Growth & Development
Mimansa Cholera, DDS, MPH
Pediatric Dental Resident
University of California, San Francsico
University of California, San Francisco
Omid Mirfendereski, DDS
University of California, San Francisco
Thomas Tanbonliong, DDS
Program Director
University of California, San Francsico
SAN FRANCISCO, California, United States
Dens evaginatus isĀ a rare dental developmental anomaly characterized by the presence of an extra cusp on the occlusal surfaces of posterior teeth or the lingual surfaces of anterior teeth. The prevalence of the anomaly ranges from less than 1% to more than 4%, being most common in Asian populations. The teeth most commonly affected are the premolars, especially the mandibular second premolars. The etiology of dens evaginatus is unclear, although autosomal and X-linked dominant genetic inheritances have been proposed. Abnormal proliferation and folding of the inner enamel epithelium and dental papilla during the bell stage of tooth development are thought to be involved. Over time, the thin pulpal extensions in the tubercles may be exposed as the tubercles are worn, resulting in pulpal necrosis and periapical pathosis. Early diagnosis and management are important to prevent occlusal interferences, fracture, and eventual periapical pathosis in these teeth. We present three cases of posterior teeth dens evaginatus, two of whom are sisters. In the older sister, pulpal necrosis in a mandibular premolar resulted in the need for endodontic treatment. In the older sister, the younger sister, and the third patient, premolars with normal pulp were prophylactically sealed or reinforced with composite restorations to prevent tubercle breakdown and pulpal exposure.