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Dens invaginatus: a review and orthodontic implications


Dens invaginatus (DI) 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. Presence of DI is considered to increase the risk of caries and pulpal pathology, but they are often missed in the initial orthodontic assessment as they present with no clinical signs of an anomaly. In absence of adequate oral hygiene and maintenance, bacterial contamination of these malformations can lead to the development of early caries and consequent pulpal death. Early diagnosis of these lesions is critical as they can negatively impact any planned orthodontic treatment and assessment of the prognosis of these lesions is therefore necessary prior to the commencement of orthodontic treatment. In this article, we aim to illustrate the need for appropriate diagnosis and multidisciplinary approach in the management of DI in patients undergoing orthodontic treatment.

Key points

  • Dens invaginatus is often missed in the initial orthodontic assessment as it presents with no clinical signs.

  • Orthodontic patients should be routinely checked for dens invaginatus on upper lateral incisors prior to commencement of treatment.

  • Early diagnosis and conservative management of dens invaginatus could avoid mid-treatment complications, delay in orthodontic treatment and facilitate better prognosis.

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Correspondence to Badri Thiruvenkatachari.

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Chaturvedula, B., Muthukrishnan, A., Bhuvaraghan, A. et al. Dens invaginatus: a review and orthodontic implications. Br Dent J 230, 345–350 (2021).

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