What is Dens Evaginatus?
Dens Evaginatus is a rare form of human dentition anomaly in which the occlusal surface of the mandibular premolars and the lingual surface of the anterior teeth are abnormally shaped to form a tubercle. It is most common in Asians and is characterized by tubercle protrusion from the posterior occlusal and anterior lingual surfaces. Tubercle enamel covers a dentin core with a thin pulp extension. These cusp-like protrusions are prone to wear or fracture due to malocclusion, which can expose the pulp and cause difficulties for the pulp shortly after the eruption.
The buccal cusp of a premolar or molar tooth has a central groove or lingual ridge that gives rise to the accessory cusp known as dens evaginatus. This disease is typically bilateral and most frequently affects the mandibular premolar.
The clinical significance of this issue is that this tubercle readily fractures or wears away, exposing the tiny pulpal extension, which can cause infection. As soon as the tooth enters occlusion, the tubercle may fracture or get abraded.
Dens Evaginatus Symptoms
A developmental aberration in the human dentition known as Dens Evaginatus (DE) or evaginated odontoma is characterized by the formation of an accessory cusp, an abnormal tubercle, or an elevation. It is made up of enamel that covers a dentinal core that typically contains pulp tissue.
Clinicians identify the cusp-like tubercle from supplemental cusps like the carabelli cusp because it possesses pulp. The extra cusp can interfere with occlusal function, shift the affected tooth and/or neighboring teeth, aggravate the tongue during speech and eating, and erode the grooves that form during development. Temporomandibular joint pain can be felt as a result of occlusal trauma induced by the tubercle.
The common and early pulpal consequences of DE present several difficulties for the practitioner. In this instance, the symptoms and signs make the diagnosis challenging, and few viable therapy options.
Dens Evaginatus Causes
DE causes are unknown. This Dens Evaginatus is a rare type of anomaly. It is an abnormal tooth formation that occurs during morphodifferentiation. Abnormal growth of the inner enamel epithelium into the enamel organ’s stellate reticulum with a core of dentin and a narrow pulp tissue extension into the tubercle causes this anomaly.
Dens Evaginatus Diagnosis
Recognizing this anomaly is usually not difficult when the impacted tooth is just erupted and is not in occlusion. Parents or guardians are supposed to be made aware of the risks associated with this anomaly. It is recommended to monitor the eruption of the impacted teeth attentively and to remove the anomalous cusp if it is found to be in the path of occlusion. If pulp exposure is present, direct pulp capping needs to be performed and the appropriate restoration is required to be installed.
A necrotic or diseased pulp becomes difficult to diagnose if there are no symptoms present. The apex may not be fully formed, and it’s hard to tell the difference between a dental follicle’s typical periapical radiolucency and a true periapical lesion. Pulp testing can be perplexing because young teeth are known to generate inaccurate pulp test results. It’s easy to ignore pulpal and/or periapical illness without trauma, restoration, or cavities, delaying treatment. The most crucial component in diagnosing and treating dens evaginatus is being aware of the condition and its progression.
Dens Evaginatus Treatment
When treating DE, a clinician’s assessment of the pulp’s condition serves as the primary guide. Prophylactic management of DE teeth with normal pulp tubercles needs to be done as early as possible using the prep-and-fill or reinforcement technique to maintain tooth vitality and root development. The prep-and-fill method is also the treatment of choice for DE teeth with reversible pulpitis. When a DE tooth has pulpal necrosis and a fully formed root, the best course of treatment is root canal therapy (RCT), which does not need surgery.
To preserve the health of the radicular pulp that triggers apexogenesis in DE teeth with irreversible pulpitis, important pulp treatment, such as partial or full/coronal pulpotomy, needs to be taken into consideration. When pulpal inflammation extends into the radicular pulp, a pulpectomy is necessary.
The treatment options for DE teeth with pulpal necrosis (or after a pulpectomy) and immature roots are as follows:
- MTA apexification, or mineral trioxide aggregate.
- REPs (Regenerative endodontic Procedures).