Guided Cavity Preparation to Access an Invagination and Preserve Pulp Vitality of an Immature Maxillary Lateral Incisor With Type IIIa Dens Invaginatus: Technical Overview and a Case Report With 3-Year Follow-Up

Abstract

Aim: Dens invaginatus (DI) is a developmental anomaly often associated with caries and periapical pathosis. This report de-scribes guided access and filling of an infected invagination in a maxillary lateral (tooth #22) with long-term preservation of pulpvitality.Summary: A 9-year-old male presented with a palatal sinus tract associated with immature tooth 22. Based on clinical andradiographic examination, a type IIIa DI with a pseudo-foramen midway along the mesial aspect of the root was identified. Thetooth had a healthy pulp and peri-invagination periodontitis. A guided endodontic cavity was prepared to selectively access theinvagination without compromising the pulp and the invagination filled with a bioceramic calcium silicate–based material. At36 months the tooth was asymptomatic, and the pulp tested positive. Radiographically, root development was complete with bonyhealing of the lesion. This case report highlights the effectiveness of guided cavity preparation to access an invagination in animmature tooth with DI while preserving pulp vitality.