Dental abscess in a tooth with intact dens evaginatus

Current Management of Dens Evaginatus Teeth Based on Pulpal Diagnosis

INTRODUCTION

Dens evaginatus (DE) is a dental anomaly with a supernumerary tubercle projection that typically contains dentin and pulp tissue. However, the tubercle projection can fracture, exposing the dentin and potentially the dental pulp, which induces pulpal diseases. Managing DE should be primarily based on the clinical diagnosis of the pulp.

METHODS

The literature search in prevalence, prophylaxis, and management of dens evaginatus was performed in PubMed database as well as by manual search, in which the related contents were collected and descriptively analyzed.

RESULTS

Of the 264 searched literatures, 62 articles were included for this scoping review. The prophylactic management of the tubercle of DE teeth with a normal pulp should be performed as early as possible by the prep-and-fill technique or the reinforcement technique to preserve tooth vitality and continued root development, with the former reported to be superior compared with the latter. Furthermore, DE teeth with reversible pulpitis should be managed with the prep-and-fill technique. For DE teeth with irreversible pulpitis, vital pulp therapy, ie, partial or full/coronal pulpotomy, should be considered when the pulpal inflammation is limited to the coronal pulp to preserve the vitality of the radicular pulp that induces apexogenesis. A pulpectomy should be performed if the pulpal inflammation has progressed into the radicular pulp. For DE teeth with pulpal necrosis (or after pulpectomy) and immature roots, mineral trioxide aggregate apexification or regenerative endodontic procedures are the treatment options. For DE teeth with pulpal necrosis and complete root formation, nonsurgical root canal treatment is the treatment of choice. A flow chart of the decision-making for managing DE teeth based on pulpal diagnosis is proposed.

CONCLUSION

DE teeth should be properly managed, by prophylaxis or treatment, depending on pulpal diagnosis and related factors.

Dens evaginatus: Current treatment options

BACKGROUND

Teeth with dens evaginatus (DE) are more commonly observed in Western countries than previously. This is due to the increase in populations of patients of Asian origin, in whom DE is more common than in people of European origin. The interest in DE has also increased with the introduction of a procedure called regenerative endodontics.

CASE DESCRIPTION

A narrative review of treatment options for teeth with DE is presented, based on pulpal conditions and maturity of the teeth.

PRACTICAL IMPLICATIONS

Early recognition of teeth with DE allows for treatment choices that generally lead to good outcomes and can aid in preserving developing teeth in young patients.

Regenerative Endodontic Treatment with Orthodontic Treatment in a Tooth with Dens Evaginatus: A Case Report with a 4-year Follow-up

Dens evaginatus is a developmental tooth anomaly in which an extra cusp or tubercle protrudes on the occlusal surface of the tooth along with some pulpal tissue. Because of the fragile nature of the protrusion, these teeth are often at risk of pulpal exposure. When this occurs in an immature tooth, regenerative endodontic treatment may be a good treatment approach to promote root formation. There is limited literature that documents the occurrence of orthodontic treatment in teeth that have undergone regenerative endodontic therapy using triple antibiotic paste. Here we present a case of an immature premolar tooth with dens evaginatus that was diagnosed with pulp necrosis and chronic apical abscess. The tooth was treated with regenerative endodontic treatment; after which, the patient received orthodontic treatment with fixed appliances for 2 years. The tooth responded favorably to the regenerative endodontic treatment and orthodontic tooth movement. Clinically and radiographically, all the follow-up examinations revealed an asymptomatic tooth with evidence of periapical healing with stunted root development. The tooth remained asymptomatic even after 4 years. The regenerative endodontic procedure (REP) was successful in treating an immature permanent premolar with pulp necrosis and apical periodontitis with dens evaginatus. In this case, the tooth treated with an REP responded to orthodontic treatment similar to the nonendodontically treated teeth. Further studies are recommended to clarify the precise effects of orthodontic treatment on teeth treated with an REP.