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CARES-A New Three-Dimensional Coding System for Classifying Teeth With Dens Invaginatus
Venkateshbabu Nagendrababu1,2, Asiya Sameer Mujawar3, Nandini Suresh4
1Department of Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE.
International Endodontic Journal
|June 18, 2026
Summary
A new 3D classification system, CARES, was developed for dens invaginatus (DI) using CBCT. This system, validated by global experts, offers reliable categorization for improved diagnosis and communication in managing DI.
Area of Science:
- Dental imaging
- Endodontics
- Dental morphology
Background:
- Dens invaginatus (DI) presents complex diagnostic challenges.
- Existing classification systems lack comprehensive 3D detail.
Purpose of the Study:
- To establish a novel, comprehensive three-dimensional coding system for classifying teeth with dens invaginatus (DI).
- To utilize cone beam computed tomography (CBCT) imaging for this classification.
Main Methods:
- Development of an initial DI classification draft by project directors.
- Consensus building through an online Delphi process with 26 global experts.
- Reliability assessment using CBCT images evaluated by six endodontists for inter-rater and intra-rater agreement.
Main Results:
- The Delphi process achieved 100% response rate in a single round.
- High inter-rater (0.89) and intra-rater (0.88) reliability scores indicated "almost perfect" agreement.
- The final CARES classification comprises five domains: Communication, Anatomy, Root formation, Extent, and Supplementary features.
Conclusions:
- The 3D CARES classification system offers a consistent and unambiguous method for categorizing DI.
- This system can enhance diagnostic precision and clinical decision-making in DI management.
- Improved communication among clinicians, patients, and healthcare professionals is anticipated.
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