title: Calcium hydroxide barrier over the apical root-end of a type III dens invaginatus after endodontic and surgical treatment.
abstract: OBJECTIVE
  To report the simultaneous endodontic and surgical treatment of a tooth associated with Oehlers type III dens invaginatus and a persistent periapical lesion, which comprised root-end resection, root-end filling and application of a calcium hydroxide barrier placed on the resected dentine surface.
  
  
  CONCLUSIONS
  Three root canals were identified in a tooth with a type III dens invaginatus, which presented with a necrotic pulp, wide foraminal opening and extensive periapical lesion, and with a previous history of acute abscess, intracanal exudate and fistula. After root canal preparation followed by intracanal application of calcium hydroxide pastes, the clinical-pathological status persisted. After periapical curettage and root-end resection, the root canals were filled, followed by root-end filling with Sealer 26 mixed with zinc oxide powder to a clay-like consistency. Calcium hydroxide paste was then applied over the exposed dentinal surface forming a covering over the root apex. At the 20-month follow-up examination the patient had no symptoms and no fistula; advanced periapical bone repair was obvious on the radiograph.
  
  
  CONCLUSIONS
  Because of the variable morphology and extent of invagination, type III dens invaginatus represents a challenge for conventional treatment, often leading to the need for a surgical approach. Sealer 26 thickened with zinc oxide powder provided satisfactory clinical properties for use as a root-end filling material. Application of a calcium hydroxide barrier over the resected root-end is a potential treatment option to encourage tissue repair.
authors.affiliation: Department of Dentistry, Federal University of Jequitinhonha and Mucuri Wales, Diamantina, Minas Gerais, Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Soares
authors.forename: S
authors.initials: S
authors.lastname: Santos
authors.forename: F
authors.initials: F
authors.lastname: Silveira
authors.forename: E
authors.initials: E
authors.lastname: Nunes
mesh_terms: D000293:Adolescent; D001047:Apicoectomy; D001729:Bismuth; D002126:Calcium Hydroxide; D003719:Dens in Dente / Q000150:complications*; D003751:Dental Fistula / Q000150:complications / Q000601:surgery; D003790:Dental Pulp Necrosis / Q000150:complications / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007180:Incisor; D008437:Maxilla; D010485:Periapical Periodontitis / Q000150:complications / Q000601:surgery*; D012184:Retrograde Obturation / Q000379:methods*; D012387:Root Canal Filling Materials; D015034:Zinc Oxide
chemical_list: D012387:Root Canal Filling Materials; C080620:Sealer 26; D002126:Calcium Hydroxide; D015034:Zinc Oxide; D001729:Bismuth