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Combined surgical and conservative endodontic management of Oehler’s type 3b dens invaginatus aided by guided tissue regeneration
  1. Sarah Ahmad,
  2. Sharique Alam,
  3. Syed Mukhtar-Un-Nisar Andrabi and
  4. Ashok Kumar
  1. Conservative Dentistry and Endodontics, Dr Z.A Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, India
  1. Correspondence to Dr Sharique Alam; sharique2004{at}


The present case describes the successful healing of a periapical lesion associated with the left maxillary lateral incisor (# 22, Federation Dentaire Internationale) having a type 3b dens invaginatus tooth morphology. The treatment was complicated by the presence of blunderbuss root apex and large periapical lesion (>10 mm) with through and through bone defect (Bucco palatal cortical bone perforation, Von Arx Type 1b). An adolescent boy reported palatal swelling and pus discharge in relation to tooth #22. A thorough clinical and radiographic examination revealed tooth #22 as having a type 3b dens invaginatus with an open apex and a diagnosis of pulp necrosis and acute apical abscess. The case was managed by non-surgical root canal treatment followed by endodontic surgery using principles of guided tissue regeneration. A 5-year recall revealed an asymptomatic functional tooth with complete healing.

  • Dentistry and oral medicine
  • Pain

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SAlam: conceptualisation, conduct, methodology, writing. SAhmad: data curation, writing- original draft preparation. SM-U-NA: visualisation, investigation. AK: supervision, reviewing and editing. The following authors gave final approval of the manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.