Iranian Endodontic Journal

Abstract

Dens invaginatus (DI) is a developmental dental anomaly characterized by the invagination of the enamel organ into the dental papilla during tooth development, often resulting in complex root canal anatomy and increased susceptibility to pulpal disease. Gemination is another uncommon developmental anomaly resulting from the incomplete division of a single tooth germ, which produces an enlarged or bifid crown. The simultaneous occurrence of these anomalies in a single tooth is extremely rare. This case report describes the diagnosis and nonsurgical endodontic management of a maxillary lateral incisor presenting with both gemination and Oehlers type II dens invaginatus. A 14-year-old female patient was referred for further endodontic management of the maxillary left lateral incisor. Normal apical tissues were diagnosed, and the referring practitioner previously initiated endodontic therapy. Clinical examination revealed a bifid crown morphology, while cone-beam computed tomography (CBCT) demonstrated type II dens invaginatus associated with gemination and a complex root canal system with apical bifurcation. Root canal treatment was performed under dental operating microscope magnification using nickel-titanium rotary instrumentation, passive ultrasonic irrigation, and calcium hydroxide intracanal medication. The root canal system was subsequently obturated using gutta-percha and AH-Plus sealer by the cold lateral compaction technique. At the 12-month follow-up, the tooth remained asymptomatic and exhibited normal clinical and radiographic findings. This case highlights the importance of CBCT and magnification-assisted endodontic treatment in the successful management of rare developmental anomalies with complex internal anatomy.