A novel approach in management of Ohler’s type III dens invaginatus in maxillary lateral incisor with guided endodontics and three-dimensional printing

An elderly female patient presented with a localized gingival swelling in relation to discolored and endodontically treated maxillary lateral incisor. Clinical examination revealed a palatal access opening and a bony hard swelling on the labial aspect of the attached gingiva. The response to percussion and sensibility tests was negative. Intraoral periapical radiograph and cone beam computed tomography suggested asymptomatic apical periodontitis in relation to an anomalous 12 presenting with features of Dens Invaginatus. Guided endodontics was used to perform root canal treatment. Three-dimensional printed sleeved templates were designed to guide the access to main canal and invaginated part of dens invaginatus by creation of two virtual paths developed through software-assisted alignment of DICOM and stereolithography files. The computerized numerical control technology helped in the formation of sleeves which guided a modified drill throughout the procedure, thus helping in successful access. Shaping and cleaning were followed by sealing the invaginated part with mineral trioxide aggregate, whereas the main canal was obturated with thermoplasticized gutta-percha. On subsequent visits, complete resolution of bony hard swelling and reduction in size of periapical lesion were observed as positive signs of healing.