Title: The endodontic management of a dilated odontoma: A case report
Abstract:
Aim: To outline the endodontic management of a dilated odontoma with an orthograde and retrograde approach, utilising CBCT imaging and 3D-printed models to aid in the treatment planning process.
Summary: This case describes the management of a 15-year-old female patient that was referred to tertiary services regarding an ectopic canine. On initial examination the patient presented with an asymptomatic dilated odontoma of the maxillary right lateral incisor with a large apical radiolucency and associated sinus tract. The patient presented with a class II division II incisal relationship on a skeletal II base with reduced vertical proportions complicated by a multitude of factors including a dilated odontoma which appeared anatomically complex to negotiate, a palatally ectopic maxillary right canine and an increased overbite in addition to her expectations of an aesthetic outcome. Orthograde endodontic treatment was initiated on the dilated odontoma, however following several inter-appointment dressings there was no resolution of the sinus tract. A CBCT confirmed a complex root canal system whereby the invagination did not communicate with the main canal. This led to the decision to carry out retrograde endodontic treatment in combination with the extraction of the ectopic canine under general anaesthesia. A consideration for the long-term prognosis of the endodontic treatment was required given the patient’s age, which would allow for subsequent treatment options in the future. Following a three-month review there was clinical and radiographic evidence of healing including resolution of the sinus tract, reduction in the size of the periapical lesion and osseous infiltration. The management of this dilated odontoma case highlights the importance of a multi-disciplinary approach to treatment planning alongside thorough clinical and radiographic investigations. A digital workflow using CBCT imaging to fabricate a 3D printed study model of the tooth aided in the preparation for the procedure. This aspect of treatment planning shows how the combination of traditional and modern approaches can achieve reliable results while maintaining tooth structure and achieving positive treatment outcomes.
Key learning points:
• Explanation of the classifications of dens invaginatus (Oehlers' classification) and their associated clinical and radiographic findings.
• Understand the challenges in treatment using a case report of the treatment of a dilated odontoma.
• Consideration of the use of CBCT and 3D printed plastic models as a key diagnostic tool in aiding in the treatment planning of the management of dilated odontomas and dens invaginatus.
• Understand the importance of how anatomy can influence decisions on the need for both orthograde and retrograde endodontic procedures.
• Consideration of the prognosis of endodontic treatment of these teeth, and the need for a multi-disciplinary approach to consider alternative treatment options.
