I nvaginatus treatment Dr Fouad Abduljabbar BDSMDS Consultant Endodontist King Abdulziz Medical City Ministry of National Guard Saudi Arabia Outlines Defintion Features Etiology ID: 535461
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Slide1
Anatomical modification of Dens Invaginatus treatment
Dr. Fouad Abduljabbar, BDS,MDS
Consultant Endodontist, King
Abdulziz
Medical City
Ministry of National Guard, Saudi ArabiaSlide2Slide3
Outlines:
Defintion
Features
Etiology
Histology
Prevalence
Classification
Diagnosis
TreatmentCase Report
Anatomical modification of dens invagenatus treatment
Abduljabbar F,
Aljehani
M,
Al
Sharafi
E, Bakhsh A, Abed H,
Alghamdi
A. Anatomical Modification
for Dens
Invaginatus
Treatment: A Literature Review and a Case
Report. Journal
of International Oral Health 2015; 7(12):
119-125Slide4
Dens invaginatus (DI) is a developmental anomaly which rarely occurs. It is the result of invagination of enamel organ into the dental papilla during the soft tissue stage of tooth development. Slide5
As the hard tissues are formed, the invaginated enamel produces a small tooth within the pulp chamber
It begins at the crown and sometimes extends into the
root
FeaturesSlide6
Root canal treatment may present a severe problem because of the complex anatomy of teeth
The malformation shows a morphologic variation and results in pulp necrosis
Features
Crown morphology: (peg-shaped, barrel-shaped, incisal
notching or increased labiolingual and
mesiodistal
diameter)Slide7
Etiology
No exact cause
Several
theories have been suggested to clarify the etiology of this
anomaly:
-
Localized failure of growth (unknown, infection, trauma)
-
Genetic factors
Slide8
Histology
The
dentin below invagination could be intact without
irregularities
It may also contain strains of vital tissue or even
fine
canals that communicate to the dental pulp.
Enamel lining the invagination was shown to be irregularly structured
Studies reported differences in structure between the external and internal enamel
.** Piatelli A, Trisi P. Dens invaginatus: A histological study of undemineralized material. Endod Dent Traumatol 1993;9:191-5 Slide9
Prevalence
The range of occurrence is between 0.04% and 26%
The most commonly
affected
teeth are maxillary lateral incisors
Data suggest a more male gender
predilection
Contralateral
tooth ** Omnell KA, Swanbeck G, Lindahl B. Dens invaginatus. II. A microradiographical, histological and micro X-ray diff raction study. Acta Odontol Scand
1960;18:303-30 ** Alani A, Bishop K. Dens invaginatus. Part 1: Classifi cation, prevalence and aetiology. Int Endod J 2008;41(12):1123-36.
**
Rotstein
I,
Stabholz
A, Heling I, Friedman S. Clinical considerations in the treatment of dens
invaginatus
.
Endod
Dent
Traumatol
1987;3(5):249-54.
**
Hülsmann
M. Dens
invaginatus
:
Aetiology
,
classifi
cation, prevalence, diagnosis, and treatment considerations.
Int
Endod
J 1997;30(2):79-90. Slide10
Classification
Oehlers
Classification:
Type I:
A minor
enamel lined
invagination, which is
confined
to the crown of the tooth but not extending beyond the
cementoenamel junction Type III: The invagination extends through the root. Usually, there is no communication with the pulpType II: Enamel-lined invagination extending beyond the cementoenamel junction; may or may not communicate with the pulp
** Oehlers FA. Dens invaginatus (dilated composite odontome). I. Variations
of
the invagination process and associated anterior crown forms. Oral
Surg
Oral
Med Oral
Pathol
1957;10(11):1204-18Slide11
Diagnosis
Dental Radiograph
- Narrow
fissure
- Tear-drop shape
- Radiolucent
periapical lesionSlide12
Clinical morphological; incisal notching,
labial groove,
exaggerated
palatal
cingulum
Magnification
DiagnosisSlide13
Treatment
Extraction
Root
canal treatment (RCT)
Different
preventive procedures
Open- apex tooth managementSlide14Slide15
Case Report
- 10-year-old
medically free girl
- Clinical
examination
- Intraoral
sinus tract buccal to the tooth
- Non-mobile
but tender to percussion
- Periapical radiograph: periapical radiolucency Slide16Slide17Slide18Slide19
6 months
2 yearsSlide20
6 months
2 years
Postoperative
Preoperative Slide21
Modificaton of the internal anatomy of the canal system may be considered by clinicians for the treatment of DI treatment, to gain better access for instrumentation, disinfection, and sealing of the root canal.
ConclusionSlide22
Thank you