Radiodiagnostic analysis of dens invaginatus in maxillary lateral incisors: a cone-beam computed tomographic study

Abstract

Purpose: This study aims to determine the prevalence of dens invaginatus (DI) in maxillary lateral teeth within a Turkish subpopulation using cone-beam computed tomography (CBCT) and to evaluate the relationship between the invagination and the main root canal. Materials and Methods: A total of 953 maxillary lateral teeth from 662 patients were evaluated for the presence of DI. To ascertain the invagination's location in the crown from the axial section, four equidistant areas were delineated, extending from the mesio-palatal to the disto-palatal surface. Measurements included the vertical distance between the top of the palatal pulp horn and the buccal pulp horn (h1), the closest distance between the invagination and the buccal pulp horn (h2), and the dentin thickness from the widest part of the invagination to the tooth's outer walls. Results: DI was observed in 5% of the patients (33/662). Invaginations in the medial region of the mesiopalatinal surface were statistically significantly more common in males (p=0.049). The distances from the invagination to the buccal and distal walls were also significantly longer in males (p=0.040 and p=0.008, respectively). There was no statistically significant difference in the mean distances h1 and h2 according to sex and age. Conclusion: Based on CBCT measurements, investigating the presence of DI more mesiopalatinally in males is recommended to prevent excessive tooth structure loss. Additionally, given that DI is significantly closer to the buccal and distal walls in females, a more conservative access cavity approach should be advised to minimize the risk of perforation.

Keywords

• Cone-beam computed tomography
• dens invaginatus
• prevalence
• root canal treatment
• tooth abnormalities

References

1. Hülsmann M. Dens invaginatus: aetiology, classification, prevalence, diagnosis, and treatment considerations. IntEndodJ 1997;30:79-90. doi: 10.1046/j.1365-2591.1997.00065 google scholar
2. Gallacher A, Ali R, Bhakta S. Dens invaginatus: diagnosis and management strategies. Br Dent J 2016;221:383-7. doi: 10.1038/sj.bdj.2016.724. google scholar
3. Segura JJ, Hattab F, Rıos V. Maxillary canine transpositions in two brothers and one sister: associated dental anomalies and genetic basis. ASDC J Dent Child 2002;69:54-8. google scholar
4. Thakur S, Thakur NS, Bramta M, Gupta M. Dens invagination: A review of literatüre and report oftwo cases. JNat Sci Biol Med 2014;5:218-21. doi: 10.4103/0976-9668.127341. google scholar
5. Oehlers FA. Dens invaginatus (dilated composite odontome). I. Variations of the invagination process and associated anterior crown forms. Oral Surg Oral Med Oral Pathol 1957;10:1204-18 doi: 10.1016/0030-4220(57)90077-4. google scholar
6. Capar ID, Ertaş H, Arslan H, Ertaş ET. A retrospective comparative study of cone-beam computed tomography versus rendered panoramic images in identifying the presence, types, and characteristics of dens invaginatus in a Turkish population. J Endod 2015;41:473-8. doi: 10.1016/j.joen.2014.12.001. google scholar
7. Colak H, Tan E, Aylıkçı BU, Uzgur R, Turkal M, Hamidi MM. Radiographic study of the prevalence of dens invaginatus in a sample set of Turkish dental patients. J Clin Imaging Sci 2012;2:34. doi: 10.4103/2156-7514.97755. google scholar
8. Hamasha AA, Alomari QD. Prevalence of dens invaginatus in Jordanian adults. Int Endod J 2004;37:307-10. doi: 10.1111/j.0143-2885.2004.00797. google scholar

9. Gotoh T, Kawahara K, Imai K, Kishi K, Fujiki Y. Clinical and radiographic study of dens invaginatus. Oral Surg Oral Med Oral Pathol 1979;48:88-91.doi:10.1016/0030-4220(79)90243-3. google scholar
10. Durack C, Patel S. The use of cone beam computed tomography in the management of dens invaginatus affecting a strategic tooth in a patient affected by hypodontia: a case report. Int EndodJ 2011;44:474-83. doi: 10.1111/j.1365-2591.2011.01866 google scholar
11. Siqueira JF Jr, Röças IN, Hernandez SR, Brisson-SuârezK, Baasch AC, Perez AR et al. Dens invaginatus: Clinical Implications and Antimicrobial Endodontic Treatment Considerations. J Endod2022;48:161-70.doi: 10.1016/j.joen.2021.11.014. google scholar
12. Rajasekharan S, Martens L, Vanhove C, Aps J. In vitro analysis of extracted dens invaginatus using various radiographic imaging techniques. Eur J Paediatr Dent 2014;15:265-70. google scholar
13. Sedentexct.eu [homepage on the Internet]. University of Manchester; 2008 [cited 13 Jan 2009]. Available from: http://www.sedentexct.eu/ google scholar
14. Cakici F, Celikoglu M, Arslan H, Topcuoglu HS, Erdogan AS. Assessment of the prevalence and characteristics of dens invaginatus in a sample of Turkish Anatolian population. Med Oral Patol Oral CirBucal 2010;15:855-8. doi: 10.4317/medoral.15.e855. google scholar
15. Gündüz K, Çelenk P, Canger EM, Zengin Z, Sümer P. A retrospective study of the prevalence and characteristics of dens invaginatus in a sample of the Turkish population. Med Oral Patol Oral CirBucal 2013;18:27-32. doi: 10.4317/medoral.18285. google scholar
16. Kirzioglu Z, Ceyhan D. The prevalence of anterior teeth with dens invaginatus in the western Mediterranean region of Turkey. Int Endod J 2009;42:727-34. doi: 10.1111/j. 13652591.2009.01579. google scholar
17. Ceyhanli K, Buyuk SK, Sekerci AE, Karataş M, Celikoglu M, Benkli YA. Investigation of dens invaginatus in a Turkish subpopulation using cone-beam computed tomography. Oral Health Dent Manag 2015;14:81-4. google scholar
18. Rozylo TK, Rozylo-Kalinowska I, Piskorz M. Cone-beam computed tomography for assessment of dens invaginatus in the Polish population. Oral Radiol 2018;34:136-42. doi: 10.1007/s11282-017-0295-7. google scholar
19. Yalcin TY, Bektaş Kayhan K, Yilmaz A, Göksel S, Ozcan I, Helvacıoglu Yigit D. Prevalence, classification and dental treatment requirements of dens invaginatus by cone-beam computed tomography. PeerJ 2022;10:14450. doi: 10.7717/peerj.14450. google scholar
20. Alkadi M, Almohareb R, Mansour S, Mehanny M, Alsadhan R. Assessment of dens invaginatus and its characteristics in maxillary anterior teeth using cone-beam computed tomography. Sci Rep 2021;11:19727. doi: 10.1038/s41598-021-99258-0. google scholar
21. Mabrouk R, Berrezouga L, Frih N. The Accuracy of CBCT in the Detection of Dens Invaginatus in a Tunisian Population. Int J Dent 2021; 8826204. doi: 10.1155/2021/8826204. google scholar
22. Chen L, Li Y, Wang H. Investigation of dens invaginatus in a Chinese subpopulation using Cone-beam computed tomography. Oral Dis 2021;27:1755-60. doi: 10.1111/odi.13702. google scholar
23. Bishop K, Alani A. Dens invaginatus. Part 2: clinical, radiographic features and management options. Int Endod J 2008;41:1137-54. doi: 10.1111/j.1365-2591.2008.01469 google scholar
24. Agrawal PK, Wankhade J, Warhadpande M. A Rare Case of Type III Dens Invaginatus in a Mandibular Second Premolar and Its Nonsurgical Endodontic Management by Using Cone-beam Computed Tomography: A Case Report. J Endod 2016;42:669-72.doi: 10.1016/j.joen.2016.01.001. google scholar
25. Kristoffersen 0, Nag OH, Fristad I. Dens invaginatus and treatment options based on a classification system: report of a type II invagination. Int Endod J 2008;41:702-9. doi: 10.1111/j.1365-2591.2008.01399. google scholar
26. Ali A, Arslan H, Jethani B. Conservative management of Type II dens invaginatus with guided endodontic approach: A case series. J Conserv Dent 2019;22:503-8.doi: 10.4103/JCD.JCD_30_20. google scholar
27. Zubizarreta MA, Ferreiroa A, Rico-Romano C, Ezpeleta LOA, Alvares JA. Diagnosis and endodontic treatment of type II dens invaginatus by using cone-beam computed tomography and splint guides forcavity access: a case report. J Am Dent Assoc 2015;146:266-70. google scholar
28. Hallet GE. The incidence, nature, and clinical significance of palatal invaginations in the maxillary incisor teeth. Proc R Soc Med 1953;46:491-9. google scholar