title: Successful nonsurgical endodontic outcome of a severely affected permanent maxillary canine with dens invaginatus Oehlers type 3.
abstract: BACKGROUND
  The morphogenic complexities of dens invaginatus (DI) Oehlers type 3 in maxillary canines offer significant endodontic challenges.
  
  
  METHODS
  A case report is provided of a 14-year-old female patient who presented with an anomalous-looking permanent maxillary canine associated with a sinus tract. Pulp testing revealed a normal response on the distal aspect of the tooth, whereas the mesial segment tested nonresponsive. A radiolucent lesion was seen on the mesiolateral radicular area adjacent to the severely distended pulp chamber. A gutta-percha point inserted into the sinus tract traced to this same region. The diagnosis was normal pulp coincident with DI Oehlers type 3 with pulp necrosis and chronic apical abscess.
  
  
  RESULTS
  Despite a concerted effort to limit the root canal therapy to only the necrotic canal, its proximity to the normal canal obviated this possibility, entailing endodontic treatment of the entire root canal system. The necrotic pulp space was subjected to sustained irrigation with 5.25% sodium hypochlorite and then completed with 17% ethylenediaminetetraacetic acid. A bolus of gutta-percha was used to create an apical barrier, and then the remainder of the enlarged pulp space was obturated with injectable thermoplasticized gutta-percha. At a 4.5-year recall, there was no clinical and radiographic evidence of infection.
  
  
  CONCLUSIONS
  Endodontic success was accomplished with meticulous efforts of disinfection. Thermoplasticized gutta-percha can offer utility for obturation of anatomically complicated pulp spaces. The use of the dental operating microscope is an invaluable aid for discernment of the intricacies of teeth affected with DI type 3 variant and can enhance clinical outcomes.
authors.affiliation: Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland. Electronic address: JBrooks@umaryland.edu.
authors.forename: John K
authors.initials: JK
authors.lastname: Brooks
authors.affiliation: Private Practice, Washington, District of Columbia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ribera
mesh_terms: D000293:Adolescent; D003481:Cuspid / Q000002:abnormalities*; D003719:Dens in Dente / Q000145:classification / Q000628:therapy*; D003751:Dental Fistula / Q000628:therapy; D003790:Dental Pulp Necrosis / Q000628:therapy; D004492:Edetic Acid / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006171:Gutta-Percha / Q000627:therapeutic use; D006801:Humans; D008437:Maxilla; D010482:Periapical Abscess / Q000628:therapy; 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*; D012973:Sodium Hypochlorite / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D012387:Root Canal Filling Materials; D012388:Root Canal Irrigants; D006171:Gutta-Percha; D004492:Edetic Acid; D012973:Sodium Hypochlorite
keywords: Cuspid; dens invaginatus; disinfection; endodontics; root canal obturation