Saudi Journal of Oral and Dental Research (SJODR)
Volume-11 | Issue-07 | 283-289
Case Report
Management of Dens Invaginatus with Concurrent Open and Closed Apex in a Single Root: A Detailed Case Report
Fathima Shahana Valiyaillath, Karayil Binu Nathan, Dinesh Kamath, Tisson Varghese Job, Sirajudheen, Hasna K
Published : July 16, 2026
Abstract
Dens invaginatus is a developmental anomaly resulting from an infolding of enamel and dentin during odontogenesis, often leading to complex internal anatomy and early pulpal involvement. The presence of atypical apical morphology further complicates diagnosis and endodontic management. This case report describes the diagnosis and nonsurgical endodontic management of a rare variant of dens invaginatus in a maxillary anterior tooth, characterized by a single root exhibiting two different apical morphologies: one normally formed closed apex and an additional lateral open apex on the palate-distal aspect of the same root. The patient presented with severe anterior pain following recent trauma and was associated with a large periapical lesion. Cone-beam computed tomography (CBCT) played a decisive role in identifying the complex canal configuration and guiding treatment planning. A staged endodontic approach was adopted, including calcium hydroxide intracanal medicament, apical barrier formation using biodentine, and a hybrid obturation technique employing gutta-percha and thermoplasticized gutta-percha. Favorable clinical and radiographic outcomes were observed. This report emphasizes the importance of advanced imaging, careful canal negotiation, and customized obturation strategies in managing rare endodontic anomalies.