Current Management of Dens Evaginatus Teeth Based on Pulpal Diagnosis.

INTRODUCTION: Dens evaginatus (DE) is a dental anomaly with a supernumerary tubercle projection that typically contains dentin and pulp tissue. However, the tubercle projection can fracture, exposing the dentin and potentially the dental pulp, which induces pulpal diseases. Managing DE should be primarily based on the clinical diagnosis of the pulp. METHODS: The literature search in prevalence, prophylaxis, and management of dens evaginatus was performed in PubMed database as well as by manual search, in which the related contents were collected and descriptively analyzed. RESULTS: Of the 264 searched literatures, 62 articles were included for this scoping review. The prophylactic management of the tubercle of DE teeth with a normal pulp should be performed as early as possible by the prep-and-fill technique or the reinforcement technique to preserve tooth vitality and continued root development, with the former reported to be superior compared with the latter. Furthermore, DE teeth with reversible pulpitis should be managed with the prep-and-fill technique. For DE teeth with irreversible pulpitis, vital pulp therapy, ie, partial or full/coronal pulpotomy, should be considered when the pulpal inflammation is limited to the coronal pulp to preserve the vitality of the radicular pulp that induces apexogenesis. A pulpectomy should be performed if the pulpal inflammation has progressed into the radicular pulp. For DE teeth with pulpal necrosis (or after pulpectomy) and immature roots, mineral trioxide aggregate apexification or regenerative endodontic procedures are the treatment options. For DE teeth with pulpal necrosis and complete root formation, nonsurgical root canal treatment is the treatment of choice. A flow chart of the decision-making for managing DE teeth based on pulpal diagnosis is proposed. CONCLUSION: DE teeth should be properly managed, by prophylaxis or treatment, depending on pulpal diagnosis and related factors.

Outcomes and Predisposing Factors of Two Prophylactic Treatments in Dens Evaginatus Premolars: A Retrospective Study.

INTRODUCTION: Dens evaginatus (DE) in premolars may contain a pulpal extension inside the occlusal tubercle. DE prophylaxis should be performed to prevent pulpal exposure due to tubercle fracture. The aim of this study was to compare the outcomes of 2 prophylactic treatments, that is, prep and fill (PF) and reinforcement (RF), in DE premolars based on clinical and radiographic data, and to identify the predisposing factors. Furthermore, DE prevalence was reported. METHODS: The DE premolar data were collected from dental and radiographic records at the Faculty of Dentistry, Mahidol University, and Bangkok Hospital, Thailand during 2000-2020. Their prevalence and characteristics were determined. Only DE teeth treated with PF or RF prophylaxis were included. Outcomes and possible predisposing factors of the 2 prophylactic groups were evaluated and statistically analyzed. RESULTS: Initially, 303 DE premolars from 110 patients were identified, with the highest prevalence observed in second mandibular premolars (37.21%). The prevalence of contralateral, same quadrant, and opposite arch DE premolars was 50.91%, 39.09%, and 34.55%, respectively. A total of 216 DE teeth met the criteria with an ∼82% recall rate, with 190 and 26 premolars treated by PF and RF, respectively. With mean recall periods of ∼31 and 23 months, the outcomes in the PF and RF group were 95.79% and 80.77% success, respectively, which were significantly different (P = .01). No significant predisposing factor was found. CONCLUSION: Prophylactic treatment in DE premolars with PF provided a significantly higher success rate than those treated with RF.

Comparison of the Effects of Intraradicular Materials on the Incidence of Fatal Root Fracture in Immature Teeth Treated with Mineral Trioxide Aggregate Apexification: A Retrospective Study.

INTRODUCTION: This study aimed to compare the incidence of root fractures that led to extraction in immature teeth endodontically treated by mineral trioxide aggregate (MTA) apexification and were restored with either reinforced (resin composite or fiber post) or nonreinforced (gutta percha or MTA) intraradicular materials. METHODS: Necrotic immature teeth treated with MTA apexification from 1996 to 2017 were selected according to the inclusion and exclusion criteria. Intraradicular materials and preoperative and treatment factors were obtained from dental charts and radiographs. The incidence of fatal root facture was identified. Kaplan-Meier survival analysis and the Cox proportional hazard model were used to show the survival rate and predisposing factors at a significance level of .05. RESULTS: The average recall period was 30 months. The incidence of root fracture in the teeth restored with the reinforced materials was 5.5%, which was not significantly different from the nonreinforced materials (8.3%). Furthermore, the fracture rates between the fiber post and resin composite groups were not significantly different. Two significant predisposing factors influencing the incidence of root fracture were detected: preoperative external inflammatory root resorption (hazard ratio = 26.86; P < .05) and patient age > 15 years (hazard ratio = 8.60, P < .05). CONCLUSIONS: Immature teeth treated with MTA apexification and restored with the reinforced or nonreinforced intraradicular materials exhibited a similar rate of root fracture. Preoperative external inflammatory root resorption and patient age > 15 years were found to be the predisposing factors that significantly increased the incidence of root fracture.