Dens Invaginatus and the Paediatric Dental Patient: Two Case Reports

Abstract

##Background Dens Invaginatus (DI) in paediatric patients presents a challenge in treatment planning, patient management and potentially complex endodontic treatment. DI has been reported to be as prevalent as 0.3% to 10% in permanent teeth. Clinicians may be challenged in managing both the patient and the dental anomaly. ##Aims The aim of these case reports is to highlight the presenting features of DI, treatment strategies and to highlight the need for a national clinical care pathway for children affected by dental anomalies such as DI, in addition to complex traumatic dental injuries and developmental defects of enamel and dentine. ##Conclusions Awareness of the clinical features and early identification of teeth affected by DI can allow for prevention, minimally invasive management, and where necessary, appropriate referral for specialist management of these cases. Sealing the palatal surfaces of young permanent incisors can limit the sequelae of pulpal necrosis in teeth with DI. Teeth with DI and complex anatomical presentation are predisposed to pulpal pathology and restorative management can be extremely challenging. Currently there are limited referral options for General Dental Practitioners who identify cases of DI in primary care settings in Ireland. This may lead to delayed treatment, prolonged symptoms and suboptimal outcomes for patients. A national clinical care pathway is recommended.