Conservative management of Dens Invaginatus with an open apex and vital pulp: A case report

Background: Dens invaginatus (DI) is a developmental anomaly characterized by a deepening or invagination of the enamel organ into the dental papilla before calcification of dental tissues. Case description: A 9-year-old female Hispanic patient was referred for evaluation of the upper left central incisor, due to swelling of the attached gingiva. Clinical examination revealed a talon cusp on the palatal surface, a draining sinus tract tracing to the apical area of tooth #9, and radiographically, a possible radiolucency. The cone beam computed tomography (CBCT) scan revealed a hypodense area involving the buccal and mesial cortical bone. The tooth was classified as Oehlers' Type IIIB dens invaginatus. Root canal treatment of the invagination was performed using an MTA apical plug. At the one-year follow-up examination, the tooth exhibited negative responses to percussion and palpation. CBCT and radiographic examinations showed bone healing and continuous root development, indicating successful treatment outcome. Conclusion: This case demonstrates that, in select cases of Type IIIB dens invaginatus with an open apex and a vital pulp, conservative treatment limited to the invagination canal can be successful when supported by accurate CBCT evaluation and appropriate material selection.