Combined Surgical and Nonsurgical Endodontic Therapy in the Treatment of Dens Invaginatus Type 3: A Case Report

Dens invaginatus (DI), also known as "dens in dente", "dilated composite odontome" or "gestant odontoma", is a developmental anomaly resulting from invagination of a portion of the crown (enamel organ) during morphodifferentiation.1-4 Salter 5 first described anatomical anomaly in 1855 as "a tooth within a tooth."The etiology is controversial and remains unclear 4 however, most authors concur the above mentioned reason.Other theories include an incomplete lateral fusion of two germs, the distortion of the enamel organ during tooth development, abnormal pressure from the surrounding tissues during tooth formation, the constriction of the dental arch in the enamel organ and a retardation or acceleration of growth of the internal enamel epithelium.[6][7][8] Dens invaginatus with a frequency of 0.04-10% is a rare dental malformation.9 The most affected permanent teeth are the maxillary lateral incisors, frequently bilateral (43 percent), 10 followed by central incisors, canines, premolars and molars.6 It also can appear in primary teeth.11 Of the three classifications designed for dens invaginatus, clinicians most commonly use the one proposed by Oehlers.8 • Type I: An enamel-lined invagination within the crown and not extending beyond the cementoenamel junction (CEJ); • Type II: The enamel invagination into the root, beyond the CEJ, ending as a blind sac; • Type III: The extension of the enamel-lined invagination through the root to form an additional apical or lateral foramen; usually, there is no direct communication with the pulp.The purpose of this article is to describe the use of combined endodontic therapy and surgery in the treatment of Type 3 dens invaginatus in a maxillary lateral incisor. CASE REPORTA ten years old boy reported to pediatric dental clinic with the chief complain of repeated swelling and pain in the anterior region of the upper jaw since 3 months.The pain was of