Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
Eur J Paediatr Dent. 2021;22(1):15-18. doi: 10.23804/ejpd.2021.22.01.03.
Dens invaginatus is a developmental anomaly that can affect both deciduous and permanent dentition. The anomaly is caused by the invagination of the enamel organ into the dental papilla prior to the calcification of the dental tissues. The treatment option changes according to the classification, from the simple filling of the invaginated enamel area to root canal treatment with or without retrograde surgery, intentional re-implantation, or the extraction of the affected tooth.
In this study we report a case of a maxillary lateral incisor invaginatus in a young adult patient. The periapical endoral X-ray showed the presence of a periapical radiolucency in tooth 22, that had a structure similar to a tooth inside it and an immature apex. Cold thermal testing showed that it was not a vital tooth. CBCT confirmed the diagnosis of Oehler Class II dens invaginatus. The treatment plan involved root canal treatment of both the "true" and the "invaginated" canal using calcium hydroxide-based intermediate medication. Then, after removing the hard internal structure with the aid of an operative microscope, MTA was used to close the immature apex. Finally, the large endodontic space was filled with self-etching, self-adhesive, dual curing resin cement. The patient was included in a follow-up programme to monitor and verify the complete healing of the periapical bone of the affected tooth.
The use of technology and of special materials allowed an adequate management and resolution of the case reported.
牙内陷是一种发育性畸形，可影响乳牙和恒牙。该畸形是由于釉质器在牙本质钙化前向内陷入牙乳头而引起的。治疗方案根据分类而变化，从简单地填充内陷的釉质区域到根管治疗（伴或不伴逆行手术）、有意再植入或患牙拔除。
本研究报告了一例年轻成人上颌侧切牙牙内陷的病例。根尖口内 X 射线显示 22 号牙存在根尖周放射性透明区，其内部结构类似于牙齿，且根尖未发育成熟。冷测牙髓活力试验显示该牙无活力。CBCT 证实了 Oehler Ⅱ类牙内陷的诊断。治疗计划包括使用基于氢氧化钙的中间药物对“真”和“内陷”根管进行根管治疗。然后，在手术显微镜的辅助下去除硬内部结构后，使用 MTA 封闭未发育成熟的根尖。最后，使用自酸蚀、自粘接、双固化树脂水门汀填充大的根管空间。患者被纳入随访计划，以监测和验证患牙根尖周骨的完全愈合。
使用技术和特殊材料可以对所报告的病例进行适当的管理和解决。
