Chaturvedula BB, Muthukrishnan A, Bhuvaraghan A Dens invaginatus: a review and orthodontic implications. Br Dent J. 2021; 230:345-350 https://doi.org/10.1038/s41415-021-2721-9
Thakur S, Thakur NS, Bramta M, Gupta M Dens invagination: a review of literature and report of two cases. J Nat Sci Biol Med. 2014; 5:218-221 https://doi.org/10.4103/0976-9668.127341
White SC, Pharoah M Oral Radiology: Principles and Interpretation. 2000;
Gündüz K, Çelenk P, Canger EM A retrospective study of the prevalence and characteristics of dens invaginatus in a sample of the Turkish population. Med Oral Patol Oral Cir Bucal. 2013; 18:e27-32 https://doi.org/10.4317/medoral.18285
Colak H, Tan E, Aylıkçı BU Radiographic study of the prevalence of dens invaginatus in a sample set of Turkish dental patients. J Clin Imaging Sci. 2012; 2 https://doi.org/10.4103/2156-7514.97755
Zhu J, Wang X, Fang Y An update on the diagnosis and treatment of dens invaginatus. Aust Dent J. 2017; 62:261-275 https://doi.org/10.1111/adj.12513
Oehlers FA Dens invaginatus (dilated composite odontome). I. Variations of the invagination process and associated anterior crown forms. Oral Surg Oral Med Oral Pathol. 1957; 10:1204-1218 https://doi.org/10.1016/0030-4220(57)90077-4
Ridell K, Mejàre I, Matsson L Dens invaginatus: a retrospective study of prophylactic invagination treatment. Int J Paediatr Dent. 2001; 11:92-97 https://doi.org/10.1046/j.1365-263x.2001.00234.x
Alkadi M, Almohareb R, Mansour S Assessment of dens invaginatus and its characteristics in maxillary anterior teeth using cone-beam computed tomography. Sci Rep. 2021; 11 https://doi.org/10.1038/s41598-021-99258-0
Kfir A, Flaisher Salem N, Natour L Prevalence of dens invaginatus in young Israeli population and its association with clinical morphological features of maxillary incisors. Sci Rep. 2020; 10 https://doi.org/10.1038/s41598-020-74396-z
Bonsor DJ, Camilleri J Hydraulic cements for various applications in endodontics: part 2. Dent Update. 2023; 48:707-709
Kjaer I Morphological characteristics of dentitions developing excessive root resorption during orthodontic treatment. Eur J Orthod. 1995; 17:25-34 https://doi.org/10.1093/ejo/17.1.25
Mavragani M, Apisariyakul J, Brudvik P, Selvig KA Is mild dental invagination a risk factor for apical root resorption in orthodontic patients?. Eur J Orthod. 2006; 28:307-312 https://doi.org/10.1093/ejo/cjl006
Kronfeld R Dens in dente. J Dent Res. 1934; 14:49-66
Fischer CH To the question of the dens in dente. Dtsch tooth mouth Kieferheilkd. 1936; 3:621-634
Sprawson EC Odontomes. Br Dent J. 1937; 62:177-201
Rushton MA A collection of dilated composite odontomas. Br Dent J. 1937; 63:65-85
Euler HMünchen, Germany: Lehmann; 1939
Atkinson SR The permanent maxillary lateral incisor. Am J Orthod. 1943; 29:685-698
Bruszt P Etiology of dens in dente. SSO Schweiz Monatsschr Zahnheilkd. 1950; 60:534-542
Gustafson G, Sundberg S Dens in dente. Br Dent J. 1950; 88:83-88
Oehlers FA Dens invaginatus. II. Associated posterior crownforms and pathogenesis. Oral Surg Oral Med Oral Pathol. 1957; 10:1302-1316
Dens invaginatus is a developmental anomaly predominantly occurring in maxillary lateral incisors, resulting in the invagination of the enamel into the dentine. This infolded area creates a void enabling the stagnation of bacteria and development of dental caries. If left untreated the caries may progress and ultimately result in pulpal necrosis. The treatment of these teeth can be challenging due to the potential complexity of the lesion. It is essential that teeth with dens invaginatus are diagnosed early allowing prophylactic treatment and prevention of pulpal necrosis. This article aims to review the aetiology, prevalence, classification, diagnosis, treatment and orthodontic considerations of teeth affected by dens invaginatus.
CPD/Clinical Relevance: Knowledge of dens invaginatus enables early diagnosis, effective management and, therefore, the best treatment outcomes.
Article
Dens invaginatus (DI) is a developmental anomaly occurring during the formation of a tooth. It is the result of an invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues.1
It has also been described as ‘dens in dente’, which translates as a ‘tooth within a tooth’ owing to its radiographic appearance.2 The name DI reflects the infolding of the enamel into the dentine, resulting in a pocket that may extend deep into the pulp chamber and, in certain cases, to the root apex. The invagination creates an area of dead space, separated from the pulpal tissues by only a thin layer of enamel and dentine.3 This stagnant area enables entry for bacteria and other potential irritants, presenting a predisposition for the development of dental caries and consequently pulpal necrosis. In certain cases, the enamel lining is incomplete, and some lesions may have channels existing between the invagination and the pulp.4 Pulp necrosis often occurs within a few years of tooth eruption, occasionally before complete closure of the apex. Immature teeth that have undergone pulpal necrosis may exhibit wide open or ‘blunderbuss’ apices radiographically (Figure 1). Abscess formation, cysts, displacement of teeth and internal root resorption have also been reported as sequelae of teeth with undiagnosed and untreated DI.1
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