Three Years Follow-Up of Endodontic Microsurgical Combined with Orthograde Retreatment of Oehler’s Type III Dens Invaginatus: A Case Report

This report describes the management of an unusual case of dens invaginatus in a 48-year-old female patient. Cone beam computed tomography and pre-operative periapical radiograph showed the presence of type III dens invaginatus with inadequate obturation, poor apical seal, and presence of periapical lesion related to maxillary lateral incisor. The case was managed successfully by a combination of nonsurgical and microsurgical endodontic retreatment. Orthograde endodontic retreatment was performed using rotary files and calcium hydroxide paste as intracanal medication for one week, then the root canal was obturated using thermoplasticized gutta percha and adseal sealer. One week later, microsurgery was done. After 3 years follow up, absence of periapical radiolucency and satisfactory healing were observed. Microsurgical retrograde with orthograde retreatment of dens invaginatus preserve the entire tooth. It should be considered to promote periapical healing with complete reconstitution of bone and periodontal ligament regeneration without signs of recurrence over a period of 3 years.