Application of personalized templates in minimally invasive management of coronal dens invaginatus: a report of two cases

• Published in: BMC oral health 2024-05, Vol.24 (1), p.592-9, Article 592
• Main Authors: Li, Mingming, Wang, Guosong, Zhu, Fangzhi, Jiang, Han, Yang, Yingming, Cheng, Ran, Hu, Tao, Zhang, Ru
• Format: Article
• Language: English
• Subjects: Adolescent; Case Report; Computed tomography; Cone-Beam Computed Tomography; Coronal dens invaginatus; CT imaging; Cysts; Debridement; Debridement - methods; Dens in Dente - complications; Dens in Dente - diagnostic imaging; Dens in Dente - therapy; Dental caries; Dental pulp; Endodontics; Ethylenediaminetetraacetic acid; Female; Guided endodontics; Gum disease; Health aspects; Humans; Incisor - abnormalities; Incisor - diagnostic imaging; Infection; Male; Microsurgery; Minimally invasive endodontics; Minimally Invasive Surgical Procedures - methods; Morphology; Pain; Root canal therapy; Root Canal Therapy - methods; Root canals; Software; Teeth; Templates
• ISSN: 1472-6831; 1472-6831
• DOI: 10.1186/s12903-024-04377-5

Treating the coronal dens invaginatus (CDI) with pulp infection commonly involves the removal of invagination, which increases the risk of perforation and fracture, and compromises the tooth structure. Minimally invasive endodontic management of CDI is highly recommended. This report describes two cases of type II CDI with the application of personalized templates. Two cases of type II CDI, affecting the main root canal in a maxillary canine and a lateral incisor, were diagnosed. A guided endodontics (GE) approach was applied. Cone-beam computed tomography and intraoral scans were imported and aligned in a virtual planning software to design debridement routes and templates. The MICRO principle (which involves the aspects of Mechanical (M) debridement, Irrigation (I), Access cavities (C), Rectilinear routes (R), and Obstruction (O)) was proposed for designing optimal debridement routes for future applications. The templates were innovatively personalized and designed to preserve the tooth structure maximally while effectively debriding the root canal. Root canal treatment with supplementary disinfection was then performed. The follow-up of the two patients revealed favorable clinical and radiographic outcomes. The GE approach could be a feasible method for preserving healthy dental structure while effectively debriding the root canal, thereby achieving successful and minimally invasive endodontic treatment for CDI.