Year : 2008 | Volume
: 12 | Issue : 2 | Page : 88--89
Dens in dente of maxillary third molar
Arun Subramaniam1, Smita Kamtane1, Rajiv Desai2, Gauri Thakre2,
1 Department of Oral Medicine and Radiology, Dr. D. Y. Patil Dental College and Hospital, Pune, India
2 Department of Oral Pathology, Dr. D. Y. Patil Dental College and Hospital, Pune, India
Flat 502, Pancharatna Towers, S. No. 38/1, Near Mantri Park, Kothrud, Pune - 411 029
«SQ»Dens in dente,«SQ» also known as dens invaginatus, is a developmental anomaly resulting from deepening or invagination of the enamel organ into the dental papilla, which begins at the crown and often extends to the root before calcification of the dental tissues. Dens in dente commonly occur in the maxillary lateral incisor. This article reports a case of dens in dente in the maxillary third molar.
|How to cite this article:|
Subramaniam A, Kamtane S, Desai R, Thakre G. Dens in dente of maxillary third molar.J Oral Maxillofac Pathol 2008;12:88-89
|How to cite this URL:|
Subramaniam A, Kamtane S, Desai R, Thakre G. Dens in dente of maxillary third molar. J Oral Maxillofac Pathol [serial online] 2008 [cited 2021 May 7 ];12:88-89
Available from: https://www.jomfp.in/text.asp?2008/12/2/88/44617
A 65-year-old apparently healthy man was referred to the Department of Oral Medicine and Radiology, Dr. D. Y. Patil Dental College and Hospital, Pune, with a request for replacement of extracted teeth with complete dentures. Clinical examination revealed edentulous ridges; only the cusp of the upper left third molar was seen [Figure 1]. The patient had no history of pain or swelling. Intraoral radiographs and orthopantomograph revealed the crown of upper left third molar with a bulbous root and cusp-like structures in between, surrounded by a radiolucent halo [Figure 2]. The provisional diagnosis of compound odontoma was made. The tooth was extracted under local anesthesia. The specimen [Figure 3] was sent for histopathologic examination. Ground section showed the enamel-lined invagination leading to fissure of the second crown [Figure 4]. The final diagnosis of dens in dente was made.
Only a relatively small number of invaginated posterior teeth have been reported in the literature, which can be taken as a good indication of the rarity with which they occur. De Smit and Demaut made the first observation of dens in dente, which dates back to 1856.  This anomaly is also known as dens invaginatus, dilated odontoma, and gestant anomaly. 
Hovland calculated the incidence of dens in dente to be 0.04% to 10.00%, with very few cases reported in the third molar.  Cases of bilateral occurrence have been reported.  Oehlers  classified dens in dente into three types, depending upon depth of invagination:
Type I: The invagination ends in a blind sac, limited to the dental crown.
Type II: The invagination extends to the amelocemental junction, also ending in a blind sac.
Type III: The invagination extends to the interior of the root, providing an opening to the periodontium, sometimes presenting another foramen in the apical region of the tooth.
The present case is an example of Oehlers' type III dens in dente.
Dens in dente are also classified into coronal and radicular variety. According to this classification, a case of radicular variety is reported. In radicular variety, two distinct types are present. The first type is presented as an infolding of a wall of the root, and it indicates an incomplete attempt at root bifurcation.  The second type is regarded as a true form of 'dens invaginatus.' It is extremely rare and is represented as an enamel-lined invagination within the root, originating at an opening on the root itself. The present case describes the second type of radicular variety of dens in dente.
Different treatment modalities have been advocated, ranging from root canal treatment to extraction.  In the present case, extraction was the treatment of choice as the patient was edentulous and wanted a denture.
|1||De Smit A, Demaut L. Nonsurgical endodontic treatment of Invaginatus teeth. J Endodont 1982;8:506-11.|
|2||Wanderly C. Upper molar dens in dente. Braz Dent J 1990;1:45-9.|
|3||Hovland EJ. Non recognition and subsequent endodontic treatment of dens invaginatus. J Endodont 1977;3:360. |
|4||Swanson WF, Walker WA. Bilateral dens in dente. J Dent Res 1947;26:167-71.|
|5||Ohlers FA. Dens invaginatus: Variation of the invagination process and associated anterior crown forms. Oral Surg 1957;10:1204-18. |
|6||Oehlers FA. Dens invaginatus: Variation of the invagination process and associated posterior crown forms. Oral Surg 1957;10:1302-16. |
|7||Kulild JC, Weller N. Treatment considerations in dens invaginatus. J Endodont 1989;15:381-4.|