Management of Oehler's Type II Dens Invaginatus in a Maxillary Lateral Incisor With Asymptomatic Periapical Periodontitis: A Case Report

Abstract

Dens invaginatus (DI), also known as dens in dente, is a rare developmental anomaly where the enamel organ folds into the dental papilla, resulting in complex anatomical structures. This anomaly predisposes teeth to early pulp involvement, periapical pathology, and treatment challenges, particularly in maxillary lateral incisors, which are most frequently affected. Early diagnosis and the use of advanced imaging are critical in ensuring effective treatment. This report details the successful nonsurgical endodontic treatment of a 23-year-old female with Oehler's type II dens invaginatus in the maxillary left lateral incisor (tooth #10). The patient presented with a non-vital tooth and periapical lesion, with CBCT confirming the invagination's extent and classification. Treatment utilized a dental operating microscope (DOM) to create dual-level access cavities, allowing thorough debridement and disinfection of both the main and invaginated canals, irrigated with sodium hypochlorite and EDTA and obturated with mineral trioxide aggregate (MTA) and gutta-percha. At a 14-month follow-up, complete periapical healing and tooth retention were observed. This case emphasizes the complexity of Type II dens invaginatus anatomy and highlights the critical roles of CBCT and DOM in diagnosis and management, alongside appropriate material selection and advanced techniques to achieve favorable outcomes. Early detection combined with precise imaging and conservative endodontic treatment can lead to successful clinical and radiographic resolution.