• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.2
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• pp.305-309
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• 2009

Dens evaginatus is a dental anomaly most commonly seen in premolar teeth in which a tubercle or protuberance projects from either the center of the occlusal surface or the buccal triangular ridge. These tubercles are easily fractured from mastication as the tooth erupts and frequently leads to pulp necrosis as a common complication. To prevent these sequelae, prophylactic treatment soon after the tooth starts erupting is essential. These preventive treatments include, selective grinding and protection of the tubercle by pit and fissure sealant. When the tooth does shows signs of pulp necrosis and apical periodontitis, endodontic procedures are needed. Apexification and apexogenesis are usually the treatment of choice for the affected teeth which have immature apices. Apexogenesis is a vital pulp therapy procedure performed to encourage continued physiological development and formation of the root end. It involves removal of the inflamed pulp and the placement of calcium hydroxide on the remaining healthy pulp tissue. This case report describes an atypical apexogenesis of a mandibular premolar which showed to be a dens evaginatus. The tooth which was treated with calcium hydroxide shows good results and is planned for permanent root canal filling.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.2
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• pp.310-317
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• 2009

Dens evaginatus is a dental anomaly involving an extra cusp or tubercle that protrudes from the occlusal surface of the affected tooth. The prevalence of dens evaginatus is 1 to 4 percent, and dens evaginatus is observed most commonly in premolars. It can be worn or fractured easily, resulting in pulpal exposure, pulpal infection, loss of vitality, facial infection and osteomyelitis. Since the tooth frequently has the immature apex when the tubercle is fractured, there is difficulty in treatment. Although calcium hydroxide is widely used for pulp treatment of an immature permanent tooth, several alternatives have been suggested to reduce patient's appointments. Mineral trioxide aggregate is considered biocom-patible and has excellent marginal sealing ability. In addition, it can minimize patient's visits. In this case report, apexification with MTA was attempted on the immature premolars in patients with cellulitis patient, caused by pulp necrosis due to dens evaginatus. Favorable clinical and radiologic results were achieved. In one case, continued root formation was observed.