Conservative management of dens evaginatus

Abstract

Dens evaginatus is a condition affecting predominantly mandibular premolars and leading frequently to pulp necrosis because of occlusal trauma. In this study, the success of treatment aimed at retaining affected teeth was evaluated in 8 patients with 15 teeth showing dens evaginatus. When the tooth was nonvital at the time of diagnosis, apexification procedures using calcium hydroxide were successful in four of five cases. Diagnosis of the condition before the tooth reached full occlusion (six teeth) allowed conservative management with preservation of pulp vitality, by prevention of traumatic occlusion. The dens evaginatus was ground down in small increments to avoid pulp exposure and promote deposition of secondary dentin. No treatment was necessary in two cases because of lack of occlusal contact, one was managed by pulpotomy and one patient refused treatment. The early diagnosis of dens evaginatus before occlusal trauma can occur should permit protection of the pulp and preservation of tooth vitality. Dens evaginatus is a condition affecting predominantly mandibular premolars and leading frequently to pulp necrosis because of occlusal trauma. In this study, the success of treatment aimed at retaining affected teeth was evaluated in 8 patients with 15 teeth showing dens evaginatus. When the tooth was nonvital at the time of diagnosis, apexification procedures using calcium hydroxide were successful in four of five cases. Diagnosis of the condition before the tooth reached full occlusion (six teeth) allowed conservative management with preservation of pulp vitality, by prevention of traumatic occlusion. The dens evaginatus was ground down in small increments to avoid pulp exposure and promote deposition of secondary dentin. No treatment was necessary in two cases because of lack of occlusal contact, one was managed by pulpotomy and one patient refused treatment. The early diagnosis of dens evaginatus before occlusal trauma can occur should permit protection of the pulp and preservation of tooth vitality.