Imaging findings of a dilated odontoma shaped type II dens in dente in a mesiodens

Caio Belém Rodrigues Barros Soares, Camila de Morais e Santiago, Flávia Maria de Morais Ramos-Perez, Gabriela Lopes de Rezende Barbosa, Marcelo Augusto Oliveira de Sales, Frederico Sampaio Neves

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Introduction: there are three types of dens in dente: Type I, minimal invagination confined to the crown of the tooth which does not extend beyond the amelocemental junction; Type II, invagination extends to the pulp chamber, but remains within the root canal with no communication with the periodontal ligament; and Type III, invagination extends to the root of the affected tooth, beyond the cementoenamel junction. The term dilated odontoma is used to describe the most severe variant of invagination (Type III), which is characterized by crown and/or root dilation of the affected tooth.
Objective: describe a rare case of a dilated odontoma shaped dens in dente in a mesiodens and its imaging findings, diagnosed by cone beam computed tomography.
Case presentation: a 14-year-old male patient was referred for radiographic examination of the mandible and maxilla to determine the cause of abnormal tooth eruption chronology. Two mesiodens were found on the maxilla. Due to the peculiar morphology of the mesiodens on the right side, cone beam computed tomography was performed. Multiplanar reconstructions revealed an oval structure on the eruption path of the upper right central incisor, in contact with its palatal surface. Coronal and sagittal reconstructions showed that invagination extended beyond the cementoenamel junction, without any additional apical/lateral formation.
Conclusions: the final diagnosis was dilated odontoma shaped type II dens invaginatus in a mesiodens.

Keywords: dens in dente; supernumerary tooth; cone beam computed tomography.