Tratamento endodôntico conservador em dens in dente: Estratégia de preservação da polpa em presença de lesão periapical

Abstract

INTRODUCTION: Dens invaginatus, especially in its type III form, presents a clinical challenge for endodontics due to its anatomical complexity and the increased risk of periapical lesions. Despite the severity of these cases, conservative strategies that preserve pulp vitality have shown promising results, particularly with the use of technologies such as cone-beam computed tomography (CBCT) and customized endodontic guides. OBJECTIVE: To report a clinical case of selective endodontic treatment in a maxillary incisor with type III dens invaginatus and a periapical lesion, using an endodontic guide to access and instrument only the invaginated canal while preserving the vitality of the main pulp. CASE REPORT: A patient with a maxillary incisor affected by type III dens invaginatus associated with a periapical lesion was treated conservatively, prioritizing the preservation of the vitality of the main pulp. Based on cone-beam computed tomography (CBCT), a detailed three-dimensional planning was performed for the fabrication of a customized endodontic guide, allowing selective and safe access exclusively to the invaginated canal. The clinical protocol included mechanized instrumentation up to size #60, active irrigation with 2.5% sodium hypochlorite, use of irrigant activation devices, antimicrobial photodynamic therapy, and obturation with a single cone and bioceramic sealer. Clinical and radiographic follow-up showed progressive regression of the periapical lesion, absence of symptoms, maintenance of pulp vitality, and functional stability of the tooth. FINAL CONSIDERATIONS: The findings demonstrate that guided, minimally invasive endodontic approaches, integrated with digital technologies, represent an effective, precise, and conservative alternative for managing complex anatomies, reinforcing their applicability as a first-choice strategy in similar cases.