Page 17 - GP Fall 2019

Fig. 2. Intra oral pictures

Summary 6. Thomas MS. Dens evaginatus as a
possible cause for pulpal compli-
The following classification of DE teeth by Fig. 3. Occlusal
image.
cations. Journal of Dental Scienc-
Levitan and Himel is particularly useful Tooth #5 has a
3
small occlusal
restoration
to the clinician in determining appropriate Tooth #12 es. 2016;11(4):470-. doi: 10.1016/j.
presents with the
jds.2016.08.002.
treatment: enamel tubercle PubMed PMID:
Type I: Normal pulp, mature apex WOS:000400956500020.
Type II: Normal pulp, immature apex 7. Turner JW, Kluemper GT, Chance K,
Type III: Inflamed pulp, mature apex Long L. Dens evaginatus: The hornet’s
Type IV: Inflamed pulp, immature apex nest of adolescent orthodontics. Amer-
Type V: Necrotic pulp, mature apex ican Journal of Orthodontics and Den-
Type VI: Necrotic pulp, immature apex tofacial Orthopedics. 2013;143(4):570-
According to Levitan and Himel , teeth Figure 3. Occlusal view of maxillary arch. 3. doi: 10.1016/j.ajodo.2012.03.034.
3

H
with normal pulp and a mature apex (Type PubMed PMID: WOS:00
I) may be treated by occlusal reduction
of the opposing tooth followed by topi- some intracanal medicament containing
cal application of fluoride varnish. The antibiotics, however the literature on which
medicament to use is inconclusive. The
DE-affected tooth can then be built up
with light-cured resin to provide protection management of DE outlined by Levitan Shariss Ostrager is a
3
from wear. Clinical re-evaluation every and Himel is further supported by other student at New York
2,5-7
six months and radiographic re-evaluation literature. University College of
each year are necessary to monitor the need Dentistry.
for adjustment and pulpal recession with Conclusions
age. Following adequate pulpal recession, Overall, it is critical to identify Dens Evag-
the tubercle can be reduced to the level of inatus early and provide prophylactic ther-
apy such as that outlined for Types I and II
the occlusal plane and exposed dentin can
be protected with light-cured resin. Teeth DE, in order to prevent pulp exposure and Drs. Angela DeBartolo
with normal pulp and an immature apex the need for root canal therapy. Providing and Gene Sherwin teach
(Type II) can be treated similarly to Type early, prophylactic treatment minimizes at New York Universi-
loss of tooth structure, ultimately enhanc-
I DE, however, re-evaluation should be ty College of Dentistry
done more frequently, every 3-4 months, to ing the lifespan of the affected teeth. Department of Cariolo-
monitor root development. Teeth with in- gy and Comprehensive
flamed pulp (i.e. irreversible pulpitis) and References of Endodontics. Care.
1. Journal
a mature apex (Type III) should be treated
with conventional root canal therapy and 1996;22(6):323-6. doi: 10.1016/s0099- Dr. Gene Sherwin
placement of a final restoration. Teeth with 2399(96)80269-x. PubMed PMID:
WOS:A1996UN51200012.
inflamed pulp and an immature apex (Type 2. Ayer A, Vikram M, Suwal P. Dens Evag-
IV) should be treated with pulpotomy, and
application of mineral trioxide aggregate inatus: A Problem-Based Approach.
(MTA) and calcium hydroxide (CaOH ) Case Reports in Dentistry. 2015:4. doi:
2
to the pulpal surface in order to stimulate 10.1155/2015/393209. PubMed PMID:
WOS:000420054100040.
formation of a dentin bridge and create a
seal that prevents bacterial microleakage 3. Levitan ME, Himel VT. Dens evagi-
into the remaining healthy pulpal tissue natus: Literature review, pathophysi- Dr. Analia Veitz-Keenan
so the root can continue to develop. Teeth ology, and comprehensive treatment teaches at New York
regimen. Journal of Endodontics.
with necrotic pulp and a mature apex (Type University College of
V) should be treated with conventional root 2006;32(1):1-9. doi: 10.1016/j. Dentistry Department of
canal therapy and placement of a final res- joen.2005.10.009. PubMed PMID: Oral and Maxillofacial
WOS:000234679500001.
toration. Finally, teeth with necrotic pulp 4. Marya CM, Parashar V, Grover S, Dahi- Pathology, Radiology
and an immature apex (Type VI) should be and Medicine.
treated with root canal therapy involving ya V. A rare case of dens evaginatus and
dens invaginatus in the same tooth,
with a review of treatment options.
Gen Dent. 2011;59(4):e182-4.
PubMed PMID: 21903560.
5. Rao YG, Guo LY, Hu T.
Multiple Dens Evaginatus of Pre-
molars and Molars in Chinese Den-
tition: A Case Report and Litera-
ture Review. International Journal
of Oral Science. 2010;2(3):177-80.
doi: 10.4248/ijos10052. PubMed
A B PMID: WOS:000282798700007.
Fig. 2. Intra oral pictures
Figure 2. A-B. Intra oral pictures www.nysagd.org l Fall 2019 l GP 17

Fig. 3. Occlusal
image.
Tooth #5 has a
small occlusal
restoration
Tooth #12
presents with the
enamel tubercle

H