Signs and symptoms
- DI is often asymptomatic with minimal external deformity
- Abnormal tooth shape, such as being wider mesio-distally or bucco-lingually, may be reported
- Increased risk of caries and periradicular pathology
- Infolding enamel can easily chip off, leading to abscess formation and displacement of dental structures
- Incisal notching or pronounced talon cusp on lateral incisors may indicate DI and should be investigated with radiographs
Cause
- Unclear cause, but several theories exist:
- Infection
- Trauma
- Growth pressure of dental arches during odontogenesis
- Rapid proliferation of internal enamel epithelium invading dental papilla
Diagnosis
- Clinical examination may reveal abnormally shaped tooth
- Radiographic examination is necessary for confirmation
- Periapical radiograph shows invagination lesion as a radiolucent pocket beneath cingulum or incisal edge
- Larger lesions can appear as fissures with radio-opaque structures
- Cone beam computed tomography (CBCT) provides detailed 3D image for diagnosis and treatment planning
Oehlers classification
- Class I: Partial invagination limited to crown, without involvement of pulp or periodontal ligament (PDL)
- Class II: Partial invagination extending beyond crown and CEJ, with possible pulp involvement but no communication with PDL
- Class IIIa: Complete invagination extending through root and communicating with PDL, usually without pulp involvement
- Class IIIb: Complete invagination extending through root and communicating with PDL through apical foramen, with potential disruption to dental anatomy
Management
- Preventative treatment, such as oral hygiene instructions and fissure sealant, is important
- Intentional replantation may be considered
- Root canal treatment with mineral trioxide aggregate can be performed
- Periapical surgery with retrograde filling is an option
- Extraction may be necessary in severe cases
Dens invaginatus (DI), also known as tooth within a tooth, is a rare dental malformation and a developmental anomaly where there is an infolding of enamel into dentin. The prevalence of this condition is 0.3 - 10%, affecting males more frequently than females. The condition presents in two forms, coronal involving tooth crown and radicular involving tooth root, with the former being more common.
| Dens invaginatus | |
|---|---|
| Other names | Dens in dente, tooth within a tooth |
| Specialty | Dentistry |
DI is a malformation of teeth most likely resulting from an infolding of the dental papilla during tooth development or invagination of all layers of the enamel organ in dental papillae. Affected teeth show a deep infolding of enamel and dentin starting from the foramen coecum or even the tip of the cusps and which may extend deep into the root. Teeth most affected are maxillary lateral incisors (80%), followed by maxillary canines (20%). Bilateral occurrence is also seen (25%).
Latin dens invaginatus
dens invaginatus (uncountable)
