The appearance of teeth varies in sizes in different individuals but they have a typical shape to serve their specific functions. Premolar teeth have two cusps on the occlusal surface. These are the normal anatomy of premolars.
However, sometimes acquired and inherited developmental abnormalities may alter the size, shape and number of teeth. Dens evaginatus is a developmental anomaly characterized by projection or tubercle protuberance of enamel and dentine that usually encloses the pulp tissue. It occurs more frequently on premolars, which is also known as Leong’s premolar.
The accessory cusp is often prone to worn or fracture in normal function or trauma.
If no proper treatment is done on the fracture cusp, there will be chances for bacteria to infect the pulp of the tooth. It may lead to pulpal and periapical pathology such as abscess or sinus formation.
Hence this condition requires root canal treatment to remove necrotic pulp tissue and disinfect the canal.
In non-vital teeth with incomplete root development, apexification with calcium hydroxide non-setting or Mineral Trioxide Aggregate ( MTA ) is undertaken.
Preventive treatment is needed to protect the tooth. In dens evaginatus of vital teeth, selective grinding of projected cusp and restoring with composite is the treatment of choice.
Dr Lim Ming Chau, B.D.S. (UM)