1 The defects may vary in size and shape from a loop like, pear-shaped or slightly radiolucent structure to a severe form resembling a ��tooth within a tooth��.4 It can be identified easily because infolding of the enamel lining is more radiopaque than the surrounding tooth structure.1 Oehlers5 described dens in dente selleck according to invagination degree in three forms: Type 1: an enamel-lined minor form occurs within the crown of the tooth and not extending beyond the cemento-enamel junction; Type 2: an enamel-lined form which invades the root as a blind sac and may communicate with the dental pulp; Type 3: a severe form which extends through the root and opens in the apical region without communicating with the pulp. Double dens invaginatus is an extremely rare dental anomaly involving two enamel lined invaginations presented in the crowns or roots of a tooth.
This article reports three cases of double dens invaginatus in maxillary lateral incisors. CASE 1 A 20 year old woman reported to our clinic for orthodontic treatment. The patient was in good general health. Extraoral examination revealed no significant findings. Intraorally the gingiva was inflamed. The maxillary left lateral permanent incisor was found to have an abnormal crown form with restoration. On the palatal surface, lingual cingulum was joined to the labial cusp by a prominent transverse ridge resembling an extra cusp was present which divided the palatal surface into two fossae. Two palatal pits was located and had restored in each fossae.
On radiographic examination of the maxillary left lateral incisor, two dens invaginatus were presented originating from each palatal pit (Figure 1). The tooth had a single root, was vital, and no evidence of periapical infection was noted. Figure 1 Periapical radiograph showing a restorated maxillary left lateral incisor with double dens invaginatus. CASE 2 22 year old woman reported to our clinic for a routine dental treatment. The patient was in good general health. Extraoral examination revealed no significant findings. Intraoral examination, showed a deep anatomic pit on palatal surface of maxillary left lateral permanent incisor. In periapical radiograph two dens invaginatus were seen (Figure 2). The patient had no associated symptoms, and there were no radiographically visible lesions associated with the affected tooth.
The tooth appeared healthy and was vital. The patient was referred for restoration of the palatal pit to avoid possible infection. Figure 2 Periapical radiograph showing a maxillary left lateral incisor Dacomitinib with double dens invaginatus. CASE 3 A 35 year old woman reported to our clinic complaining of pain in the maxillary right central incisor. The patient was in good general health. Extraoral examination revealed no significant findings. In intraoral examination a maxillary right lateral incisor with an abnormal crown form was observed.