A gift from the Netherlands

Holland possesses two things of beauty – tulips and Marga Ree

Patient is a young 16 year old guy that presented with pain and a huge swelling. Virgin tooth. I saw a strange structure in the radiograph, and decided to run a scan: There appeared to be  a dens invaginatus in 17, you can clearly see the enamel lining in the some of the slides. 

Dens invaginatus presents in many varieties, this one was a Class II according to Oehlers, and invagination ending in a blind sac, usually easier to treat than a class III, meaning that the dens has an own apical foramen

After initial treatment and application of CaOH, the swelling subsided and the patient turned symptom free

I was in doubt whether or not to remove the dens, initially there were “2 palatal canals“,but the structure bridging the 2 palatal orifices was the dens,taking up the space in the palatal canal and pushing away the original canal walls. In order to instrument this, you need to access the space between the dens and the original canal 360 degrees, which is virtually impossible.  So I decided to remove the dens. The drawback was a hogged out root, but the scan showed a pretty robust palatal root, so I was not too concerned about weakening the root. The problem was that I didn’t have burs that were long and thin enough to get access to the dens. US tips are pretty useless here, the enamel of the dens is so hard, it will take forever to remove it with US tips. 

Then I got the EG (Endo Guide) burs of John Khademi. Wow, what a gift from heaven, it was very easy and completely safe to remove the dens. The apical foramen was very wide, so I used an apical MTA plug to fill the palatal canal, and I could easily accommodate 2 posts  in the palatal root. 

Thanks to John, I could finish this case without problems! 



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