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Endo tips    Better Endo    Endo abstracts    Endo discussions

 Type 3 Dens
The opinions within this web page are not ours.Authors have been credited
for the individual posts where they are. - www.rxroots.com photographs courtesy: Sashi Nallapati

From: Sashi Nallapati
To: ROOTS
Sent: Saturday, September 13, 2008 1:04 AM
Subject: [roots] Type 3 Dens

here is one Dens Invaginatus Type 3 from last week.

Here is an interesting case that is classified as Dens Invaginatus Type 3.
the chief characterstics of this anomaly is the enamel lined tract 
that connects the crown to the root and invaginates the apical or lateral 
aspect of the root.

commonly the root canal that houses the vital pulp is unaffected . this 
invagination of the enamel tract however, pushes the root canal laterally. 
Typically the enamel tract opens coronally , gets contaminated,
and results in a infection in the bone where it opens apically. 
Because the enamel tract opens into the 'sac' or 'pouch' apically, the 
infection rapidly forms a lesion. However the vital pulp in the root canal
survives as it is not in communication with either the enamel tract or at 
the periapex. Treatment may include

1. Treating the enamel tract orthograde with long term CaOH apexification 
   till the pouch closes.
2. Treating the enamel tract orthograde as well as sealing the apical pouch 
   with root end surgery.

i prefer to do the second approach as i had much success with that approach.
So the enamel tract was opened orthograde, drainage obtained, irrigated 
orthograde. Then using the surgical approach, raised a flap , through and 
through flushing and debridement with chlorhexidine,  retrograde filling
with flowable resin for the deeper part of the defect and MTA for the outer rim.

Flap was sutured back , and then finally the enamel tract coronally was 
sealed with warm obturation with Gp + selaer and resin to seal access.

Pulp in the root canal retained its vitality during this whole procedure.

Pictures explain the treatment.

you can see the appearance of the root end surgically and the canal openings 
into the root end pouch. I have published a similar case in the JOE 4 years ago. 
These cases are complex and very fulfilling when they are treated successfully. 
- Sashi Nallapati



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