Dens invaginatus: diagnostic and therapeutic challenges of a rare developmental dental anomaly

Abstract

Dens invaginatus (DI) is a rare developmental dental anomaly resulting from the invagination of the enamel organ into the dental papilla during odontogenesis. This condition leads to a broad spectrum of morphological variations, with maxillary lateral incisors being the most frequently affected. The resulting deep pits or invaginations often communicate with the oral cavity, creating ideal environments for bacterial retention. This anatomical irregularity predisposes affected teeth to early onset dental caries, pulpitis, and, if untreated, progression to periapical pathology and soft tissue necrosis. Radiographically, dens invaginatus typically appears as a radiolucent tract surrounded by radiopaque enamel, limited to the crown or extending into the root. The complexity of the internal anatomy poses significant diagnostic and therapeutic challenges, particularly in endodontic management. Management strategies vary depending on the type and severity of the anomaly, ranging from preventive sealing to advanced endodontic procedures such as nonsurgical root canal therapy (NS-RCT), apexification, regenerative endodontic procedures (REPs), surgical root canal treament (S-RCT), or intentional replantation. Regardless of the classification, the invaginated tract should always be addressed, and NS-RCT is indicated when irreversible pulpitis or necrosis is present. This review explores the etiopathogenesis, classification, histopathology, diagnostic approaches, and evidence-based treatment modalities for DI, emphasizing the importance of early diagnosis and tailored management strategies to preserve teeth that were once considered non-restorable.