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.
Highlights
Dens evaginatus (DE) or evaginated odontoma is a developmental anomaly characterized by the presence of an accessory cusp, abnormal tubercle, or elevation that occurs in human dentition
Calcium hydroxide root canal dressing was performed and changed every 10 days followed by frequent root canal irrigation with chlorhexidine for the period of two months (Figure 4); the access cavity was temporized with the intermediate restorative material (IRM, Dentsply Caulk, Milford, USA)
In the presented case, when the long-standing chronic apical periodontitis did not respond to the chemomechanical preparation and calcium hydroxide interappointment therapy, we performed microbiological culture in which growth of Enterococcus faecalis and Streptococcus species was observed
Summary
Dens evaginatus (DE) or evaginated odontoma is a developmental anomaly characterized by the presence of an accessory cusp, abnormal tubercle, or elevation that occurs in human dentition. It consists of enamel covering a dentinal core that usually contains pulp tissue. Detection and management of this condition are important because trauma during mastication causes fracture or wear of the tubercle that leads to necrosis of pulp and periapical infection. This condition is predominantly found on the occlusal surface of mandibular premolars [2] and lingual surface of anterior teeth (mainly maxillary lateral incisors) [3]. It is usually observed as bilateral, symmetric distribution, with a slight sexual predilection for females
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