Cone-Beam Computed Tomography (CBCT) Diagnosis of Dens Invaginatus: a Case Series

Dens invaginatus, also known as dens in dente, is a developmental anomaly caused by the invagination of the enamel organ into the dental papilla prior to calcification. This malformation shows wide morphological variability and represents a diagnostic and therapeutic challenge, especially when it is not clinically evident. Three-dimensional imaging, such as cone-beam computed tomography (CBCT), enables precise and detailed identification of the anomaly. This study described the radiographic and tomographic characteristics of four clinical cases of dens invaginatus diagnosed by CBCT at a radiology center in Cuenca, Ecuador. An observational, descriptive, and retrospective study was conducted on four clinical cases diagnosed with dens invaginatus. Information was collected from existing tomographic records using CBCT scans obtained for routine clinical purposes. Images were analyzed to determine the type of invagination according to the Oehlers classification, as well as anatomical findings and potential clinical implications. Four cases of dental invagination were identified in maxillary lateral incisors (three cases) and one maxillary canine (one case). Three corresponded to Oehlers type II and one to type IIIA. No patients presented associated periapical lesions. CBCT enabled precise definition of the extent, morphology, and relationship with the pulp chamber. Early diagnosis of dens invaginatus using CBCT allows detailed characterization of the anomaly and the planning of conservative therapeutic approaches, helping to to prevent of complications such as pulp infections or invasive treatments.