Tooth within a tooth (dens in dente): A case report and a systematic review of population studies
Vaia-Aikaterini ALEXOUDI, Dimitrios TATSIS, Dimitrios DELIGIANNIDIS, Konstantinos ANTONIADES
Department of Oral and Maxillofacial Surgery, School of Dentistry, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital of Thessaloniki, Greece (Head: Professor K. Antoniades)
Hellenic Archives of Oral & Maxillofacial Surgery (2020) 2, 95-102
SUMMARY: The term dens in dente (also dens invaginatus) refers to an anomaly in tooth formation, in which the enamel organ is submerged into the dental papilla, causing a tooth-like formation inside the tooth. We present a case with a concomitant dental abscess formation and its management. A systematic review of population studies was conducted in search engines MEDLINE and Google Scholar. In total, 28 studies are included in our study, presenting a wide diversity of incidence from 0.3 to 26%. The diversity can be attributed to factors such as diagnostic difficulties, differences in the study popula- tions, and differences in diagnostic criteria.
This anomaly is more frequent in maxillary lateral incisors, may be underdiagnosed, and has a higher prevalence of infections and abscess formation. Thus, the complication rate is higher and the need of proper documentation is important for the clinician.
KEY WORDS: Dens in dente, dens invaginatus
REFERENCES
Alani A, and Bishop K: Dens Invaginatus. Part 1: Classification, Preva- lence and Aetiology. International Endodontic Journal 41 (12): 1123–36, 2008
Altinbulak H, and Ergül N: Multiple Dens Invaginatus. A Case Report. Oral Surgery, Oral Medicine, Oral Pathology 76 (5): 620–22, 1993 Amos ER: Incidence of the Small Dens in Dente. The Journal of the
American Dental Association 51 (1): 31–33, 1955
Atkinson SR: The Permanent Maxillary Lateral Incisor. American Journal of Orthodontics and Oral Surgery 29 (12): 685–98, 1943
Bäckman B, and Wahli YB: Variations in Number and Morphology of Permanent Teeth in 7-Year-Old Swedish Children. International Journal of Paediatric Dentistry 11 (1): 11–17, 2001
Boyne PJ: Dens in Dente: Report of Three Cases. Journal of the American Dental Association (1939) 45 (2): 208–9, 1952
Bramante Clovis Monteiro, Simone Maria Galvao de Sousa, and Sonia Maria Ratto Tavano: Dens Invaginatus in Mandibular First Premo- lar. Oral Surgery, Oral Medicine, Oral Pathology 76 (3): 389, 1993
Cakici F, Celikoglu M, Arslan H, Topcuoglu S, and Erdogan AS: Assessment of the Prevalence and Characteristics of Dens Invaginatus in a Sample of Turkish Anatolian Population. Medicina Oral Pa- tología Oral y Cirugia Bucal, e855–58, 2010
Capar Ismail Davut, Huseyin Ertas, Hakan Arslan, and Elif Tarim Ertas: A Retrospective Comparative Study of Cone-Beam Computed Tomography versus Rendered Panoramic Images in Identifying the Presence, Types, and Characteristics of Dens Invaginatus in a Turkish Population. Journal of Endodontics 41 (4): 473–78, 2015
Chaniotis AM, Tzanetakis GN, Kontakiotis EG, and Tosios KI: Combined Endodontic and Surgical Management of a Mandibular Lat- eral Incisor with a Rare Type of Dens Invaginatus. Journal of En- dodontics 34 (10): 1255–60, 2008
Demartis P, Dessì C, Cotti M, and Cotti E: Endodontic Treatment and Hypotheses on an Unusual Case of Dens Invaginatus. Journal of Endodontics 35 (3): 417–21, 2009
Ezoddini AF, Sheikhha MH, and Ahmadi H: Prevalence of Dental Developmental Anomalies: A Radiographic Study. Community Den- tal Health 24 (3): 140–44, 2007
Fujiki Y, Tamaki N, Kawahara K, and Nabae M: Clinical and Radiographic Observations of Dens Invaginatus. Dentomaxillofac Ra- diol 3: 343–48, 1974
Gotoh Toshifumi, Kenji Kawahara, Kazuhiko Imai, Kanji Kishi, and Yoshishige Fujiki: Clinical and Radiographic Study of Dens Invaginatus. Oral Surgery, Oral Medicine, Oral Pathology 48 (1): 88–91, 1979
Grahnén H: Dens Invaginatus. I. A Clinical, Roentgenological and Genetical Study of Permanent Upper Lateral Incisors. Odontologisk Revy 10: 115–37, 1959
Gündüz Kaan, Peruze Çelenk, Emin Murat Canger, Zeynep Zengin, and Pinar Sümer: A Retrospective Study of the Prevalence and Char- acteristics of Dens Invaginatus in a Sample of the Turkish Popula- tion. Medicina Oral, Patologia Oral y Cirugia Bucal 18 (1): e27- 32, 2013
Gupta Saurabh K, Payal Saxena, Sandhya Jain, and Deshraj Jain: Preva- lence and Distribution of Selected Developmental Dental Anom- alies in an Indian Population. Journal of Oral Science 53 (2): 231– 38, 2011
Hallett GEM: The Incidence, Nature, and Clinical Significance of Palatal Invaginations in the Maxillary Incisor Teeth. Proceedings of the Royal Society of Medicine 46 (7): 491–99, 1953
Hamasha AA, and Alomari QD: Prevalence of Dens Invaginatus in Jor- danian Adults. International Endodontic Journal 37 (5): 307–10, 2004 Hosey M-T, and Bedi R: Multiple Dens Invaginatus in Two Brothers. Dental Traumatology 12 (1): 44–47, 1996
Jindal MK, Asadullah MD, and Misra SK: Surgical Management of Peri- apical Lesion with Dens in Dente. International Journal of Clinical Pediatric Dentistry 2 (1): 39–41, 2009
Kronfeld R: Dens in Dente. Journal of Dental Research 14 (1): 49–66, 1934
Miyoshi S, Fujiwara J, Nakata T, Yamasmoto K, and Deguchi K: Dens Invaginatus in Japanese Incisors. Japanese Journal of Oral Biology 13 (4): 539–43, 1971
Mühlreiter E: Die Natur Der Anomalen Höhlenbildung Im Oberen Seitenschneidezahne. Deutsche Vierteljahresschrift Für Zahn- heilkunde 13: 367–72, 1873
Mupparapu M, Singer SR, and Goodchild JH: Dens Evaginatus and Dens Invaginatus in a Maxillary Lateral Incisor: Report of a Rare Occurrence and Review of Literature. Australian Dental Journal 49(4): 201-3, 2004
Oehlers FAC: Dens Invaginatus (Dilated Composite Odontome). I. Variations of the Invagination Process and Associated Anterior Crown Forms. Oral Surgery, Oral Medicine, Oral Pathology 10 (11): 1204–18, 1957
Patil Santosh, Bharati Doni, Sumita Kaswan, and Farzan Rahman: Preva- lence of Dental Anomalies in Indian Population. Journal of Clinical and Experimental Dentistry 5 (4): 183–86, 2013
Pokala P, and Acs G: A Constellation of Dental Anomalies in a Chro- mosomal Deletion Syndrome (7q32): Case Report. Pediatric Dentistry 16 (4): 306–9, 1994
Poyton HG, and Morgan GA: Dens in Dente. Dental Radiography and Photography 39 (2): 27-33, 1966
Różyło T. Katarzyna, Ingrid Różyło-Kalinowska, and Magdalena Piskórz: Cone-Beam Computed Tomography for Assessment of Dens In- vaginatus in the Polish Population. Oral Radiology 34 (2): 136– 42, 2018
Ruprecht A, Batniji S, Sastry KA, and el-Neweihi E: The Incidence of Dental Invagination. The Journal of Pedodontics 10 (3): 265–72,
1986
Ruprecht A, Sastry KA, Batniji S, and Lambourne A: The Clinical Sig- nificance of Dental Invagination. The Journal of Pedodontics 11 (2): 176–81, 1987
Rushton MA: A Collection of Dilated Composite Odontomas. British Dental Journal 63: 65–85, 1937
Sajnani AK, and King NM: Dental Anomalies Associated with Buccally- and Palatally-Impacted Maxillary Canines. Journal of Investigative and Clinical Dentistry 5 (3): 208–13, 2014
Shafer WG: Dens in Dente. NY State Dent J 19: 220–25, 1953 Shashirekha G, and Jena A: Prevalence and Incidence of Gemination
and Fusion in Maxillary Lateral Incisors in Odisha Population and Related Case Report. Journal of Clinical and Diagnostic Research 7 (10): 2326–29, 2013
Stephens RR: The Diagnosis, Clinical Significance and Treatment of Minor Palatal Invaginations in Maxillary Incisors. Proceedings of the Royal Society of Medicine 46 (7): 499–503, 1953
Tavano SMR, Sousa SMG, and Bramante CM: Dens Invaginatus in First Mandibular Premolar. Dental Traumatology 10 (1): 27–29, 1994
Thakur S, Thakur N, Bramta M, and Gupta M: Dens Invagination: A Review of Literature and Report of Two Cases. Journal of Natural Science, Biology and Medicine 5 (1): 218–21, 2014
Thomas JG: A Study of Dens in Dente. Oral Surgery, Oral Medicine, Oral Pathology 38 (4): 653–55, 1974
Thongudomporn U, and Freer TJ: Prevalence of Dental Anomalies in Orthodontic Patients. Australian Dental Journal 43 (6): 395–98, 1998
Ulmansky M, and Hermel J: Double Dens in Dente in a Single Tooth. Report of a Case and Radiologic Study of the Incidence of Small Dens in Dente. Oral Surgery, Oral Medicine, Oral Pathology 17 (1): 92–97, 1964
Department of Oral and Maxillofacial Surgery, School of Dentistry, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital of Thessaloniki, Greece (Head: Professor K. Antoniades)
Hellenic Archives of Oral & Maxillofacial Surgery (2020) 2, 95-102
SUMMARY: The term dens in dente (also dens invaginatus) refers to an anomaly in tooth formation, in which the enamel organ is submerged into the dental papilla, causing a tooth-like formation inside the tooth. We present a case with a concomitant dental abscess formation and its management. A systematic review of population studies was conducted in search engines MEDLINE and Google Scholar. In total, 28 studies are included in our study, presenting a wide diversity of incidence from 0.3 to 26%. The diversity can be attributed to factors such as diagnostic difficulties, differences in the study popula- tions, and differences in diagnostic criteria.
This anomaly is more frequent in maxillary lateral incisors, may be underdiagnosed, and has a higher prevalence of infections and abscess formation. Thus, the complication rate is higher and the need of proper documentation is important for the clinician.
KEY WORDS: Dens in dente, dens invaginatus
REFERENCES
Alani A, and Bishop K: Dens Invaginatus. Part 1: Classification, Preva- lence and Aetiology. International Endodontic Journal 41 (12): 1123–36, 2008
Altinbulak H, and Ergül N: Multiple Dens Invaginatus. A Case Report. Oral Surgery, Oral Medicine, Oral Pathology 76 (5): 620–22, 1993 Amos ER: Incidence of the Small Dens in Dente. The Journal of the
American Dental Association 51 (1): 31–33, 1955
Atkinson SR: The Permanent Maxillary Lateral Incisor. American Journal of Orthodontics and Oral Surgery 29 (12): 685–98, 1943
Bäckman B, and Wahli YB: Variations in Number and Morphology of Permanent Teeth in 7-Year-Old Swedish Children. International Journal of Paediatric Dentistry 11 (1): 11–17, 2001
Boyne PJ: Dens in Dente: Report of Three Cases. Journal of the American Dental Association (1939) 45 (2): 208–9, 1952
Bramante Clovis Monteiro, Simone Maria Galvao de Sousa, and Sonia Maria Ratto Tavano: Dens Invaginatus in Mandibular First Premo- lar. Oral Surgery, Oral Medicine, Oral Pathology 76 (3): 389, 1993
Cakici F, Celikoglu M, Arslan H, Topcuoglu S, and Erdogan AS: Assessment of the Prevalence and Characteristics of Dens Invaginatus in a Sample of Turkish Anatolian Population. Medicina Oral Pa- tología Oral y Cirugia Bucal, e855–58, 2010
Capar Ismail Davut, Huseyin Ertas, Hakan Arslan, and Elif Tarim Ertas: A Retrospective Comparative Study of Cone-Beam Computed Tomography versus Rendered Panoramic Images in Identifying the Presence, Types, and Characteristics of Dens Invaginatus in a Turkish Population. Journal of Endodontics 41 (4): 473–78, 2015
Chaniotis AM, Tzanetakis GN, Kontakiotis EG, and Tosios KI: Combined Endodontic and Surgical Management of a Mandibular Lat- eral Incisor with a Rare Type of Dens Invaginatus. Journal of En- dodontics 34 (10): 1255–60, 2008
Demartis P, Dessì C, Cotti M, and Cotti E: Endodontic Treatment and Hypotheses on an Unusual Case of Dens Invaginatus. Journal of Endodontics 35 (3): 417–21, 2009
Ezoddini AF, Sheikhha MH, and Ahmadi H: Prevalence of Dental Developmental Anomalies: A Radiographic Study. Community Den- tal Health 24 (3): 140–44, 2007
Fujiki Y, Tamaki N, Kawahara K, and Nabae M: Clinical and Radiographic Observations of Dens Invaginatus. Dentomaxillofac Ra- diol 3: 343–48, 1974
Gotoh Toshifumi, Kenji Kawahara, Kazuhiko Imai, Kanji Kishi, and Yoshishige Fujiki: Clinical and Radiographic Study of Dens Invaginatus. Oral Surgery, Oral Medicine, Oral Pathology 48 (1): 88–91, 1979
Grahnén H: Dens Invaginatus. I. A Clinical, Roentgenological and Genetical Study of Permanent Upper Lateral Incisors. Odontologisk Revy 10: 115–37, 1959
Gündüz Kaan, Peruze Çelenk, Emin Murat Canger, Zeynep Zengin, and Pinar Sümer: A Retrospective Study of the Prevalence and Char- acteristics of Dens Invaginatus in a Sample of the Turkish Popula- tion. Medicina Oral, Patologia Oral y Cirugia Bucal 18 (1): e27- 32, 2013
Gupta Saurabh K, Payal Saxena, Sandhya Jain, and Deshraj Jain: Preva- lence and Distribution of Selected Developmental Dental Anom- alies in an Indian Population. Journal of Oral Science 53 (2): 231– 38, 2011
Hallett GEM: The Incidence, Nature, and Clinical Significance of Palatal Invaginations in the Maxillary Incisor Teeth. Proceedings of the Royal Society of Medicine 46 (7): 491–99, 1953
Hamasha AA, and Alomari QD: Prevalence of Dens Invaginatus in Jor- danian Adults. International Endodontic Journal 37 (5): 307–10, 2004 Hosey M-T, and Bedi R: Multiple Dens Invaginatus in Two Brothers. Dental Traumatology 12 (1): 44–47, 1996
Jindal MK, Asadullah MD, and Misra SK: Surgical Management of Peri- apical Lesion with Dens in Dente. International Journal of Clinical Pediatric Dentistry 2 (1): 39–41, 2009
Kronfeld R: Dens in Dente. Journal of Dental Research 14 (1): 49–66, 1934
Miyoshi S, Fujiwara J, Nakata T, Yamasmoto K, and Deguchi K: Dens Invaginatus in Japanese Incisors. Japanese Journal of Oral Biology 13 (4): 539–43, 1971
Mühlreiter E: Die Natur Der Anomalen Höhlenbildung Im Oberen Seitenschneidezahne. Deutsche Vierteljahresschrift Für Zahn- heilkunde 13: 367–72, 1873
Mupparapu M, Singer SR, and Goodchild JH: Dens Evaginatus and Dens Invaginatus in a Maxillary Lateral Incisor: Report of a Rare Occurrence and Review of Literature. Australian Dental Journal 49(4): 201-3, 2004
Oehlers FAC: Dens Invaginatus (Dilated Composite Odontome). I. Variations of the Invagination Process and Associated Anterior Crown Forms. Oral Surgery, Oral Medicine, Oral Pathology 10 (11): 1204–18, 1957
Patil Santosh, Bharati Doni, Sumita Kaswan, and Farzan Rahman: Preva- lence of Dental Anomalies in Indian Population. Journal of Clinical and Experimental Dentistry 5 (4): 183–86, 2013
Pokala P, and Acs G: A Constellation of Dental Anomalies in a Chro- mosomal Deletion Syndrome (7q32): Case Report. Pediatric Dentistry 16 (4): 306–9, 1994
Poyton HG, and Morgan GA: Dens in Dente. Dental Radiography and Photography 39 (2): 27-33, 1966
Różyło T. Katarzyna, Ingrid Różyło-Kalinowska, and Magdalena Piskórz: Cone-Beam Computed Tomography for Assessment of Dens In- vaginatus in the Polish Population. Oral Radiology 34 (2): 136– 42, 2018
Ruprecht A, Batniji S, Sastry KA, and el-Neweihi E: The Incidence of Dental Invagination. The Journal of Pedodontics 10 (3): 265–72,
1986
Ruprecht A, Sastry KA, Batniji S, and Lambourne A: The Clinical Sig- nificance of Dental Invagination. The Journal of Pedodontics 11 (2): 176–81, 1987
Rushton MA: A Collection of Dilated Composite Odontomas. British Dental Journal 63: 65–85, 1937
Sajnani AK, and King NM: Dental Anomalies Associated with Buccally- and Palatally-Impacted Maxillary Canines. Journal of Investigative and Clinical Dentistry 5 (3): 208–13, 2014
Shafer WG: Dens in Dente. NY State Dent J 19: 220–25, 1953 Shashirekha G, and Jena A: Prevalence and Incidence of Gemination
and Fusion in Maxillary Lateral Incisors in Odisha Population and Related Case Report. Journal of Clinical and Diagnostic Research 7 (10): 2326–29, 2013
Stephens RR: The Diagnosis, Clinical Significance and Treatment of Minor Palatal Invaginations in Maxillary Incisors. Proceedings of the Royal Society of Medicine 46 (7): 499–503, 1953
Tavano SMR, Sousa SMG, and Bramante CM: Dens Invaginatus in First Mandibular Premolar. Dental Traumatology 10 (1): 27–29, 1994
Thakur S, Thakur N, Bramta M, and Gupta M: Dens Invagination: A Review of Literature and Report of Two Cases. Journal of Natural Science, Biology and Medicine 5 (1): 218–21, 2014
Thomas JG: A Study of Dens in Dente. Oral Surgery, Oral Medicine, Oral Pathology 38 (4): 653–55, 1974
Thongudomporn U, and Freer TJ: Prevalence of Dental Anomalies in Orthodontic Patients. Australian Dental Journal 43 (6): 395–98, 1998
Ulmansky M, and Hermel J: Double Dens in Dente in a Single Tooth. Report of a Case and Radiologic Study of the Incidence of Small Dens in Dente. Oral Surgery, Oral Medicine, Oral Pathology 17 (1): 92–97, 1964
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