A Rare Presentation of Bilateral Maxillary Dens Invaginatus Diagnosed Using Cone Beam Computed Tomography
A 22-year-old male patient presented with a complaint of occasional pain and tenderness in the right maxillary lateral incisor. Patient had an unremarkable medical history and reported no history of dental trauma.\nPatient was under treatment planning stage of orthodontic therapy for Angle's Class I malocclusion. The bilateral dens invaginatus was identified on a dental panoramic tomography taken for orthodontic diagnostic purposes.\nClinical examination revealed maxillary right lateral incisor (tooth 12) positioned out of the arch and caries on the palatal aspect of the maxillary left lateral incisor (tooth 22). Morphologic alteration was observed in both teeth. Crown portion of tooth 12 was wider both mesiodistally and buccolingually with prominent cingulum and a palatal groove []. A palatal groove was observed in tooth 22 with no significant alteration in the dimensions of the crown []. On pulp sensitivity testing using cold test, tooth 12 did not respond, while tooth 22 responded normally. On radiographic examination, two enamel-lined invaginations were observed for tooth 12, but the extent of invaginations was unclear []. A single pear shaped enamel-lined invagination extending on to the root surface was observed for tooth 22 [].\nBecause of the invagination, the morphology of the pulp canal space and the relationship between the two were not entirely clear from the conventional diagnostic radiographs. It was decided that a limited-volume CBCT scan of the maxilla may be helpful in understanding the internal anatomy of the tooth and determining the most appropriate treatment protocol.\nPatient was informed of the intended benefits and potential risks of the CBCT scan. After obtaining written informed consent, a CBCT (CS 3D Imaging Software) of the maxilla was performed with the following exposure parameters: 70 kV, 10 mA and 10.8 s [].\nCareful examination of cross-sectional images of tooth 22 revealed invagination extending apically beyond the cemento-enamel junction and ending as a blind sac without communicating with the dental pulp, confirming it as Oehlers Type 2 variant []. Cross-sectional images of tooth 12 revealed large Type 2 invagination as it was extending toward the root and communicating with the pulp and the second invagination was Type 1 with no communication with the pulp [Figure and ].\nBased on the confirmative findings of CBCT, conservative nonsurgical endodontic treatment was planned for tooth 12 with the double dens and simple restorative procedure for Type 2 dens invaginatus in tooth 22.