Ludwig Julia, Reymus Marcel, Winkler Alexander, Soliman Sebastian, Krug Ralf, Krastl Gabriel
Center of Dental Traumatology, Department of Conservative Dentistry and Periodontology, University Hospital Würzburg (UKW), Pleicherwall 2, 97070 Würzburg, Germany.
Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University Munich, Goethestrasse 70, 80336 Munich, Germany.
Dent J (Basel). 2023 Feb 10;11(2):47. doi: 10.3390/dj11020047.
The clinical management of teeth with complex dens invaginatus (DI) malformations and apical periodontitis may be challenging due to the lack of routine. The aim of this case report is to describe the endodontic treatment of an immature tooth with DI and to discuss strategies for preclinical training for teeth with such malformations.
A 9-year-old male presented with an immature maxillary incisor with DI (Oehlers Type II) and apical periodontitis which was diagnosed by cone beam computed tomography (CBCT). Revitalization was initially attempted but then abandoned after failure to generate a stable blood clot. Nevertheless, considerable increase in both root length and thickness could be detected after medication with calcium hydroxide followed by root canal filling with MTA as an apical plug.
The endodontic management of teeth with DI requires thorough treatment planning. In immature teeth, under certain conditions, root maturation may occur even with conventional apexification procedures. From an educational perspective, different strategies including CBCT and 3D-printed transparent tooth models for visualization of the complex internal morphology and redesigned 3D-printed replica with various degrees of difficulty for endodontic training, can be used to overcome the challenges associated with endodontic treatment of such teeth.
由于缺乏常规方法，复杂型牙内陷（DI）畸形且伴有根尖周炎的牙齿的临床管理可能具有挑战性。本病例报告的目的是描述一颗患有DI的未成熟牙齿的根管治疗，并讨论针对此类畸形牙齿的临床前培训策略。
一名9岁男性患者有一颗上颌未成熟切牙，患有DI（奥勒斯II型）和根尖周炎，通过锥形束计算机断层扫描（CBCT）诊断。最初尝试进行牙髓再生，但在未能形成稳定血凝块后放弃。然而，在用氢氧化钙药物治疗后，随后用MTA作为根尖充填物进行根管充填，可以检测到牙根长度和厚度都有显著增加。
患有DI的牙齿的根管治疗需要全面的治疗计划。在未成熟牙齿中，在某些情况下，即使采用传统的根尖诱导成形术也可能发生牙根发育成熟。从教育角度来看，不同的策略，包括用于可视化复杂内部形态的CBCT和3D打印透明牙齿模型，以及重新设计的具有不同难度等级的3D打印复制品用于根管治疗培训，可用于克服与此类牙齿根管治疗相关的挑战。
