Complex endodontic-surgical management of dens invaginatus in multiple teeth associated with unusual morphology by using cone-beam computed tomography as a diagnostic aid

Dens invaginatus (DI) as a dental anomaly suggests a broad spectrum of morphologic variations and predisposes the tooth to decay and in intense invaginations to pulpitis and apical periodontitis. The involved tooth requires endodontic or combined endodontic-surgical treatment which often is complicated because of the abnormal morphology. As intraoral periapical radiographs provide insufficient information because of its two-dimensional nature, a cone-beam computed tomographic scan is recommended in complex cases with aberrant root canal anatomy that allows visualization of pathology in three dimensions. This article reports a case in which multiple teeth were involved with DI associated with open apex and periapical pathology which was successfully treated with endodontic and combined endodontic-surgical approach. The success of the present case suggest MTA as a preferable material to aid regeneration of the apical tissue in nonvital teeth with open apex and thus can be used in cases of DI.