: A Comprehensive Review of Classification and Clinical Approaches.

Craig Anderson, Jorge N R Martins, Abayomi O Baruwa, Adam Monroe, Flávia Cracel Nogueira, Luís Corte-Real

Journal: Medicina (Kaunas, Lithuania) 2025;61(7):

PMID: 40731909

Abstract

is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep invaginations extending through the root, occasionally communicating with periodontal or periapical tissues. The internal complexity of affected teeth presents diagnostic and therapeutic challenges, particularly in severe forms that mimic root canal systems or are associated with pulpal or periapical pathology. Maxillary lateral incisors are most frequently affected, likely due to their unique developmental timeline and morphological susceptibility. Although various classification systems have been proposed, Oehlers' classification remains the most clinically relevant due to its simplicity and correlation with treatment complexity. Recent advances in diagnostic imaging, especially cone beam computed tomography (CBCT), have revolutionized the identification and classification of these anomalies. CBCT-based adaptations of Oehlers' classification allow for the precise assessment of invagination extent and pulpal involvement, facilitating improved treatment planning. Contemporary therapeutic strategies now include calcium-silicate-based cement sealing materials, endodontic microsurgery for inaccessible anatomy, and regenerative endodontic procedures for immature teeth with necrotic pulps. Emerging developments in artificial intelligence, genetic research, and tissue engineering promise to further refine diagnostic capabilities and treatment options. Early detection remains critical to prevent complications such as pulpal necrosis or apical disease. A multidisciplinary, image-guided, and patient-centered approach is essential for optimizing clinical outcomes in cases of .

Address: Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman 346, United Arab Emirates.; Private Practice, Biloxi, MS 39532, USA.; Private Practice, Vista, CA 92083, USA.; Private Practice, 4700-262 Braga, Portugal.; Department of Endodontics, Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal.; Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal.; LIBPhys-FCT UID/FIS/04559/2013, 1600-277 Lisboa, Portugal.; Grupo de Investigação em Bioquimica e Biologia Oral (GIBBO), Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), 1600-277 Lisboa, Portugal.; Centro de Estudos de Medicina Dentária Baseada na Evidência (CEMDBE), 1600-277 Lisboa, Portugal.
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