Dens Evaginatus: Prophylactic Management and the Treatment of Pulp Infection

Abstract

Dens evaginatus is a developmental anomaly. It is characterized by the occurrence of an extra cusp shaped as a tubercle projecting from the occlusal surface. Premolars are more likely to be affected. In teeth with dens evaginatus, the pulp horn may extend into the tubercle. If the tubercle is worn off or fractured, the pulp may be exposed, leading to pulpitis, pulp necrosis, and even severe dental infection. Traditional endodontic treatment with gutta point canal filling is sufficient when the root formation is completed. Unfortunately, pulp infection originated from dens evaginatus is usually found on teeth with immature root formation. In these cases, apexogenesis or apexification procedures are the choices of pulp treatment. This report includes three cases: one 11-year-old girl and two 11-year-old boys. We display a preventive procedure of enamoplasty-preventive resin restoration for the newly erupted premolars to protect the dens evaginatus tubercle. Furthermore, the treatment options for pulp infection of teeth with immature root formation are discussed.