Dens invaginatus: a clinical update and a proposed new three-dimensional classification

Dens invaginatus is a developmental anomaly characterised by enamel and dentine infolding, resulting in highly variable internal anatomy that can complicate diagnosis, treatment planning and long-term prognosis. Traditional two-dimensional classifications such as Oehler's Classification do not fully reflect the morphological complexity of invaginations which can now be evaluated with cone beam computed tomography. This paper provides an updated clinical overview of the aetiology, developmental principles, diagnostic features and key considerations for the management of dens invaginatus.A new three-dimensional classification - the Manchester Classification - is introduced which assesses the vertical extent of the invagination, its horizontal morphology and the proximity to the main canal. This classification offers a more detailed and clinically relevant representation of this anomaly, supporting more predictable diagnostic interpretation and treatment planning.Management recommendations informed by the Manchester Classification are outlined, offering structured guidance for a range of clinical presentations. The classification is intended to support clinical decision-making and bridge the gap between specialist endodontic understanding and general practice. Early recognition and three-dimensionally informed treatment planning have the potential to improve outcomes for teeth affected by dens invaginatus.