Oehlers' Type II Dens Invaginatus Case Report: Outcome of Sequential Management With Primary Targeted Invagination...

Diversity of possible anatomical variations and configurations of dens invaginatus limits the possibility to conduct its complex treatment in a fully standardized protocol manner. Thus, the objective of the present case report was to approbate targeted approach to Type II dens invaginatus treatment, which may also be interpreted as part of a sequential management strategy with the intention to keep the vitality of a pulp within the main root canal in the first place. The present case report also opens a topic for discussion if "partial success" definition may be applicable for assessment of Type II dens invaginatus treatment outcomes. A 16-year-old patient referred to the dentist complaining of painful percussion in the area of Tooth 12. Clinical examination methods (visual examination, sensitivity testing, percussion, and probing) were used for the diagnostics of problematic Tooth 12. To confirm the diagnosis of dens invaginatus, Type II CBCT examination was held. The following treatment was provided: root canal treatment of the invaginated canal only in the first place, while root canal treatment of the main canal was planned to be provided on demand if needed. From the perspective of the presented case report, targeted endodontic treatment of invagination has resolved all the symptoms from the very beginning; meanwhile, the recurrence of the symptoms after some time was due to the involvement of the main root canal. Sequential management with primary targeted invagination treatment of Oehlers' Type II dens invaginatus presented in this case report seems to be a possible approach for a carefully selected clinical situation aimed at minimizing the level of iatrogenic intervention; however, in the described case report, the end tooth required full endodontic treatment. Considering the risk of potential endodontic complications, development periodical screening of patients, who have undergone primary targeted invagination treatment, seems to be beneficial and reasonable to provide.