Dens Invajinatus: Tanı, Sınıflama ve Güncel Tedavi Yaklaşımları
Özet
Bu bölümde, mine organının dental papilla içine invajinasyonu ile karakterize gelişimsel bir dental anomali olan dens invajinatus kapsamlı şekilde ele alınmaktadır. Anomalinin etiyolojisi, prevalansı ve klinik önemi açıklanmış; çürük olmaksızın erken pulpal ve periapikal patoloji gelişimine yatkınlığı vurgulanmıştır. Tanı ve tedavi planlamasında yaygın olarak kullanılan Oehlers sınıflaması detaylandırılmıştır. Tanı sürecinde konvansiyonel radyografiler ve konik ışınlı bilgisayarlı tomografinin kompleks kanal morfolojisinin değerlendirilmesindeki rolü öne çıkarılmıştır. Güncel tedavi yaklaşımları, invajinasyon tipine göre koruyucu restoratif işlemlerden ileri endodontik ve cerrahi girişimlere kadar geniş bir yelpazede sunulmuştur. Dental mikroskop, ultrasonik sistemler, gelişmiş irrigasyon protokolleri ve biyoseramik materyallerin tedavi başarısına katkısı vurgulanmıştır. Erken tanı, doğru sınıflama ve bireyselleştirilmiş tedavi planlamasının uzun dönem başarı için kritik olduğu belirtilmiştir.
This chapter provides a comprehensive overview of dens invaginatus, a developmental dental anomaly characterized by the invagination of the enamel organ into the dental papilla, resulting in an enamel-lined cavity within the tooth. It discusses the etiology, prevalence, and clinical significance of the condition, emphasizing its predisposition to early pulpal and periapical pathology even in the absence of caries. The widely used Oehlers classification system is presented to guide diagnosis and treatment planning. Diagnostic approaches, including conventional radiography and cone-beam computed tomography, are highlighted for their role in evaluating complex internal morphology. Contemporary treatment strategies are reviewed according to invagination type, ranging from preventive restorative procedures in superficial cases to complex endodontic and surgical interventions in advanced forms. The importance of magnification, ultrasonic devices, advanced irrigation protocols, and bioceramic materials in improving treatment outcomes is emphasized. The chapter underlines that early diagnosis, accurate classification, and individualized treatment planning are critical for achieving favorable long-term outcomes.
Referanslar
Hülsmann M. Dens invaginatus:aetiology, classification, prevalence, diagnosis, and treatment considerations. Int Endod J. 1997;30:79–90.
Chen YHM, Tseng CC, Harn WM. Dens invaginatus. Oral Surgery, Oral Med, Oral Pathol, Oral Radiol, and Endod. 1998;86:347–52.
Oehlers FAC. Dens invaginatus (dilated composite odontome). Oral Surg, Oral Med, Oral Pathol. 1957;10:1204–18.
Stefen H, Splieth C. Conventional Treatment of Dens Invaginatus in Maxillary Lateral Incisor with Sinus Tract: One Year Follow-Up. J Endod. 2005;31:130–3.
Afkar M, Gholamshahi M, Mohammadi M. Nonsurgical Treatment of Type II Dens Invaginatus in a Maxillary Lateral Incisor Using Cone-Beam Computed Tomography. Iran Endod J. 2018;13:132–4.
Plotino G, Pameijer C, Mariagrande N, Somma F. Ultrasonics in Endodontics: A Review of the Literature. J Endod. 2007;33:81–95.
Del Fabbro M, Taschieri S, Lodi G, Banfi G, Weinstein RL. Magnification devices for endodontic therapy. Cochrane Database of Syst Rev. 2015;12:CD005969.
Kirzioğlu Z, Ceyhan D. The prevalence of anterior teeth with dens invaginatus in the western mediterranean region of Turkey. Int Endod J. 2009;42:727–34.
Gallacher A, Ali R, Bhakta S. Dens invaginatus: diagnosis and management strategies. Br Dent J. 2016;221:383–7.
Baruwa AO, Anderson C, Monroe A, Cracel Nogueira F, Corte-Real L, Martins JNR. Dens Invaginatus: A Comprehensive Review of Classification and Clinical Approaches. Medicina (B Aires). 2025;61:1281.
Alani A, Bishop K. Dens invaginatus. Part 1: classification, prevalence and aetiology. Int Endod J. 2008;41:1123–36.
Bishop K, Alani A. Dens invaginatus. Part 2: clinical, radiographic features and management options. Int Endod J. 2008;41:1137–54.
Cohenca N, Berg J. Diagnosis and conservative treatment of dens invaginatus type III using cone beam computed tomography: two case reports. Pediatr Dent. 2013;35:E33-7.
Uzun İ, Keskin C, Güler B, Özdemir Ö. Management of Dens Invaginatus Type II Wıth Perıapıcal Lesıon: Case Report. Eur Oral Res. 2015;49:51–4.
Sachdeva GS, Sachdeva LT, Goel M, Bala S. Regenerative endodontic treatment of an immature tooth with a necrotic pulp and apical periodontitis using platelet‐rich plasma (PRP) and mineral trioxide aggregate (MTA): a case report. Int Endod J. 2015;48:902–10.
Zaatari WA, Tarakji M, Ayoubi HR. A Non-Surgical Endodontic Treatment for a Dens in Dente Type II in a Maxillary Lateral Incisor with Chronic Apical Periodontitis: A Case Report. Front Dent. 2025;22:25.
Vier‐Pelisser F V., Pelisser A, Recuero LC, Só MVR, Borba MG, Figueiredo JAP. Use of cone beam computed tomography in the diagnosis, planning and follow up of a type III dens invaginatus case. Int Endod J. 2012;45:198–208.
Naqibeiranvand M, Nasrabadi N, Jahanshahi N. Minimally Invasive Management of Two Separated Dens Invaginatus Oehler’s Type I and II: A Case Report. Iran Endod J. 2025;20:e38.
Candeiro GT de M, de Menezes AST, de Oliveira ACS, Alves FRF. Successful nonsurgical treatment of type II dens invaginatus with 5 root canals using a self-adjusting file: a case report. Restor Dent Endod. 2023;48:e17.
Fujii R, Asai T, Yamada M, Sako R, Tamiya Y, Furusawa M. Root Canal Treatment of Oehlers Type III Dens Invaginatus in Maxillary Lateral Incisor and Remote Sinus Tract Using Dental Surgical Microscope and Cone-Beam Computed Tomography. Bull Tokyo Dent Coll. 2023;64:2022–0032.
Kfir A, Telishevsky‐Strauss Y, Leitner A, Metzger Z. The diagnosis and conservative treatment of a complex type 3 dens invaginatus using cone beam computed tomography (CBCT) and 3D plastic models. Int Endod J. 2013;46:275–88.
Diogenes A, Ruparel NB. Regenerative Endodontic Procedures. Dent Clin North Am. 2017;61:111–25.
Ahmad S, Alam S, Andrabi SMUN, Kumar A. Combined surgical and conservative endodontic management of Oehler’s type 3b dens invaginatus aided by guided tissue regeneration. BMJ Case Rep. 2023;16:e255546.
Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K. Cone beam computed tomography in Endodontics - a review. Int Endod J. 2015;48:3-15.
Van Der Sluis LWM, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007;40:415–26.
De Moor RJG, Meire M, Goharkhay K, Moritz A, Vanobbergen J. Efficacy of Ultrasonic versus Laser-activated Irrigation to Remove Artificially Placed Dentin Debris Plugs. J Endod. 2010;36:1580–3.
Kaya-Büyükbayram I, Özalp Ş, Aytugar E, Aydemir S. Regenerative Endodontic Treatment of an Infected Immature Dens Invaginatus with the Aid of Cone-Beam Computed Tomography. Case Rep Dent. 2014;2014:1–5.
Referanslar
Hülsmann M. Dens invaginatus:aetiology, classification, prevalence, diagnosis, and treatment considerations. Int Endod J. 1997;30:79–90.
Chen YHM, Tseng CC, Harn WM. Dens invaginatus. Oral Surgery, Oral Med, Oral Pathol, Oral Radiol, and Endod. 1998;86:347–52.
Oehlers FAC. Dens invaginatus (dilated composite odontome). Oral Surg, Oral Med, Oral Pathol. 1957;10:1204–18.
Stefen H, Splieth C. Conventional Treatment of Dens Invaginatus in Maxillary Lateral Incisor with Sinus Tract: One Year Follow-Up. J Endod. 2005;31:130–3.
Afkar M, Gholamshahi M, Mohammadi M. Nonsurgical Treatment of Type II Dens Invaginatus in a Maxillary Lateral Incisor Using Cone-Beam Computed Tomography. Iran Endod J. 2018;13:132–4.
Plotino G, Pameijer C, Mariagrande N, Somma F. Ultrasonics in Endodontics: A Review of the Literature. J Endod. 2007;33:81–95.
Del Fabbro M, Taschieri S, Lodi G, Banfi G, Weinstein RL. Magnification devices for endodontic therapy. Cochrane Database of Syst Rev. 2015;12:CD005969.
Kirzioğlu Z, Ceyhan D. The prevalence of anterior teeth with dens invaginatus in the western mediterranean region of Turkey. Int Endod J. 2009;42:727–34.
Gallacher A, Ali R, Bhakta S. Dens invaginatus: diagnosis and management strategies. Br Dent J. 2016;221:383–7.
Baruwa AO, Anderson C, Monroe A, Cracel Nogueira F, Corte-Real L, Martins JNR. Dens Invaginatus: A Comprehensive Review of Classification and Clinical Approaches. Medicina (B Aires). 2025;61:1281.
Alani A, Bishop K. Dens invaginatus. Part 1: classification, prevalence and aetiology. Int Endod J. 2008;41:1123–36.
Bishop K, Alani A. Dens invaginatus. Part 2: clinical, radiographic features and management options. Int Endod J. 2008;41:1137–54.
Cohenca N, Berg J. Diagnosis and conservative treatment of dens invaginatus type III using cone beam computed tomography: two case reports. Pediatr Dent. 2013;35:E33-7.
Uzun İ, Keskin C, Güler B, Özdemir Ö. Management of Dens Invaginatus Type II Wıth Perıapıcal Lesıon: Case Report. Eur Oral Res. 2015;49:51–4.
Sachdeva GS, Sachdeva LT, Goel M, Bala S. Regenerative endodontic treatment of an immature tooth with a necrotic pulp and apical periodontitis using platelet‐rich plasma (PRP) and mineral trioxide aggregate (MTA): a case report. Int Endod J. 2015;48:902–10.
Zaatari WA, Tarakji M, Ayoubi HR. A Non-Surgical Endodontic Treatment for a Dens in Dente Type II in a Maxillary Lateral Incisor with Chronic Apical Periodontitis: A Case Report. Front Dent. 2025;22:25.
Vier‐Pelisser F V., Pelisser A, Recuero LC, Só MVR, Borba MG, Figueiredo JAP. Use of cone beam computed tomography in the diagnosis, planning and follow up of a type III dens invaginatus case. Int Endod J. 2012;45:198–208.
Naqibeiranvand M, Nasrabadi N, Jahanshahi N. Minimally Invasive Management of Two Separated Dens Invaginatus Oehler’s Type I and II: A Case Report. Iran Endod J. 2025;20:e38.
Candeiro GT de M, de Menezes AST, de Oliveira ACS, Alves FRF. Successful nonsurgical treatment of type II dens invaginatus with 5 root canals using a self-adjusting file: a case report. Restor Dent Endod. 2023;48:e17.
Fujii R, Asai T, Yamada M, Sako R, Tamiya Y, Furusawa M. Root Canal Treatment of Oehlers Type III Dens Invaginatus in Maxillary Lateral Incisor and Remote Sinus Tract Using Dental Surgical Microscope and Cone-Beam Computed Tomography. Bull Tokyo Dent Coll. 2023;64:2022–0032.
Kfir A, Telishevsky‐Strauss Y, Leitner A, Metzger Z. The diagnosis and conservative treatment of a complex type 3 dens invaginatus using cone beam computed tomography (CBCT) and 3D plastic models. Int Endod J. 2013;46:275–88.
Diogenes A, Ruparel NB. Regenerative Endodontic Procedures. Dent Clin North Am. 2017;61:111–25.
Ahmad S, Alam S, Andrabi SMUN, Kumar A. Combined surgical and conservative endodontic management of Oehler’s type 3b dens invaginatus aided by guided tissue regeneration. BMJ Case Rep. 2023;16:e255546.
Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K. Cone beam computed tomography in Endodontics - a review. Int Endod J. 2015;48:3-15.
Van Der Sluis LWM, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007;40:415–26.
De Moor RJG, Meire M, Goharkhay K, Moritz A, Vanobbergen J. Efficacy of Ultrasonic versus Laser-activated Irrigation to Remove Artificially Placed Dentin Debris Plugs. J Endod. 2010;36:1580–3.
Kaya-Büyükbayram I, Özalp Ş, Aytugar E, Aydemir S. Regenerative Endodontic Treatment of an Infected Immature Dens Invaginatus with the Aid of Cone-Beam Computed Tomography. Case Rep Dent. 2014;2014:1–5.
