Treatment options for dens in dente: state-of-art literature review

Abstract

Background. Dens in dente represents developmental anomaly of tooth structure, characterized with different depth of invagination lined with either enamel or cementum, and associated with different clinical and roentgenological features. Objective. To methodize available treatment options for dens invaginatus in systematic manner and analyze suitability of such for different clinical scenarios. Materials and Methods. Aggregation of data regarding treatment options for dens invaginatus cases was provided through literature search within Pubmed Central and PubMed databases. Literature review was provided in accordance to the available guidelines. Results. Provided literature review helped to establish four main strategies of treating teeth with present dens invaginatus anomaly:1) preventive treatment (with no endodontic intervention);2) preventive treatment (with endodontic intervention only in invaginated canal);3) treatment of dens invaginatus-associated complications (with endodontic treatment of original and invaginated canals);4) complex treatment of dens invaginatus-associated complications, which includes not only root canal treatment, but also periodontal treatment and other potential treatment options, such as extraction. Conclusion. Dens invaginatus represents several clinical challenges during the treatment related with type of structural anomaly due to the Oehlers classiŢcation, variability of its conŢguration, depth of invagination and its localization within coronal or root portion of tooth, proximity to the pulp and pretreatment pulp and periodontium vitality conditions, while also with periapical status in means of apex size and thickness of root residual walls.