Microscopic removal of dens invaginatus.

Endodontic treatment for teeth that exhibit the dental anomaly, dens invaginatus, can be difficult due to the bizarre anatomy and relative inaccessibility of the diseased pulp tissue. Surgical intervention or extraction are common approaches to dealing with this condition. This article reports the treatment of an extreme form of dens invaginatus, employing the dental-operating microscope and the ultrasonic instrument. Removal of the entire anomalous structure and pulp tissue was possible, and conventional orthograde obturation was accomplished. Two and 4-yr follow-up radiographs show that healing has occurred. The article demonstrates that the anomalous structure of dens invaginatus is a separate entity from the rest of the tooth. This implies that in many instances it may be entirely removed to facilitate conventional endodontic therapy.