Diagnosing dens invaginatus with Orthophos SL CBCT

Drs. Prashant P. Jaju and Sushma Jaju use Orthophos SL CBCT to view commonly overlooked clinical signs of dens invaginatus.

Drs. Prashant P. Jaju and Sushma P. Jaju diagnose and treat a difficult condition with the help of smaller volume CBCT

As a practice specialized in dental radiology, many dentists use our services. We were the first practice in India to use 3D imaging. With the introduction of Dentsply Sirona’s Orthophos SL CBCT, complicated cases are diagnosed and treated efficiently and more successfully with the help of a smaller volume specific for endodontic purposes. Indeed, cone beam computed tomography is a boon for endodontists across the globe. In this article, we are presenting a difficult endodontic case in which an Orthophos SL CBCT 5 x 5.5-volume aided in identifying dens invaginatus and its subsequent treatment planning.

A 24-year-old male patient had swelling in the upper right canine region. An intraoral periapical radiograph showed variation in pulpal floor anatomy, but the lack of a third dimension limited its utility. For further evaluation of tooth root canal anatomy, limiting volume CBCT was advised. Orthophos SL CBCT 5 x 5.5 High Definition (HD) volume at 80 microns showed variation in pulpal floor anatomy. CBCT images revealed invagination extending through the root and communicating laterally with the periodontal ligament space through a pseudo foramen without communicating with the main root canal space. A single major orifice was present surrounded by two radiolucent areas on mesial and distal sides extending approximately 4 mm within the root not associated with the main canal (Figure 1). A single, large, periapical radiolucency was present with the tooth resulting in thinning of labial cortical plates.

This was radiographically diagnosed as a case of dens invaginatus Type IIIA, resulting in chronic periapical abscess.1 With three-dimensional visualization of the root canal space anatomy variation, the endodontist was able to proceed with a new, improved treatment protocol resulting in successful root canal filling and restoration.

Dens invaginatus is a developmental anomaly resulting in a deepening or invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues. Although dens invaginatus is common, it may be easily overlooked because of the absence of any significant clinical signs of the anomaly.

Periapical radiographs are limited in revealing the type, extension, and complex morphology of dens invaginatus as well as the actual bone loss when compared to tomographic techniques. More advanced imaging techniques such as CBCT may aid the diagnosis as well as the management plan and follow-up of teeth with this developmental defect.2

Figure 1: Sagittal, cross-sectional, and axial images of upper right canine on Orthophos SL with a resolution of 80 µm

Read more about the versatility of Orthophos SL CBCT in our sister publication, Orthodontic Practice UShttps://orthopracticeus.com/industry-news/dentsply-sirona-imaging-enhances-versatility-orthophos-sl/

Prashant P. Jaju, BDS, MDS, is a gold medalist in Oral Medicine and Radiology from the reputed Pune University. He is currently serving as professor, head of the department, and guide in Rishiraj College of Dental Sciences and Research Centre, Bhopal, India. He is the director of CBCT imaging centers and also the director at Oral Imaging Solutions — a teleradiology company providing online reporting services. He is author of two books on CBCT, which have been appreciated worldwide. Dr. Jaju has published more than 20 research papers in international journals. He is the recipient of profile of the month and year awards by the Indian Dental association. He is certified CBCT trainer and trains dentists and specialists in CBCT imaging nationally and internationally.

Sushma P. Jaju, BDS, MDS, is a specialist in Conservative Dentistry and Endodontics from the reputed Dr. NTR University. She is currently serving as Associate Professor in Rishiraj College of Dental Sciences and Research Centre, Bhopal, India. She is the director of CBCT imaging centers and also the director at Oral Imaging Solutions — a teleradiology company providing online reporting services. She has contributed book chapters on the role of CBCT in endodontics, which have been appreciated worldwide, and has published numerous papers in international journals.

Disclosure: Dr. Prashant P. Jaju is a key opinion leader for Dentsply Sirona India for imaging since 2011.

  1. Alani A, Bishop K. Dens invaginatus. Part 1: Classification, prevalence and aetiology. Int Endod J. 2008;41(12): 1123-1136.
  2. Pradeep K, Charlie M, Kuttappa MA, Rao PK. Conservative management of Type III dens in dente using cone beam computed tomography. J Clin Imaging Sci. 2012;2(1): 51.


This article was previously published in the brochure “Orthophos SL – around the world,” 2019 by Dentsply Sirona.

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