Dens evaginatus


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Dens evaginatus

  1. 1. Dens Evaginatus
  2. 2. Introduction:  Developmental aberration of a tooth resulting in formation of an accessory cusp  Abnormal tubercle, elevation, excrescence, extrusion, or bulge.  Enamel protuberance, covering a dentinal core that usually contains pulp tissue that on occasion may have a slender pulp horn which extends various distances up to the full length of the tubercle’s dentin core.
  3. 3. The presence of pulp within the cusp-like tubercle has great clinical significance and distinguishes the anomaly from supplemental cusps, such as the cusp of Carabelli. Asian descent (including Chinese, Malay, Thai, Japanese, Filipino, and Indian populations) with varying estimates reported at 0.5 to 4.3%
  4. 4. Most commonly seen on lingual surface of anterior teeth (mainly maxillary lateral incisors) & Occlusal surface of mandibular premolars. There is typically a bilateral, symmetric distribution, with a slight sexual predilection for females.
  5. 5. Etiology :  Remains undetermined.  Autosomal dominant and X-linked dominant inheritance patterns are seen,  Localized trauma, possibly from pressure exerted upon the developing tooth bud has been suggested.
  6. 6. Synonyms  Odontome, odontoma (odontome) of the axial core type, evaginatus odontoma (evaginated odontome)  Occlusal enamel pearl, occlusal tubercle, tuberculum anomalous,  Accessory cusp, supernumerary cusp, interstitial cusp, tuberculated cusp,  Tuberculated cusp premolar, Leong’s premolar, and talon
  7. 7. Pathophysiology: An abnormal proliferation and folding of a portion of the inner enamel epithelium and subjacent ectomesenchymal cells of the dental papilla Into the stellate reticulum of the enamel organ During the bell stage of tooth formation
  8. 8. Oehlers: 1. 2. 3. 4. 5. Wide pulp horns (34%) Narrow pulp horns (22%) Constricted pulp horns (14%) Isolated pulp horn remnants (20%) No pulp horn (10%)
  9. 9. Malocclusion with the opposing tooth upon the cusp-like elevation occurs as involved teeth erupt into the dental arches. The resultant occlusal traumatic force causes abnormal wear or fracture of the tubercle, and is the usual manner of pulp exposure for this anomaly
  10. 10. A 20 year old female was referred for consult and treatment of mandibular right posterior tooth. Patient was concerned about the ‘bubble on her gums’. Occlusal tubercle present in all four mandibular premolars & an associated Periapical radiolucency w.r.t. 44
  11. 11.  EPT: Except #44 other teeth were vital.  Root canal therapy of #44. Reduction of opposing tooth contact and composite restoration of #34, 35, 45.
  12. 12.  Calcium hydroxide root canal dressing was performed 15 days for the period of four months.  Obturation of the tooth was done using gutta-percha and endodontic sealer (Endoflas FS)
  13. 13. Six months follow up
  14. 14. References 1. 2. 3. 4. 5. 6. Marc E. Levitan, Van T. Himel Dens Evaginatus: Literature Review, Pathophysiology, and Comprehensive Treatment Regimen . J Endod 2006;32:1–9 Neville B, Damm D, Allen C, Bouquot J. Oral and maxillofacial pathology, 2nd ed. Philadelphia: WB Saunders, 2002;77–9. Ash M. Wheeler’s dental anatomy, physiology and occlusion, 8th ed. Philadelphia:WB Saunders, 2003;241–2. Kocsis G, Marcsik A, Kokai E, Kocsis K. Supernumerary occlusal cusps on permanent human teeth. Acta Biol Szeged 2002;46:71– 82 Stewart R, Dixon G, Graber R. Dens evaginatus (tuberculated cusps): genetic and treatment considerations. Oral Surg Oral Med Oral Pathol 1978;46:831– 6. Davies P, Brook A. The presentation of talon cusp: diagnosis, clinical features, associations and possible aetiology. Br Dent J 1985;159:84–8.