Abstract：
Dens invaginatus is a developmental dental anomaly that can predispose the tooth to pulp and periradicular disease. Management of this condition can be challenging because of anatomic and microbiologic issues. This case report describes the regenerative endodontic treatment using a strategic antimicrobial protocol for management of an immature maxillary lateral incisor with type-II dens invaginatus associated with apical periodontitis in a 13-year-old patient. The tooth presented with a complex anatomy and was associated with an active sinus tract. Because the true root canal was not negotiable in its coronal part due to the presence of the dens invaginatus, the closed end of the invagination (pseudocanal) was perforated to permit access to the apical segment of the true root canal for cleaning and disinfection. Both the invagination and the true canal were treated using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation, supplementary disinfection with passive ultrasonic irrigation and interappointment calcium hydroxide medication. After 2 exchanges of calcium hydroxide medication, the sinus tract did not disappear, then the antimicrobial protocol was changed to include an antibiotic solution for irrigation and antibiotic paste for intracanal medication. After signs and symptoms disappeared, regenerative endodontic treatment was performed by inducing blood clot formation within the root canal. The coronal canal segment including the invagination was filled with Biodentine. Follow-up including cone-beam computed tomography examination showed complete healing of the apical periodontitis lesion and mineralized tissue formation at the apical portion of the true root canal.
摘要：
Densinvaginatus是一种发育性牙齿异常，可使牙齿易患牙髓和神经根周疾病。由于解剖和微生物问题，这种情况的管理可能具有挑战性。该病例报告描述了再生牙髓治疗（REP），该治疗使用了战略性抗菌方案，用于治疗未成熟的上颌侧切牙，其中II型牙窝与根尖牙周炎相关。牙齿具有复杂的解剖结构，并与活跃的窦道相关。因为真正的根管在它的冠状部分是不可协商的，由于牙根的存在，内陷（假肛门）的封闭端穿孔，以允许进入真根管的根尖段进行清洁和消毒。内陷和真管均使用基于化学机械制备的次氯酸钠冲洗的抗菌方案进行治疗，被动超声冲洗和间歇氢氧化钙药物辅助消毒。两次交换氢氧化钙药物后，窦道没有消失,然后将抗菌方案改为包括用于冲洗的抗生素溶液和用于肛门内药物治疗的抗生素糊剂.症状和体征消失后，通过诱导根管内的血凝块形成来进行REP。包括内陷的冠状管段充满了Biodentine。包括锥形束计算机断层扫描检查在内的随访显示，根尖牙周炎病变完全愈合，并在真根管的根尖部分形成矿化组织。
