Combined Endodontic and Surgical Therapy for Resolution of Type III Dens Invaginatus

Dens invaginatus is an abnormal dental developmental, probably resulting of the invagination of mineralized tissues from the tooth crown surface before its calcification. The teeth that are most affected by this abnormality are the maxillary lateral incisors. This dental developmental anomaly has various types and the rarest is type III which has the worst prognosis, because of its complex anatomy. Conventional root canal therapy may not sufficiently resolve the case itself and in some circumstances the surgical intervention is also necessary. This report addresses a complex combined endodontic treatment of a type III dens invaginatus in a maxillary lateral incisor in an 18 years-old female patient, with an extensive periapical lesion affecting the buccal and palatine cortical bone, diagnosed by cone-beam computed tomography (CBCT). The case was conducted with the combination of endodontic and surgical treatment, under the use of the surgical operating microscope. The association of CBCT, visual magnification, XP-endo Finisher, bioceramic sealer, MTA Repair HP and bone graft were important to ensure predictable success.Keywords: Bioceramic Sealer; Dens Invaginatus; Endodontic Surgery; Endodontic Therapy; Periapical Lesio

Guided Endodontics in Complex Scenarios of Calcified Molars

This study aimed to report a case series and describe the use of guided endodontics in complex symptomatic cases of mandibular and maxillary molars; presenting calcification of all three root canals. The arches of the referred patients were scanned, and high-resolution cone-beam computed tomography (CBCT) imaging was performed. Then, the taken CBCT and tooth scans were aligned and processed using software. A virtual copy of a drill was superimposed onto the scans and evaluated in 3 dimensions. Subsequently, a 3-dimensional (3D) template was designed and printed. Drilling was performed and a radiograph was taken to confirm its position. The canals were reached and endodontic treatment was performed. At the 12-month follow-up, the teeth were completely asymptomatic. The use of guided endodontics _in cases of calcification in molars_ was demonstrated to be a viable and reliable alternative treatment. The technique was based on 3D planning.Keywords: Access Opening; Apical Periodontitis; Dental Trauma; Guided Endodontics; Pulp Canal Calcification