Endodontic Management of Dens in Dente – A Systematic Review of Case Reports and Case Series

Abstract

ABSTRACT Objective: Dens in dente is a developmental dental malformation with various anatomical traits that make treatment difficult. The importance of a timely and correct diagnosis in determining the most effective treatment approach cannot be overstated. Using three-dimensional (3D) imaging techniques has improved the diagnosis of teeth with complex anatomies, such as dens in dente. This systematic review aimed to determine the different techniques for endodontic management of teeth with Dens in dente having periapical lesions. Materials and Methods: Case reports and case series were identified in databases - PubMed-MEDLINE, Google Scholar, Research Gate, EBSCO-Host, Scopus, and Cochrane Library based on title, abstract, and full text published in the English language between January 1, 2016 and April 30, 2023. Patients who have periapical lesions and dens in dente in their permanent teeth and reporting on the results of nonsurgical or surgical intervention in terms of healing were eligible for this review, while editorial reviews, review papers, abstracts, letters to the editor, and animal studies are all excluded. Case studies on deciduous teeth, dens in dente retreatment, or dens associated with other developmental disorders are also excluded. Three authors evaluated the quality of the included studies. The quality of the included case reports and case series was evaluated using the Joanna Briggs Institute’s Critical Appraisal Checklist for Case Reports and Case Series. Results and Discussion: A total of 28 articles were suitable for inclusion, with 24 case reports and 4 case series. According to the available evidence, the condition is linked to an increased prevalence of pulp disease. Any necessary endodontic treatment may be difficult due to the aberrant anatomy. Early identification and preventive intervention rescued the teeth from further dental diseases. Conclusion: Nevertheless, thorough diagnoses and treatment planning are essential. Maintaining the vitality of the pulp or conserving the tooth using the least invasive way is the guiding principle when choosing a treatment modality. A surgical approach is only needed if the conservative approach fails. In the current systematic review, all cases showed reduction in the size of the periapical lesion or complete periapical healing.