Non-surgical management of dens invaginatus type IIIB in maxillary lateral incisor with three root canals and 6-year follow-up:A case report and review of literature

BACKGROUND The presence of dens invaginatus(DI)complicates treatment of any tooth,from diagnosis to access cavity and biomechanical preparation and obturation.Reports of successful non-surgical management of DI type IIIB in maxillary lateral incisor are rare.Here,we report such a case,with three root canals and a long follow-up.CASE SUMMARY A 13-year-old female patient presented with mild pain in the maxillary right lateral incisor(#7)for 10-15 d.On examination,the tooth was slightly rotated,with slight tenderness on percussion and grade I mobility but with no caries,pockets or restorations and non-vital pulp(via vitality tests).Radiographic examination revealed unusual configuration of the tooth’s root canals,with an enamel-lined invagination extending to the apex,suggesting the possibility of DI Oehler’s type IIIB and a periapical radiolucency.Widening the access cavity lingually revealed one distinct buccal orifice and two distinct palatal orifices;under higher magnification of a dental operating microscope(DOM),the mesio palatal and disto-palatal orifices were observed as connected by a C-shaped groove.The root canals were prepared with hand K-files following a step-back technique,and obturated using a combination technique of lateral condensation and vertical compaction.At the 6-year follow-up,the patient was asymptomatic,and the periapical radiography displayed significant healing around the apical end of the root.CONCLUSION Proper knowledge of unusual root canal anatomy is required in treating DI.Conventional methods of root canal treatment can successfully resolve such complex cases,facilitated by DOM and cone-beam computed tomography.

Management of the palato-radicular groove with a periodontal regenerative procedure and prosthodontic treatment:A case report

BACKGROUND Palato-radicular groove(PRG)is defined as an anomalous formation of teeth.The etiology of PRG remains unclear.The prognosis of a tooth with a PRG is unfavorable.The treatment of combined periodontal-endodontic lesions requires multidisciplinary management to control the progression of bone defects.Some researchers reported cases that had short-term observations.The management of teeth with PRGs is of great clinical significance.However,to date,no case reports have been documented on the use of bone regeneration and prosthodontic treatment for PRGs.CASE SUMMARY This case reported the management of a 40-year-old male patient with the chief complaint of slight mobility and abscess in the upper right anterior tooth for 15 d and was diagnosed with type II PRG of tooth 12 with combined endodonticperiodontal lesions.The accumulation of plaque and calculus caused primary periodontitis and a secondary endodontic infection.A multidisciplinary management approach was designed that included root canal therapy,groove sealing,a periodontal regenerative procedure,and prosthodontic treatment.During a 2-year follow-up period,a good prognosis was observed.CONCLUSION This report indicates that bone regeneration and prosthodontic treatment may contribute to the long-term favorable prognosis of teeth with PRGs.