Dens Invaginatus Literature Review
Keywords:
Dens invaginatus, Dens in dent, Developmental abnormality, Trauma, Infection, Radiographic features, Pulp necrosis.Abstract
Dens invaginatus is a developmental malformation of the tooth germ which originates as a result of the infolding of the enamel organ. It has been expressed as a ‘tooth within a tooth’ or ‘dens in dent’ or as an invagination of an enamel-lined tract extending into the root at a various depth, with or without involvement of the dental pulp. Search engines as Pak-Medinet, Pub Med, Medline and Google scholar were used to search literature about this abnormality. Dens invaginatus has complicated root canal morphology and the etiology of this developmental abnormality is still ambiguous. Possible causes include trauma, infection, development retardation of specific cells, interruption in factors regulating the development of enamel organ, and associations to genetic factors. Clinical features, radiological findings (periapical, occlusal radiograph, 3-dimensional imaging system CBCT) and surgical operating microscope help the clinician in classifying the morphology of the dens so that correct treatment planning and management alternative can be chosen. The treatments choices consist of; preventive sealing, restoration of the invagination, endodontic management, apical curettage and surgical endodontic, planned replantation and removal of tooth.
References
Zengin AZ, Sumer AP, CelenkP. Double dens invaginatus. EurJ Dent 2009; 3:67-70.
Beynon AD. Developing dens invaginatus (dens in dente).A quantitative microradiographic study and a reconsideration of the histogenesis of this condition.Br Dent J 1982;153, 255–60.
Ridell K, Mejàre I, Matsson L. Dens invaginatus: a retrospective study of prophylactic invagination treatment. Int J Paediatr Dent 2001; 11:92-7.
Gustafson G, Sunderberg S. Dens in dente. Br Dent J 1950; 88:111−22.
Atkinson SR.The permanent maxillary lateral incisor. Am JOrthodont.1943; 29:685–98.
Hulsmann M. Densinvaginatus: etiology, classification, and prevalence diagnosis and treatment considerations. Int J Endodont1997; 30: 79−90.
Tomes J. A System of Dental Surgery 3rdedn. London, UK: J and A Churchill, 1887: pp. 652−5.
Hallet GE. The incidence, nature and clinical significance of palatal invagination in maxillary incisors.Proceedings of the Royal College of Medicine 1953; 46: 491−9.
Silberman A, Cohenca N, Simon JH. Anatomical redesign for the treatment of dens invaginatus type III with open apexes: a literature review and case presentation. JAm Dent Assoc, 2006 ;137:180-5.
Hunter HA .Dilated composite odontome. Oral Surg Oral Med Oral Pathol 1951; 4:668–73.
Alani A, Bishop K. Densinvaginatus. Part 1: classification, prevalence, etiology. Int Endod J 2008; 41:1123-36.
Steffen H, Splieth C. Conventional treatment of dens invaginatus in maxillary lateral incisor with sinus tract: one year follow-up. J Endod 2005; 31:130–3.
Stamfelj I, Kansky AA, Gasperic D. Unusual variant of type 3 Dens invaginatus in a maxillary Canine: A rare case report. J Endod 2007; 33:64-8.
Kronfield R. Dens in dente. J Dent Res 1934;14: 49−66.
Rushton MA. A collection of dilated composite odontomes.BrDent J1937; 63:65-85.
Oehlers FAC. Densinvaginatus. Part I: variations of the invagination process and association with anterior crownforms. Oral Surg Oral Med Oral Pathol 1957;10 :1204–18.
Brust P. Uber die Entsehung des, Dens undente, Schweizer Monatsschrift fur Zahnheikunde1950;60: 534-42.
Sprawnson EC. Odontomes. Brit Dent J 1937;62:177-201.
Sapp JP, Eversole LR, Wysocki GP.Contemporary Oral and Maxillo-facial Pathology.2nd ed. St Louis: Mosby. 2003:8-9.
Kettunen P, Laurikkala J, Itaranta P. Association of FGF- 3 and Fgf-10 with signaling networks regulating tooth morphogenesis. Developmental Dynamics 2000; 219:322-32.
Schultze C. Developmental abnormalities of the teeth and the jaws. In: Thomas’s Oral Pathology.Gorlin O, Goldman H, eds. St Louis, USA: Mosby, 1970: pp. 96−183.
Hovland E J, Block R M. Non recognition and subsequent endodontic treatment of dens invaginatus. J Endod 1977;3:360–2.
Cakici F, Celiekoglu M, Arslan H, Topcuoglu HS, Erdogan AS. Assessment of the prevalence and characteristics of dens invaginatus in a sample of Turkish Anatolian population. Med Oral Pathol Oral Cir Bucal2010;15e:855-8.
Swanson WF, McCarthyFM. Bilateral dens in dente. Journal of Dental research 1947;26:167-71.
Ulmansky M, Hermel J. Double dens in dente in a single tooth. Oral Surgery, Oral Medicine and Oral Pathology 1964;17: 92–7.
Schulze C, Brand E. Uber den Dens Invaginatus (Dens in dente). Zahnarztliche Welt, zahnarztliche Reform, ZWR1972; 81:569-73,613-20,653-60,699–703.
OehlersFA.The radicular variety of dens invaginatus. J Oral Surg Oral Med and Oral Pathol Oral Radiol Endod 1958;11:1251-60.
Damm N, Bouquet A. Oral and Maxillofacial pathology. 3rd ed. Saunders 2009:90-3.
Ridell K, Meja`re I, Matsson L. Dens invaginatus: a retrospective study of prophylactic invagination treatment. Int J of Paediatric Dent2001;11:92–7.
BhaskarSN. Orban`s Oral Histology and Embryology. 11thed, Mosby Company, London, 1990: 44-9.
Omnell KA, Swanbeck G, Lindahl B. Densinvaginatus. II. A microradiographical, histological and micro X-ray diffraction study. Buchbinder SP, Vittinghoff E, HeagertyActaOdontologicaScandinavica1960;18, 303–30.
De Smit A, Jansen HW, Dermaut L. A histological investigation of invaginated human incisors. Journal de BiologieBuccale1984;12: 201–9.
Piatelli A, Trisi P. Densinvaginatus: a histological study of undermineralized material. Endodontics and Dental Traumatology 1993; 9:191–5.
Morfis AS. Chemical analysis of a dens invaginatus by SE Mmicroanalyses. The Journal of Clinical Pediatric Dentistry.1993; 17:79–82.
Bloch-Zupan A, Cousandier L, Hemmerle J, Obry-MussetAM, ManiereMC .Electron microscopical assessments (FDI abstract FC-11# 123). Int Dent J 1995; 45:306.
Kramer IRH. The pathology of pulp death in non-carious maxillary incisors with minor palatalinvaginations. Proceedings of the Royal Society of Medicine 1953; 46:503–6.
Seow WK. Diagnosis and management of unusual dental abscesses in children. AustralianDental Journal 2003;48:156–68.
Patel S, Dawood DA, Ford TP. The potential applications of cone beam computed tomography in a management of endodontic problems. Int Endod J2007;40:818-30.
Alani A. Densinvaginatus;a problem from the outside in.IntDent J 2009;59:343-8.
Gotoh T, Kawahara K, Imai K, Kishi K, Fujiki Y. Clinical and radiographic study of dens invaginatus. Oral Surg, Oral Med and Oral Pathol 1979; 48: 88–9.
Bishop k,Alani A. Densinvaginatus. Part 2:Clinical, radiographic features and management options. Int Endod J 2008;41: 1137-54.
Aguiar CM, Ferreira JP, Câmara AC, de Figueiredo JA. Type 2 dens invaginatus in a maxillary lateral incisor: a case report of a conventional endodontic treatment. J Clin Pediatric Dent. 2008;33:103-6.
Bansal M, Singh NN, Singh AP. A rare presentation of dens in dente in the mandibular third molar with extra oral sinus.J Oral MaxillofacPathol 2010;14:80-2.
Kristofferson O, Nag OH, Fristad. Dens invaginatus and treatment options based on a classification system: report ofa type II invagination. IntEndod J 2008;41:702-9.
Schmitz MS, Montagner F, Flores CB, Morari VHC. Management of dens invaginatus type I and open apex. Report of three cases. J Endod 2010;36:1079-85.
Roth JS. CBCT technology: endodontics and beyond, part I. Dent Today 2011; 30:146.148,150–1.
Roth JS. CBCT technology: endodontics and beyond, part 2. Dent Today 2011;30:78.80-3.
Trope M. Treatment of the immature tooth with a non–vital pulp and apical periodontitis. Dent Clin North Am 2010;54:313–24.
Szajkis S, Kaufman AY. Root invagination: a conservative approach in endodontics. J Endodont1993; 19: 576−8.
Torabinejad M, Chivan N. Clinical application of Mineral trioxide aggregate. J Endodont1999; 25: 197−205.
Beltes P. Endodontic treatment in three cases of Dens invaginatus. J Endodont 1997; 23:399−440.
Steffen H, Splieth C. Conventional treatment of Dens invaginatus in maxillary lateral incisor with a sinus tract: one-year follow-up. J Endodont2005; 31: 130−3.
da Silva Neto UX, Goto Hirani VH, Papalexiou V .Combined endodontic therapy and surgery in the treatment of Dens Invaginatus Type 3: case report. J Can Dent Assoc2006; 71: 855−8.
Narayana P, Hartwell GR, Wallace R, Nair UP. Endodontic Clinical Management of a Dens Invaginatus Case by Using a Unique Treatment Approach: A Case Report. JOE 2012;38:1145-8.
Kaneko T, Sakaue H, Okiji T, Suda H. Clinical management of dens invaginatus in a maxillary lateral incisor with the aid of cone-beam computed tomography: a case report. Dent Traumatol 2011 ;27:478–83.
Schmitz MS, Montagner F, Flores CB,Morari VHC. Management of dens invaginatus type I and open apex. Report of three cases. J Endod 2010;36:1079-85.
Jung M. Endodontic treatment of dens invaginatus type III with three root canals and open apical foramen. Int Endod J 2004;37:205-13.
Kristofferson O, Nag OH, Fristad. Dens invaginatus and treatment options based on a classification system: report of a type II invagination. In Endod J 2008 ;41:702-9.
Yang J, Zhao Y, Qin M, Ge L. Pulp Revascularization of Immature Dens Invaginatus with peri apical Periodontitis JOE 2013;39:288-92.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2013 Shama Asghar, Farheen Fatima
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0 
