Diagnosis and treatment of dens invaginatus with open apex in a young adult patient by using cone-beam computed tomography and operative microscope

BACKGROUND: 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. CASE REPORT: 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. CONCLUSION: The use of technology and of special materials allowed an adequate management and resolution of the case reported.