Triple Dens Invaginatus with Three Invaginations in a Single Tooth: A Rare Phenomenon—A Case Report

The developmental aberration known as dens invaginatus, or "dens in dente," is defined by the invagination of enamel and dentin into the pulp cavity before dentin calcification. There are very few occurrences of multiple dens invaginations documented in the literature, especially with three invaginations in a single tooth. This is a case report of a rare anatomical variation showing triple dens invagination in a 34-year-old patient involving the right maxillary lateral incisor associated with a periapical lesion. On radiographic investigation, cone beam computed tomography revealed one deep invagination (primary) and two accessory invaginations, thus allowing for precise evaluation of canal morphology and categorization as Oehler’s Type II. Endodontic intervention was started; however, extended monitoring was not feasible. The prognosis was fair based on the canal morphology and the associated periapical pathology, which measured about 1 cm × 1 cm. This case emphasizes the importance of advanced three-dimensional imaging for accurate diagnosis and effective treatment planning of a unique and intricate dens invaginatus case, rather than its overall diagnostic usefulness.