title: The diagnosis and conservative treatment of a complex type 3 dens invaginatus using cone beam computed tomography (CBCT) and 3D plastic models.
abstract: OBJECTIVE
  To investigate the use of 3D plastic models, printed from cone beam computed tomography (CBCT) data, for accurate diagnosis and conservative treatment of a complex case of dens invaginatus.
  
  
  CONCLUSIONS
  A chronic apical abscess with a draining sinus tract was diagnosed during the treatment planning stage of orthodontic therapy. Radiographic examination revealed a large radiolucent area associated with an invaginated right maxillary central incisor, which was found to contain a vital pulp. The affected tooth was strategic in the dental arch. Conventional periapical radiographs provided only partial information about the invagination and its relationship with the main root canal and with the periapical tissues. A limited-volume CBCT scan of the maxilla did not show evidence of communication between the infected invagination and the pulp in the main root canal, which could explain the pulp vitality. A novel method was adopted to allow for instrumentation, disinfection and filling of the invagination, without compromising the vitality of the pulp in the complex root canal system. The CBCT data were used to produce precise 3D plastic models of the tooth. These models facilitated the treatment planning process and the trial of treatment approaches. This approach allowed the vitality of the pulp to be maintained in the complex root canal space of the main root canal whilst enabling the healing of the periapical tissues.
  
  
  CONCLUSIONS
  Even when extensive periapical pathosis is associated with a tooth with type III dens invaginatus, pulp sensibility tests should be performed. CBCT is a diagnostic tool that may allow for the management of such teeth with complex anatomy. 3D printed plastic models may be a valuable aid in the process of assessing and planning effective treatment modalities and practicing them ex vivo before actually performing the clinical procedure. Unconventional technological approaches may be required for detailed treatment planning of complex cases of dens invaginatus.
authors.affiliation: Department of Endodontology, Tel Aviv University, Tel Aviv, Israel. dr.andakfir@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Kfir
authors.forename: Y
authors.initials: Y
authors.lastname: Telishevsky-Strauss
authors.forename: A
authors.initials: A
authors.lastname: Leitner
authors.forename: Z
authors.initials: Z
authors.lastname: Metzger
mesh_terms: D000293:Adolescent; D017607:Aluminum Compounds / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017610:Calcium Compounds / Q000627:therapeutic use; D017076:Computer-Aided Design; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003707:Demeclocycline / Q000627:therapeutic use; D003719:Dens in Dente / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D003751:Dental Fistula / Q000175:diagnosis; D003786:Dental Pulp Cavity / Q000473:pathology; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007180:Incisor / Q000002:abnormalities* / Q000473:pathology; D003765:Models, Dental; D010087:Oxides / Q000627:therapeutic use; D010347:Patient Care Planning; D010482:Periapical Abscess / Q000175:diagnosis; D010969:Plastics / Q000737:chemistry*; D016300:Radiography, Bitewing; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D012388:Root Canal Irrigants / Q000627:therapeutic use; D018915:Root Canal Preparation / Q000379:methods; D012390:Root Canal Therapy / Q000379:methods; D017640:Silicates / Q000627:therapeutic use; D014222:Triamcinolone Acetonide / Q000627:therapeutic use
chemical_list: D017607:Aluminum Compounds; D000900:Anti-Bacterial Agents; D017610:Calcium Compounds; D004338:Drug Combinations; D010087:Oxides; D010969:Plastics; D012387:Root Canal Filling Materials; D012388:Root Canal Irrigants; D017640:Silicates; C086631:mineral trioxide aggregate; D003707:Demeclocycline; C001527:Ledermix; D014222:Triamcinolone Acetonide