{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T15:56:59Z","timestamp":1764259019182,"version":"build-2065373602"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T00:00:00Z","timestamp":1710460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Dens invaginatus (DI), an unusual developmental anomaly is a challenge for the operating dentist with regard to its diagnosis and treatment. This case report presents the successful management of a Type\u20103b DI in a permanent maxillary lateral incisor associated with a large radicular cyst and communicating apico\u2010marginal defect (Von Arx type IIb).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>A 19\u2010year\u2010old female patient reported pain and palatal swelling. During the clinical examination, tooth #12 exhibited tenderness to percussion, and presented a deep periodontal pocket depth (PPD) of 12\u00a0mm, along with grade I mobility. Radiographic examination revealed a large peri\u2010radicular radiolucency with atypical tooth morphology. Cone beam computed tomography clarified the complicated root canal anatomy to be Type\u20103b DI associated with an apico\u2010marginal defect. The case was managed successfully by non\u2010surgical endodontic therapy followed by surgical intervention utilizing a guided bone regenerative (GBR) approach. Eighteen\u2010month follow\u2010up showed an asymptomatic and functional tooth with a significant reduction in pocket depth. The periapical radiographs showed continued healing of the osseous defect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The successful healing outcome of a challenging case, characterized by a complex DI morphology, a large peri\u2010radicular lesion, a through\u2010and\u2010through defect, and a combined endodontic\u2010periodontal apico\u2010marginal defect was achieved through accurate diagnosis, treatment planning, and execution using contemporary endodontic and periodontal treatment techniques. The application of GBR techniques during the surgical phase of treatment may have contributed to the improved regenerative healing outcome in this case, which was initially considered prognostically questionable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key points<\/jats:title><jats:p><jats:bold>Why is this case new information?<\/jats:bold>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Type\u20103b DI exhibits a complex root canal structure, each case displaying unique characteristics, necessitating a case\u2010specific treatment plan. In this case report the Type\u20103b DI morphology was associated with a large peri\u2010radicular, through and through defect and combined endodontic periodontal apico\u2010marginal defect. The treatment approach involved incorporating guided bone regenerative (GBR) principles during the surgical phase. This case report contributes to the existing evidence on the diagnosis and successful management of Type\u20103b DI with a concurrent apico\u2010marginal defect.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><jats:p><jats:bold>What are the keys to successful management of this case?<\/jats:bold>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>The successful management of a prognostically challenging case was achieved through a closely integrated multidisciplinary coordination between the endodontist and periodontist.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Utilization of contemporary techniques and tools contributed to the successful management<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>The use of three\u2010dimensional radiological examination through cone beam computed tomography enabled a precise preoperative assessment, facilitating the formulation of a treatment plan for managing both the Type\u20103b DI morphology and the associated peri\u2010radicular lesion.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Employing GBR techniques in peri\u2010radicular surgery may have assisted in the healing of through\u2010and\u2010through periapical defects with concurrent apico\u2010marginal defects (Von Arx type IIb).<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><jats:p><jats:bold>What are the primary limitations to the success of this case?<\/jats:bold>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>A complex root canal anatomy associated with Type\u20103b DI morphology<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>A large peri\u2010radicular through and through defect with concurrent apico\u2010marginal defect.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Difficulty in weekly and long\u2010term follow\u2010up of the patient.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/cap.10283","type":"journal-article","created":{"date-parts":[[2024,3,16]],"date-time":"2024-03-16T02:39:49Z","timestamp":1710556789000},"page":"276-283","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Non\u2010surgical and guided\u2010bone\u2010regeneration surgical management of Type\u20103b dens invaginatus with an apico\u2010marginal defect: A case report"],"prefix":"10.1002","volume":"14","author":[{"given":"Aaliya","family":"Rahman","sequence":"first","affiliation":[{"name":"Department of Conservative Dentistry &amp; Endodontics Dr. Ziauddin Ahmed Dental College Aligarh Muslim University  Aligarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharique","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry &amp; Endodontics Dr. Ziauddin Ahmed Dental College Aligarh Muslim University  Aligarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afaf","family":"Zia","sequence":"additional","affiliation":[{"name":"Department of Periodontics and Community Dentistry Dr. Ziauddin Ahmed Dental College Aligarh Muslim University  Aligarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. 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Mukhtar Un Nisar","family":"Andrabi","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry &amp; Endodontics Dr. Ziauddin Ahmed Dental College Aligarh Muslim University  Aligarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maahin","family":"Mahmood","sequence":"additional","affiliation":[{"name":"Kothiwal Dental College and Research Centre  Moradabad India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2591.2008.01468.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/00220345340140010801"},{"key":"e_1_2_9_4_1","first-page":"65","article-title":"A collection of dilated composite odontomes","volume":"63","author":"Rushton MA","year":"1937","journal-title":"Br Dent J"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1242\/dev.127.22.4775"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0177(2000)9999:9999<::AID-DVDY1062>3.0.CO;2-J"},{"key":"e_1_2_9_7_1","article-title":"Dilated odontoma: an incidental finding","volume":"2015","author":"Syed AZ","year":"2015","journal-title":"Case Rep"},{"issue":"7","key":"e_1_2_9_8_1","first-page":"491","article-title":"Incidence, nature and clinical significance of palatal invaginations in the maxillary incisor teeth","volume":"46","author":"Hallet GE","year":"1953","journal-title":"Proc R Soc Med"},{"issue":"12","key":"e_1_2_9_9_1","first-page":"569","article-title":"Dens invaginatus (Dens in dente) [Uber den Dens invaginatus]","volume":"81","author":"Schulze C","year":"1972","journal-title":"ZWR"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(57)90077-4"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2014.12.001"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/adj.12513"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2591.2006.01081.x"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2591.2000.00263.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2023-255546"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2011.03.003"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004770-200106000-00009"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2591.2011.01956.x"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2015.08.017"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.5125\/jkaoms.2020.46.5.361"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr\u20102012\u2010008240"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.id.0000204762.39826.0f"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40729-020-00266-y"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.10283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T20:33:09Z","timestamp":1760041989000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/cap.10283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,15]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1002\/cap.10283"],"URL":"https:\/\/doi.org\/10.1002\/cap.10283","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"type":"print","value":"2573-8046"},{"type":"electronic","value":"2163-0097"}],"subject":[],"published":{"date-parts":[[2024,3,15]]},"assertion":[{"value":"2023-09-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}