socket, and stabilized using a flexible wire-composite splint for 4 weeks. Unfortunately, the patient was lost to follow-up, but reported 2 years later when all teeth were retained without signs of disease. Two years following intentional replantation without root canal treatment, tooth number 21 with an Oehler's Type IIIb DI with peri-invagination periodontitis had no symptoms and radiographic examination revealed a reduction in the dimensions of the peri-invagination periodontitis.