Clinical management of a dens in dente type 3, with five canals and acute apical periodontitis in a maxillary lateral incisor


Submitted: 29 March 2022
Accepted: 26 May 2022
Published: 1 July 2022
Abstract Views: 1651
PDF: 187
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Authors

  • Octavio Amezcua University of Guadalajara, Health Sciences University Center, University of Guadalajara, Mexico.
  • Alvaro Cruz Endodontics Posgraduate Program, Health Sciences University Center, University of Guadalajara, Mexico.
  • Horacio Flores-Rivas University of Guadalajara, Health Sciences University Center, University of Guadalajara, Mexico.
  • Luis Gerardo Gascón University of Guadalajara, Health Sciences University Center, University of Guadalajara, Mexico.

Aim: This report describes the clinical management of a dens in dente type 3 in a maxillary lateral incisor with five canals and acute apical periodontitis in a ten years old child.

Summary: An upper lateral incisor presenting dens in dente type III necrotic pulp and acute apical periodontitis was treated. After antibiotic therapy, root canal treatment was initiated and five root canals were located, four converging to an apical pulp chamber. All canals were enlarged using hand files, irrigated with sodium hypochlorite ultrasonically activated. Calcium hydroxide was placed into the canals. The patient missed his next appointment. Eight months after, the canals were re-instrumented, and calcium hydroxide was placed again. Three weeks later the five canals were filled with gutta-percha and an epoxy resin sealer, using a warm technique. Four of the canals were interconnected. Dens in dente was restored with a metal cast post with three retainers and a full porcelain crown. After three years, the periapical lesion showed healing.

Key learning points:

  • Despite its very complex anatomy type III dens in dente can be successfully treated with conventional root canal treatment.
  • To achieve success in each particular case when root canal therapy is needed, the clinician should be aware of the diverse clinical techniques available. The use of magnification with clinical microscope, ultrasonic activated irrigation, use of intracanal medication, and warm filling technique are encouraged.
  • A restoration with a specific cast post, with three retainers, was used due to its particular root anatomy.

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Octavio Amezcua, University of Guadalajara, Health Sciences University Center, University of Guadalajara

Endodontics Postgraduate, Associate Professor

Alvaro Cruz, Endodontics Posgraduate Program, Health Sciences University Center, University of Guadalajara

Endodontics Postgraduate, Biomedical Sciences Research Institute

Horacio Flores-Rivas, University of Guadalajara, Health Sciences University Center, University of Guadalajara

Endodontics Postgraduate, Student

Luis Gerardo Gascón, University of Guadalajara, Health Sciences University Center, University of Guadalajara

Endodontics Postgraduate, Chairman

Supporting Agencies

Sub-Secretaría de Educación Superior, SEP, México, grant UDG-CA-657, IDCA 10087, Fortalecimiento de Cuerpos Académicos., PROINPEP 2022 Universidad de Guadalajara

Amezcua, O., Cruz, A., Flores-Rivas, H., & Gascón, L. G. (2022). Clinical management of a dens in dente type 3, with five canals and acute apical periodontitis in a maxillary lateral incisor . Giornale Italiano Di Endodonzia, 36(2). https://doi.org/10.32067/GIE.2021.36.02.03

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