References

Geist JR. Dens evaginatus. Case report and review of the literature. Oral Surg Oral Med Oral Pathol. 1989; 67:628-631
Stecker S, Diangelis AJ. Dens evaginatus. A diagnostic and treatment challenge. J Am Dent Assoc. 2009; 133:190-193
Neville B, Damm D, Allen C, Bouquot J., 2nd edn. Philadelphia: WB Saunders; 2002
Echeverri EA, Wang MM, Chavaria C, Taylor DL. Multiple dens evaginatus: diagnosis, management, and complications: case report. Pediatr Dent. 1994; 16:314-317
Merrill R. Occlusal anomalous tubercles on premolars of Alaskan Eskimos and Indians. Oral Surg Oral Med Oral Pathol. 1964; 17:484-496
Kocsis G, Marcsik A, Kokai E, Kocsis K. Supernumerary occlusal cusps on permanent human teeth. Acta Biol Szeged. 2002; 36:71-82
Curzon M, Curzon J, Payton H. Evaginated odontomes in the Keewatin Eskimo. Br Dent J. 1970; 129:324-328
Palmer M. Case reports of evaginated odontomes in Caucasians. Oral Surg Oral Med Oral Pathol. 1973; 35:772-779
Siqueira V, Braga T, Martins MA, Raitz R, Martins MD. Dental fusion and dens evaginatus in the permanent dentition: literature review and clinical case report with conservative treatment. J Dent Child. 2004; 71:69-72
Yip W. The prevalence of dens evaginatus. Oral Surg Oral Med Oral Pathol. 1974; 38:80-87
Geist J. Dens evaginatus – case report and review of the literature. Oral Surg Oral Med Oral Pathol. 1989; 67:628-631
Senia E, Regezi J. Dens evaginatus in the etiology of bilateral periapical involvement in caries-free premolars. Oral Surg Oral Med Oral Pathol. 1974; 38:465-468
Stewart R, Dixon G, Graber R. Dens evaginatus (tuberculated cusps): genetic and treatment considerations. Oral Surg Oral Med Oral Pathol. 1978; 46:831-836
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Stecker S, Diangelis A. Dens evaginatus a diagnostic and treatment challenge. J Am Dent Assoc. 2002; 133:190-193
Oehlers F, Lee K, Lee E. Dens evaginatus (evaginated odontome): its structure and responses to external stimuli. Dent Pract Dent Rec. 1967; 17:239-244
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Pre-eruptive diagnosis and management of occlusal dens evaginatus in premolar teeth

From Volume 45, Issue 9, October 2018 | Pages 882-888

Authors

Farhad B Naini

Consultant Orthodontist, St George's and Kingston Hospitals, London, UK

Articles by Farhad B Naini

Ioannis Levisianos

BDS, MSc, MFDS RCPS(Gla), MOrth RCS(Eng)

Specialist Orthodontist, Edinburgh, Scotland, Eastman Dental Hospital, London, UK.

Articles by Ioannis Levisianos

Lee Foo

Associate Specialist in Paediatric Dentistry, St George's Hospital, Eastman Dental Hospital, London, UK.

Articles by Lee Foo

Daljit S Gill

BDS, BSc, MSc, FDS RCS, MOrth, FDS(Orth) RSC(Eng)

Consultant Orthodontist/Honorary Senior Lecturer, UCL Eastman Dental Institute, Honorary Consultant Orthodontist, Great Ormond Street Hospital, London

Articles by Daljit S Gill

Abstract

Dens evaginatus is an uncommon dental aberration that occurs primarily on the occlusal surfaces of premolar teeth. Developmentally, it is similar to a talon cusp, though the latter manifests on the palatal or lingual surfaces of anterior teeth. Its anatomical location is often the central fossa of the associated tooth; it can vary significantly in size and can be present symmetrically in the ipsilateral and contralateral quadrants. Histologically, the enamel protuberance may contain dentinal and pulpal tissue. If early, ideally pre-eruptive diagnosis is not made, there is a significant risk that, on eruption, these protuberances will shear off under occlusal forces, exposing the pulp, and potentially leading to loss of teeth in an otherwise healthy dentition. Therefore, its clinical implications are significant to the general dental practitioner, the paediatric dentist, the orthodontist and the restorative dentist.

CPD/Clinical Relevance: This review article aims to summarize the available dental literature and illustrate the appropriate management of a patient with dens evaginatus.

Article

Dens evaginatus (DE) is a developmental dental anomaly that presents as an enamel protuberance commonly associated with the tooth's anatomical fossa.1,2 This uncommon dental aberration may project superior to the neighbouring enamel tissue and histologically it is comprised of an external enamel shell, a dentine core and, occasionally, a pulp tissue horn. The pulp tissue may extend partially or entirely into the tubercle.3 DE most frequently arises from the occlusal fossa of posterior teeth and the palatal/lingual surface of anterior teeth. It is more commonly seen in premolars but it can present in molars and canines; its presentation being five times more common in the mandible than the maxilla.4 Typically, the anomaly will present bilaterally in a symmetrical fashion with a slight gender predilection for females.5 There is no evidence that the occurrence is related to any medical problems or syndromes. Indeed, the literature is awash with nomenclature that have been used to describe this morphological phenomenon, such as odontome, odontoma of the axial core type, evaginatus odontoma, occlusal enamel pearl, occlusal tubercle, tuberculum anomalus, accessory cusp, supernumerary cusp, interstitial cusp, tuberculated cusp, tuberculated premolar, Leong's premolar, dens evaginatus and talon cusp (in reference to the anterior teeth).5,6,7,8,9,10,11,12,13,14,15,16,17,18-19 Most of the literature is in agreement that the developmental processes that lead to the presentation of DE and talon cusp are very similar,1,6,19,20 to the extent that the terminology ‘talon cusp’ has traditionally been used to describe DE. The latter, coined by Oehlers (1967), was later universally adopted to allow differentiation between the anterior and posterior tooth presentations.18 Other developmental oddities, such as the cusp of Carabelli, with a reported prevalence of 17.4 to 90%, typically seen on the palatal surface of the maxillary first molar mesiopalatal cusp, seem to be morphologically distinct. The differentiation is primarily histological, as the enamel process rarely contains pulpal tissue and only occasionally dentinal tissue. In addition, the position of Carabelli's cusp is inconsequential and would not normally present an occlusal interference, in contrast to DE or a talon cusp.1

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