Endoaesthetic Management of Type II Dens Invaginatus Associated With Root Perforation and Apical Abscess: A Case Report

TL;DR

This case report describes a successful treatment of a rare dental anomaly in a young patient, combining endodontic therapy and aesthetic restoration to achieve both health and appearance goals.

Contribution

The paper presents a novel multidisciplinary approach to managing Type II dens invaginatus with root perforation and apical abscess, emphasizing endoaesthetic outcomes.

Findings

Nonsurgical root canal treatment and perforation repair resolved the apical abscess and restored tooth function.

Aesthetic restoration using bleaching and composite resin veneers improved the appearance of the anterior teeth.

The patient remained asymptomatic with complete resolution of the periapical lesion at the 2-year follow-up.

Abstract

Dens invaginatus (DI) is a developmental anomaly that affects teeth. This case report demonstrates the successful endoaesthetic management of a Type II DI in the maxillary right lateral incisor (Tooth 12). A 12-year-old female patient presented with pain and swelling in Tooth 12, which had previously been diagnosed with DI and accessed endodontically. The patient was also concerned about the aesthetic appearance of her anterior teeth. Clinical, radiographic, and tomographic findings confirmed Oehler's type II DI, with root perforation and an apical abscess in Tooth 12, as well as pulp necrosis in Tooth 13. Nonsurgical root canal treatment was recommended for both teeth, with additional root perforation repair for Tooth 12. Multiple visits were required for nonsurgical endodontic therapy. During the initial visit, the perforation was identified and sealed, followed by chemomechanical preparation and placement of calcium hydroxide paste. Ten months later, the root canals were filled. After endodontic treatment, the patient underwent in-office bleaching, followed by composite resin veneers on the upper anterior teeth, using the preformed metal matrix technique. This resulted in excellent aesthetic outcomes. At the 2-year follow-up examination, the patient remained asymptomatic, and radiographic assessment showed complete resolution of the periapical lesion. This case highlights the importance of multidisciplinary collaboration, precise treatment planning, and patient-centered care in achieving optimal endoaesthetic results in complex cases.

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