This case describes the presentation of dens evaginatus on a maxillary central incisor in an 8-year-old Caucasian male, its subsequent monitoring and later management. Dens evaginatus is a dental anomaly most commonly noted as an accessory tubercle on the occlusal surface of premolars and the palatal aspect of incisors as a talon cusp. Complications can result in loss of pulp vitality, sometimes causing periapical periodontitis. Clinicians should be aware of the presentation and the advantages of different approaches to the management of dens evaginatus.
CPD/Clinical Relevance: To raise awareness of dens evaginatus in dental professionals working in primary and secondary care.
Article
Dens evaginatus (DE) is a rare dental developmental anomaly that is found in teeth where the enamel outer surface appears to have an anatomic anomaly, or an extra cusp in the form of a tubercle, or both. The tubercle is composed of an outer enamel layer, a dentine core and prominent pulp tissue, which can extend to the main part of the pulp.1
Upper incisors are less frequently affected than premolars, which are the most common teeth to display extra cusps. These can occur bilaterally and can be symmetrical. The occlusal surfaces of posterior teeth and labial or palatal surfaces of anterior teeth are commonly affected.2,3
The prevalence of DE ranges from 0.06% to 7.7%, depending on race.4,5
DE occurs more commonly in Asian patients6 and has been reported to have higher rates amongst Chinese7 populations. DE is more common in men than women,5 and occurs more frequently in the mandible than the maxilla.8 Patients with Ellis-van Creveld syndrome, Mohr syndrome, Rubinstein-Taybi syndrome and Sturge-Weber syndrome are at a higher risk of having DE.9–12
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