Dens invaginatus is also known as dens in dente. This condition appears when the enamel epithelium invaginates into the dental papilla. This leads to the invagination in the tooth crown. Sometimes this invagination can extend in the root of the tooth. On the x-rays this abnormality can be seen as a enamel line in the crown or the root of the tooth. Other names for dens in dente are gestant composite odontome and dilated composite odontome (they are rarely used).
The most commonly affected tooth is the maxillary lateral incisor. Clinically the dentist can spot a lateral incisor with a deep cingulum pit on the palatal side of the tooth. In the extreme version of dens in dente the tooth root and crown may have abnormal shape. For example it can be spotted as a tuberculate tooth with invaginations on the cusp of the tooth. The pulp is displaced and the enamel line is very thin surrounding the pulp. In some cases the enamel line is even missing. This invagination can change the shape of the root. It is easy to differentiate dense in dente if you have taken x-rays of the abnormal tooth.
Dens in dente frequency
Dense in dente is more common in males than in females. This ratio varies in different groups but we can summarize it to 2:1. Dens invaginatus differs in racial groups – the Chinese ethnicity is more commonly affected.
The presence of one invaginated tooth is a reason for the dentist to take a look at the other surrounding teeth with the idea of having additional abnormalities. Dens in dente can cause dental caries due to its abnormal shape (which is the reason for more plaque retention) and poor mineralization.
Dens in dente can be spotted in a single tooth but very often there is an abnormality in the contralateral and adjacent teeth. An experienced dentist should take this fact under consideration. At the x-rays he can spot a incomplete root formation and periapical artefacts. When a dens in dente is diagnosed it is very common for the patient to have supernumerary teeth as well. Some of the supernumerary teeth have abnormal shape (conical, tuberculate e.t.c.) but that doesn’t mean that they are invaginated teeth.
Treatment of dens in dente
If a dens invaginatus is diagnosed at an early stage it can be covered with sealant in order to protect the deep fissures. They are a retention factor for plaque and cariogenic bacteria. Antibiotic therapy has to be prescribed if a cellulitis is at present. Other inflammatory conditions call for drainage and incision (i.e abscess). If there is a periapical changes an endodontic treatment should be executed. If the tooth apex is not formed yet the endodontic treatment should be executed after the apex fixation (using calcium hydroxide root filling materials).