Intentional Replantation for the Management of Type I Dens Invaginatus with External Inflammatory Root Resorption after Dental Trauma: A Case Report with an 18-Month Follow-Up

Abstract

Dens invaginatus (DI) represents a rare developmental anomaly that may predispose affected teeth to pulpal and periapical pathologies. When complicated by external inflammatory root resorption (EIRR), treatment becomes considerably more challenging and prognosis may be compromised. Intentional replantation (IR) has reemerged as a conservative alternative in cases where conventional nonsurgical endodontic retreatment or periapical surgery is not feasible. A 20-year-old systemically healthy male presented with intraoral swelling in the maxillary lateral incisor region. Cone beam computed tomography (CBCT) revealed a periapical lesion approximately 12 mm in diameter associated with a maxillary lateral incisor exhibiting Oehlers Type I DI and severe EIRR. The tooth was atraumatically extracted, and granulation tissue on the root surface was removed using ultrasonic tips under continuous saline irrigation, followed by apical resection. A 3-mm retrograde filling using mineral trioxide aggregate (MTA) was placed. All extraoral procedures were completed within 14.5 min. The patient was followed at 1, 3, 6, 12, and 18 months. Radiographic evaluation demonstrated complete periapical healing and cortical bone regeneration at the 18-month follow-up. This case demonstrates that IR can be a reliable and conservative option for the management of complex endodontic cases involving dens invaginatus and extensive inflammatory root resorption.

Keywords

• Dens invaginatus
• external inflammatory root resorption
• intentional replantation
• mineral trioxide agregat

Diş Travması Sonrası Gelişen Tip I Dens İnvajinatus ve Eksternal Inflamatuvar Kök Rezorpsiyonunun Kasıtlı Replantasyon ile Tedavisi: 18 Aylık Olgu Sunumu

Öz

Dens invaginatus etkilenen dişlerin pulpal ve periapikal patolojilere yatkınlığını artırabilen nadir görülen gelişimsel dental anomalidir. Eksternal inflamatuvar kök rezorpsiyonu ile komplike olduğunda tedavi süreci belirgin şekilde zorlaşmakta ve prognoz olumsuz yönde etkilenebilmektedir. Kasıtlı replantasyon, cerrahi olmayan endodontik yeniden tedavi veya periapikal cerrahinin uygulanamadığı olgularda konservatif bir tedavi alternatifi olarak gündeme gelmektedir. Bu olgu sunumunda, maksiller lateral kesi ci diş bölgesinde intraoral şişlik şikâyeti bulunan sistemik olarak sağlıklı 20 yaşında erkek hasta değerlendirilmiştir. Konik ışınlı bilgisayarlı tomografi incelemesinde, Oehlers Tip I dens invaginatus ve şiddetli eksternal inflamatuvar kök rezorpsiyonu bulunan maksiller lateral kesici dişle ilişkili yaklaşık 12 mm çapında bir periapikal lezyon saptanmıştır. İlgili diş atravmatik olarak çekilmiş; kök yüzeyindeki granülasyon dokusu, sürekli serum fiz- yolojik irrigasyonu altında ultrasonik uçlar kullanılarak uzak laştırılmış ve apikal rezeksiyon yapılmıştır. Ardından mineral trioksit agregat (MTA) kullanılarak 3 mm derinliğinde retrograd dolgu yapılmıştır ve tüm ekstraoral işlemler 14.5 dakika içerisinde tamamlanmıştır. Hasta 1., 3., 6., 12. ve 18. aylarda klinik ve radyografik olarak takip edilmiştir. 18. ay kontrolünde, radyografik değerlendirmede tam periapikal iyileşme ve kortikal kemik dokusu miktarında artış gözlenmiştir. Bu olgu, dens invaginatus ve yaygın inflamatuar kök rezorpsiyonu ile seyreden kompleks endodontik vakaların tedavisinde, dikkatli klinik uygulama ile kasıtlı replantasyonun güvenilir ve konservatif bir tedavi seçeneği olabileceğini göstermektedir.

Anahtar Kelimeler

• Dens invaginatus
• eksternal inflamatuvar kök rezorpsiyonu
• kasıtlı replantasyon
• mineral trioksit agregat

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