09/27/2025
High Dens-ITY! When it rains it pours...
Lateral incisors can have a rare anomaly and this was a combination of several- Dens Invaginatus and an Extra cusp (talon cusp)
Dens invaginatus (DI) is a developmental defect where the enamel and dentin fold inward, creating a deep invagination lined by enamel, often connecting to a deep lingual pit, making it a “microbial harbor” highly susceptible to caries and early pulpal necrosis, even before root formation is complete
Talon Cusp (TC) - an extra cusp-like structure on the lingual/palatal surface) contains enamel, dentin, and frequently a pulp horn, making it vulnerable to wear, fracture, and subsequent pulp exposure.
The main canal can get invaded by bacteria trolling within the finer niches of these invaginations.
An ounce of prevention - can prevent the need for root canal treatment.
• Prophylactic Sealing: For asymptomatic teeth, the priority is preventive resin restoration to seal any deep pits or grooves associated with the DI and TC to prevent caries infiltration.
• Talon Cusp Management: If the TC causes occlusal interference or tongue irritation, slow, selective enameloplasty over multiple appointments is favored to allow for reparative dentin formation and avoid iatrogenic pulp exposure.
• Earlier intervention and if necessary + sealing the areas in close proximity to the pulp with bioceramic materials.
• Endodontic intervention might be necessary necrotic or irreversibly inflamed teeth. The complex anatomy requires special consideration.
Case attached -tooth #7 tested wnl to pulp sensibility testing, tooth #7 did appear to have an occlusal interference as well.
Fire On!
Stay calm and practice ZENdo!
