case_images: PMC11287048_01
case_images: A) Initial periapical radiograph of tooth #12 showing the presence of Oehlers type II dens invaginatus, in addition to a radiolucent area in the periapical region; B) Coronal CBCT section of tooth #12 showing the anatomy of the dens invaginatus, presence of calcification in the cervical third of the main canal, and a hypodense area in the periapical region; C) Sagittal section of the dens invaginatus canal; D) Sagittal section of the main canal; E) Axial section showing the two canals (left: flattened main canal; right: dens invaginatus canal); F) Axial section showing an extensive periapical lesion; G) Panoramic view of the upper arch showing the presence of the unilateral dens invaginatus
case_images: IEJ-19-232-g001.jpg
case_images: PMC11287048_01_IEJ-19-232-g001.jpg
case_images: F1
case_images: Periapical radiography and CBCT (Figures 1) showed a unilateral DI (Figure 1G) in the right maxillary lateral incisor, with the invagination extending beyond the cementoenamel junction, and making no contact with the periapical tissues, consistent with Oehlers type II DI. A periapical hypodense image associated with the affected tooth was also identified (Figure 1). A hyperdense image was detected in the cervical third root, suggesting the presence of pulpal calcification (Figure 1A and 1B). C-shaped flattening was observed in the mesiodistal direction (Figure 1E) and a broad blunderbuss-shaped foramen was found in apical third of the root (Figure 1B). The DI canal was characterized by great anatomic variability (Figure 1B and 1C).
case_images: A) Periapical radiograph after removal of the calcification in the cervical third of the main canal and confirmation of the working length; B) Radiograph of the quality of the intracanal medication (calcium hydroxide); C) Final radiograph of endodontic treatment of tooth #12; D) Radiograph obtained after two years of follow-up showing complete repair of the periapical lesion
case_images: IEJ-19-232-g002.jpg
case_images: PMC11287048_01_IEJ-19-232-g002.jpg
case_images: F2
case_images: The working length was established with an electronic apex locator (Finepex-Schuster, Santa Maria, RS, Brazil) and confirmed by periapical radiography (Figure 2A).  The medication was left inside the root canal system for 30 days (Figure 2B). The tooth was then restored with composite resin (Filtek Z250 XT, 3M, Sumare, Sao Paulo, Brazil) (Figure 2C).
case_images: A) Sagittal CBCT section of tooth #12; B) Coronal; C) Axial CBCT sections showing complete repair of the periapical lesion and bone neoformation
case_images: IEJ-19-232-g003.jpg
case_images: PMC11287048_01_IEJ-19-232-g003.jpg
case_images: F3