From Volume 42, Issue 2, March 2015 | Pages 126-128
A case of an unusual anomaly in a maxillary canine is described. A deep enamel invagination resulted in pulpal necrosis, longstanding infection and development of an associated radicular cyst. Diagnostic X-ray imaging was invaluable in demonstrating the complex root anatomy of the dilated odontome. In particular, a cone beam CT scan helped in the formulation of an appropriate treatment plan.
Developmental anomalies in teeth cover a wide spectrum of complexity of anatomy, which can sometimes be challenging to diagnose and manage. Dilated odontomes are also known as dens invaginatus, gestant odontome and dens in dente.1 The different names represent the varied opinions on the aetiology. Dens invaginatus is a well known tooth anomaly which is the result of an infolding of the enamel epithelium during tooth development. The deformity in the crown, and sometimes the root, acts as a channel and brings oral bacteria much closer to the pulp, frequently causing early pulpal necrosis. The most commonly affected tooth is the maxillary lateral incisor, followed by the maxillary central incisor, while other teeth, including the maxillary canine, are occasionally invaginated.2 A review of the literature has identified only six published cases of dilated odontomes occurring in maxillary canines.
The most regularly used classification system for dens invaginatus is that by Oehlers who described three forms of the anomaly:3
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