Fregnani E R, Spinola L F B, Sônego J R O, Bueno C E S, De Martin A S
Department of Stomatology, A. C. Camargo Cancer Hospital, São Paulo, Brazil.
Int Endod J. 2008 Oct;41(10):913-9. doi: 10.1111/j.1365-2591.2008.01414.x. Epub 2008 Aug 11.
To report the endodontic treatment of an immature maxillary central incisor with dens invaginatus.
Dens invaginatus is a rare malformation of teeth, probably resulting from an infolding of the dental papilla during tooth development. The present case describes the complex endodontic treatment of a type III dens invaginatus in an immature maxillary central incisor with a necrotic pulp and abscess formation. The initial treatment goal was to achieve apexification of the pseudocanal root and conservative root canal treatment in the main canal. Following 1-year of treatment with calcium hydroxide dressings, radiography revealed a healing response, but no sign of a hard tissue barrier at the apex. Periapical surgery with the placement of a zinc oxide cement (IRM) root-end filling was considered successful at the 4-year follow-up.
The complexity of the canal system and open apex in dens invaginatus present a challenge to endodontic treatment. Correct diagnosis and treatment planning are fundamental to treatment of dens invaginatus. Periapical surgery is indicated in cases of unsuccessful apexification in immature teeth with dens invaginatus and nonvital pulp.
报告1例伴牙内陷的上颌未成熟恒中切牙的根管治疗情况。
牙内陷是一种罕见的牙齿发育畸形，可能是由于牙齿发育期间牙乳头内陷所致。本病例描述了1例上颌未成熟恒中切牙伴III型牙内陷、牙髓坏死及脓肿形成的复杂根管治疗过程。最初的治疗目标是使假性根管牙根实现根尖诱导成形，并对主根管进行保守的根管治疗。在用氢氧化钙糊剂治疗1年后，影像学检查显示有愈合反应，但根尖未见硬组织屏障形成迹象。在4年的随访中，根尖手术并放置氧化锌粘固粉（IRM）进行根尖倒充填被认为是成功的。
牙内陷根管系统的复杂性及根尖孔开放给根管治疗带来了挑战。正确的诊断和治疗计划是牙内陷治疗的基础。对于牙内陷且牙髓坏死的未成熟恒牙，若根尖诱导成形失败，则需进行根尖手术。
