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CASE REPORTS
Year : 2005  |  Volume : 23  |  Issue : 3  |  Page : 151-152
 

Radicular dens invaginatus - A case report


1 Provincial Health and Medical Services of the State of UP, India
2 Department of Pedodontics with Preventive Dentistry UP King George's Dental University, Lucknow, UP, India

Correspondence Address:
S C Pandey
'PANDEYS', B-83/B, Nirala Nagar, Lucknow - 226 020, UP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.16890

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   Abstract 

Case report showing classical Radicular dens invaginatus; along with in vitro illustrations of the extracted tooth and RVG (Radiovisiography) after radiopaque dye injection.


Keywords: Dens, Invaginatus


How to cite this article:
Pandey S C, Pandey R K. Radicular dens invaginatus - A case report. J Indian Soc Pedod Prev Dent 2005;23:151-2

How to cite this URL:
Pandey S C, Pandey R K. Radicular dens invaginatus - A case report. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2020 Sep 18];23:151-2. Available from: http://www.jisppd.com/text.asp?2005/23/3/151/16890


Radicular dens invaginatus is a rare dental anomaly with only three human cases [1],[2],[3] reported in the world literature till date.

Radicular dens invaginatus presenting a clinical crown and an inter-radicular crown; followed by a discussion of this structure and possible treatment modalities. The in vitro illustrations of the structure, and in vitro radioactive dye injected RVG image exhibiting the interlinked pulpal canals are the classical feature of this anomaly.

The dens invaginatus arise as a result of invagination in the surface of tooth crown before calcification has occurred. The etiological factors responsible are increased localized external pressure. Focal growth retardation and focal growth stimulation in certain area of tooth buds.

Bhatt and Dholakhia[4] claimed that the radicular invagination usually results from an enfolding of Hertwig's root sheath and originates within the root after development is complete. The dens invaginatus usually presents a bizarre radiographic appearance. The present case report depicts the morphologically and anatomically altered tooth structure. The classical appearance of clinical crown with extra inter-radicular crown was noticed within the confines of multiple roots. The RVG reveals the separated radicular pulp, which are interlinked with large sigmoid pulp chamber of the inter-radicular crown, suggestive of classical radicular dens invaginatus.


   Case History Top


A 14-year-old girl reported to the dental clinic with severe persistent dental pain with history of pain in the right maxillary quadrant since 2 years. The swelling was associated with mobility of penultimate teeth, canine, and second premolar. The clinical picture had all the symptoms of a slowly growing maxillary tumor. However, the patient reported persistent pain, and only recently reported the inability to masticate food owing to the tenderness in the maxillary teeth. None of the teeth were carious and the patient maintained good oral hygiene. The crown of the first premolar was positioned slightly buccally and tipped upwards by an angle of 20°, not a very uncommon finding in crowded dentitions at this age. However, the radiograph revealed a noncystic multirooted hazy radio opaque mass below the crown of the first premolar instead of a normal root. In such a situation, it was creating deleterious effects on the adjacent teeth and surrounding soft and hard tissues. Because fine needle aspiration cytology was impossible (as the structure was osseous in nature) the structure was removed from the oral cavity as a whole.


   Discussion Top


Under local anesthesia the cystic lesions was removed after raising a palatal flap. Very thin palatal bone easily gave way and no abnormal tissue was encountered during the surgical extraction. The surgical defect was closed by a mobilized palatal flap with a crescent-shaped relaxation incision given far below the attached gingival, both palatally and buccally.

The surgically-removed structure had three roots, and a clinical crown [Figure - 1]. On the palatal aspect within the confines of the root in the cementum area was another crown of premolar [Figure - 2]. It was interesting to note that the patient had a normally erupted second premolar.

The root apices of the lateral two roots had nearly no instrumentable opening (as file No. 6 could not enter them on retrograde instrumentation) whereas the middle root had an apical canal, which could receive a No. 6 file on retrograde instrumentation. This canal was then enlarged only in the apical region to receive a small dye injection needle tip. The tooth was first forcibly injected with radio-opaque dye, and thereafter the dye was drained by manual jerking to visualize canal lumens as shown in this RVG image [Figure - 3]. This RVG image proved the communicability of all the three canals with a large sigmoid pulp chamber in the center and therefore the characteristic criteria of radicular dens invaginatus was fulfilled by the radioactive dye injection imaging.

The development of this structure is still controversial.[5],[6] However, it's existence is not yet confirmed; more insight on the development of this structure shall be achieved after the histopathological analysis is completed which will be subsequent to section cutting. However, as this is the first classical case of this country and fourth of the world, the structure deserves a mention before it is subjected to histopathology which will put an end to it's physical form.

Pulpal treatment of this type of anomaly is still out of question because the amount of disturbing force that a tooth of this size exerts on the supporting structures disturbs normal anatomy. Its complex internal morphology, however, is still an open vista for endodontic research. Nevertheless, total removal of such a structure from the body is one of the most suited treatment modality to the patient.



 
   References Top

1.Payne M, Craig GT. A radicular dens invaginatus. Br Dent J 1990;169:94-5.  Back to cited text no. 1  [PUBMED]  
2.Soames JV, Kuyebi TA. A radicular dens invaginatus. Br Dent J 1982;152:308-9.  Back to cited text no. 2  [PUBMED]  
3.Oehlers FA. The radicular variety of dens invaginatus. Oral Surg Oral Med Oral Pathol 1958;11:1251-60.  Back to cited text no. 3  [PUBMED]  
4.Bhutt AP, Dholakia HM. Radicular variety of Double Dens Invaginatus, O Surg 1974;39:284.  Back to cited text no. 4    
5.Pindborg JJ. Radicular invagination (dens in dente) and dentinogenisis imperfecta of the incisors in the white rat. Tandlaegebladet 1950;54:711-25.  Back to cited text no. 5  [PUBMED]  
6.Pindborg JJ. Radicular invagination (Dens in Dente) and Dentinogenisis imperfecta in a rat incisor. Acta Odontol Scand 1950;8:301-18.  Back to cited text no. 6  [PUBMED]  


Figures

[Figure - 1], [Figure - 2], [Figure - 3]


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