Martins Jorge N R, da Costa Rui Pereira, Anderson Craig, Quaresma Sérgio André, Corte-Real Luís S M, Monroe Adam D
Department of Endodontics, Implantology Institute, Lisbon, Portugal.
Department of Endodontics, International University of Catalunya, Barcelona, Spain.
Eur J Dent. 2016 Oct-Dec;10(4):561-565. doi: 10.4103/1305-7456.195176.
Dens invaginatus may be seen as a developmental malformation. It is characterized by an invagination of the enamel and dentin, creating a lumen inside the affected tooth, which may extend as deep as the apical foramen. Oehlers Type IIIb is considered the most challenging clinical conditions. The purpose of this study is to discuss the nonsurgical endodontic management of vital and necrotic dens invaginatus Type IIIb cases. Due to the complex anatomical consideration of dens invaginatus Type IIIb, endodontic treatment is extremely technique sensitive. A conservative approach was used in a vital case to treat the invaginated lumen only, to preserve the vitality of the pulp, and a more invasive approach was used in a necrotic case to debride the lumen and necrotic pulp for proper disinfection of the root canal system. Although different, all the approaches were successful. The clinical signs and symptoms were resolved. The vital case remains vital after 19 months, and the recall radiographs were able to show satisfactory periapical healing both in vital and necrotic cases. Due to the highly complex anatomy of dens invaginatus Type IIIb, the decision of preserving the pulp vitality may not be related only to pulpal diagnosis but also to the technical requirements of the treatment. Although very technically sensitive, it may be possible to treat the invaginated lumen exclusively, while preserving the vitality of the pulp. Necrotic cases may require a more aggressive approach to achieve a favorable prognosis.
牙中牙可被视为一种发育畸形。其特征是釉质和牙本质内陷，在患牙内部形成一个管腔，该管腔可延伸至根尖孔深度。奥勒斯IIIb型被认为是最具挑战性的临床情况。本研究的目的是探讨IIIb型活髓和坏死牙中牙病例的非手术根管治疗。由于IIIb型牙中牙的解剖结构复杂，根管治疗对技术极为敏感。在一例活髓病例中采用了保守方法，仅治疗内陷管腔以保留牙髓活力，而在一例坏死病例中采用了更具侵入性的方法，清理管腔和坏死牙髓以对根管系统进行适当消毒。尽管方法不同，但所有方法均取得成功。临床体征和症状得到缓解。活髓病例在19个月后仍保持活力，复查X线片显示活髓和坏死病例的根尖周均愈合良好。由于IIIb型牙中牙的解剖结构高度复杂，保留牙髓活力的决定可能不仅与牙髓诊断有关，还与治疗的技术要求有关。尽管对技术要求非常高，但有可能仅治疗内陷管腔，同时保留牙髓活力。坏死病例可能需要更积极的方法以获得良好的预后。
