Clinical Guideline for Diagnosis and Treatment of Dens Invaginatus


Dens Invaginatus


How to Cite

ACHABI N, Chhoul H, Ramdi H. Clinical Guideline for Diagnosis and Treatment of Dens Invaginatus. Integr J Med Sci [Internet]. 2021 Apr. 22 [cited 2024 Jun. 15];8. Available from:


The invaginated tooth, also called dens invaginatus or dens in dente, is a rare anomaly affecting human dentition, resulting from invagination of enamel organ into the dental papilla.
Maxillary lateral incisors are the most commonly affected teeth. The accentuated pit within the DI accumulates debris causing prompt initiation and progression of dental caries with subsequent involvement of the pulp, resulting in periapical pathology. Invagination depth varies from a slight enlargement of the cingulum to an extended invagination into the apex. This anatomic variation means a true clinical challenge because of its complex anatomy. Early diagnosis is then essential to avoid any periodontal complications.
This study aims to review: etiopathogenics, classification, elements of the diagnosis and provides guidelines for the management of dens invaginatus cases in clinic that provide hope for teeth that could not be saved before.


Thomas J, Stéphane S. Cas clinique : stratégie thérapeutique d’une dens in dente. Roots 2015;3 :14.

Baumagart M, Hanni S, Suter B, Schaffner M, Lussi A. Dent invaginée (dens invaginatus). Schweiz Monatsschr Zahnmed. 2009;119(7):706-714. [Accessed 2021 Feb 02]. Available from:

Lejri W, Kallel I, Marwen O, Douki N. Diagnostic and therapeutic approach in dens in dente. Endodontology 2016;28:192-8.

Zhu J, Wang X, Fang Y, Von den Hoff JW, Meng L. An update on the diagnosis and treatment of dens invaginatus. Aust Dent J. 2017 Sep;62(3):261-275.

Thakur Narbir S, Hakur Seema. Dens Invaginatus (Tooth Within Tooth). A Review Of The Literature And Diagnostic And Management Guidelines For Practicing Dentists. Ind J Dent Sci. 2012 ; 4(3) : 111-116.

Gallacher A, Ali R, Bhakta S. Dens invaginatus: diagnosis and management strategies. Br Dent J. 2016 Oct 7;221(7):383-387.

Tebbeb N, Zaabar D, Zouiten S, Boughzala A. Dens invaginatus: A review and case series. Saudi Endod J. 2018;8:44-9.

Abduljabbar F, Aljehani M, Alghamdi A, Al Sharafi E, Abed H, Baksh A. Anatomical Modification for Dens Invaginatus Treatment: A Literature Review and a Case Report. J Intern Oral Health. 2015; 7(12):119-125. [Accessed 2021 Feb 02]. Available from:

Alenazy MS, Murwahi AE, Altwaijri SM,Mosadomi HA. Endodontic management of dens invaginatus of maxillarylateral incisor: Report of two cases. Saudi Endod J. 2017;7:194 8.

Alimadadi H, Hengameh A, Nasrabadi N. Dens Invaginatus with Palatal Expansion and Buccal Sinus Tract: A Case Report. Intern J Sci Res dent med sci. 2019;1:52–56.

Azoulay E, Bouton A, Pasquet G. Apport de l’imagerie tomographique volumique à faisceau conique (cone beam) dans le diagnostic et la prise en charge des dens invaginatus. Actualités Odonto-Stomatologiques. 2012; 257:49-55.

Kfir A, Flaisher Salem N, Natour L, Metzger Z, Sadan N, Elbahary S. Prevalence of dens invaginatus in young Israeli population and its association with clinical morphological features of maxillary incisors. Scientifc Reports. 2020 ; 10:17131.

Pastoriza A, Peña A, Sierra A, Boquete A, Granero JM. Manejo de un dens invaginatus: Revisión de la literatura. Revista Científica PgO 2020; 4:1-5. [Accessed 2021 Feb 02]. Available from:

Dembinskaite A, Veberiene R, Machiulskiene V. Successful treatment of dens invaginatus type 3 with infected invagination, vital pulp, and cystic lession: A case report. Clin Case Rep. 2018 Jun 25;6(8):1565-1570.

Rodekirchen H, Jung M, Ansari F. Dent invaginatus type 2: case repport with 2year radiographic follow-up. Oral Surg Oral Med Pathol Oral Radiol Endod. 2006;102(4): 121–125.

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Copyright (c) 2021 Achabi N et al.


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