Dens Evaginatus: A Problem-Based Approach

Abstract

Dens evaginatus is an uncommon developmental anomaly of human dentition characterized by the presence of tubercle on the occlusal surface of mandibular premolars and lingual surface of anterior teeth. Due to occlusal trauma this tubercle tends to fracture thus exposing the pathway to the pulp chamber of teeth. This case report is about the presentation of dens evaginatus in mandibular premolars bilaterally; among them tooth 44 was associated with chronic apical periodontitis. Fractured tubercle of three premolars was sealed with composite resin. Root canal treatment was performed with tooth 44. Routine endodontic treatment did not result in remission of infection. Therefore, culture and sensitivity tests were performed to identify the cause and modify treatment plan accordingly. Triple antibiotic paste was used as an intracanal medicament to disinfect the root canal that resulted in remission of infection.

Bilateral dens evaginatus and associated cystic pathology: An unusual case report

“…As the accessory cusp is usually fractured from the remaining tooth due to occlusal interference and concomitant trauma, observing external evidence of the anomaly clinically is rather challenging. Consequently, early detection and preventative management during routine dental examinations is paramount 13 …”

“…Consequently, early detection and preventative management during routine dental examinations is paramount. 13 With regards to treatment, the vitality of the pulp, presence of the DE tubercle on the tooth, along with the maturity of the root of the tooth may dictate the modality taken. Specifically, DE on a tooth with vital, normal pulp may warrant selective reduction of the opposing occluding tooth to prevent later fracture, while the application of acid-etched flowable light-cured resin may be indicated to seal the base of the tubercle area that has already been fractured from the tooth.…”

The Effect of Etiology on the Function of Hertwig\'s Epithelial Root Sheath in Regenerative Endodontic Procedures—A Review of Literature

“…18 In dens evaginatus or evaginatus odontoma which commonly involves mandibular premolars and maxillary lateral incisors bilaterally can be identified by a raised tubercle of around 3.5 mm in the occlusal surface of premolars and 6.0 mm in the palatal surface of anterior teeth. 19 This raised tubercle consists of enamel and dentin layer and sometimes may have the pulpal extension, 20 which makes these teeth more prone to early pulpal involvement following caries or occlusal trauma and this usually happens at a faster rate even before the completion of the root.…”

Conducto con exudado persistente: Causas y manejo clínico

“…La pasta triple antibiótica (ciprofloxacina, minociclina y metronidazol) ha demostrado ser útil como medicación intraconducto en los canales con exudado persistente, cuando la infección persiste luego de la terapia con hidróxido de calcio. Así lo demuestra un reporte de caso de un diente #44 con dens evaginatus (Ayer et al, 2015), en el que a pesar de terapia con hidróxido de calcio durante 2 meses, persistían el exudado intraconducto y el tracto sinusal. En este punto del tratamiento se realizaron un cultivo y test de sensibilidad con varios medicamentos, siendo la pasta triple antibiótica la que mostró la zona de inhibición más grande.…”

“…Se procedió a cambiar la medicación intraconducto, reemplazando al hidróxido de calcio por la pasta triple antibiótica, haciendo recambios cada 15 días, durante un período de tres meses. Luego de este período, habían ya remitido el exudado y el tracto sinusal, por lo que se procedió a obturar el conducto radicular; a los 6 meses se evidenció reparación de la lesión periapical (Ayer et al, 2015).…”