Management of Dens Invaginatus with Fractured Ni-Ti Instrument: A Case Report

Abstract

Background: Dens invaginatus, is an uncommon condition where there is an infolding of a part of dental tissues, leaving a complex shape of the tooth, which is not a self-cleansable area and can lead to caries. This forms a portal of entry of bacteria to the root canal, causing the tooth to suffer from pulp necrosis.

Methods: This case report is about how a 19-year-old male patient with chronic apical abscess and a fractured S2 nickel-titanium (Ni-Ti) rotary instrument, during treatment in a maxiallary left lateral incisor with dens invaginatus, was treated conservatively. Treatment plan was made in accordance to the AAE guidelines and the instrument was bypassed and root canal treatment was completed instead of any surgical procedure to remove the fractured instrument. CBCT images taken 13 months apart revealed gradual improvement at the root apex, while the patient did not experience any pain. Conservative approach and reliance on advanced images are highlighted in this case as keys to a positive outcome (1–3).