Severe dens invaginatus in the maxillary central incisor

Dens invaginatus is a developmental anomaly that results in an enamel-lined cavity intruding into the crown or root before the mineralization phase. The cause of dens invaginatus is still unknown and controversial. Some hypotheses suggested by authors are: local external forces, apical proliferation of ameloblast or local retardation, arresting of development and focal developmental stimuli. The anomaly occurs most frequently in the lateral incisors, although occasionally the maxillary central incisors, maxillary cuspids, mandibular incisors and mandibular premolars may be affected. Treatment ranges from conservative procedures to non-surgical root canal treatment, surgical root canal treatment or extraction followed by intentional replantation. A 14-years-old female patient was referred for the treatment of infected maxillary left central incisor. After clinical and radiographic examination, type 3 dens invaginatus was diagnosed. The result of combined surgical and endodontic treatment was clinically satisfactory. After a 3-year follow-up period, there was no sign of inflammation and pathosis.