Concommitant occurance of dens invaginatus and talon cusp: A case report / Ocorrência simultânea de dens invaginatus e cúspide talon: relato de caso

PURPOSE: Morphological dental anomalies of the maxillary lateral incisors are relatively common. However, their simultaneous occurrence is a relatively rare event. We report a case of dens invaginatus and talon cusp concurrently affecting maxillary lateral incisors. The etiology, pathophysiology, association with other dental anomalies, as well as various treatment modalities of these anomalies are discussed. CASE DESCRIPTION: An 18-year-old male patient reported with a complaint of crowding of maxillary front teeth. On intraoral examination, permanent dentition with Class I malocclusion with anterior crowding was observed. Tooth 12 showed a radiopaque invagination from a lingual pit but confined to the crown of the tooth. This invagination was approximately circular with a central core of radiolucency, which was consistent with the diagnosis of a dens invaginatus type I. Tooth 22 showed the talon cusp as a typical inverted cone with enamel and dentine layers and a pulp horn extending only into the base of the cusp. Talon cusp was treated by prophylactic enameloplasty to avoid plaque accumulation, the deep lingual pit was sealed using composite resin and regular clinical and radiographic follow-up was advised. Patient was scheduled for orthodontic treatment to correct crowding of maxillary anterior teeth. CONCLUSION: We emphasize the fact that detailed clinical and radiographic examination of the maxillary lateral incisors is vital in avoiding complications.

OBJETIVO: Anomalias morfológicas dentárias dos incisivos laterais superiores são relativamente comuns. No entanto, a sua ocorrência simultânea é um evento relativamente raro. Relatamos um caso de dens invaginatus e cúspide talon simultaneamente afetando incisivos laterais superiores. A etiologia, fisiopatologia, associação com outras anomalias dentárias, bem como várias modalidades de tratamento destas anomalias são discutidas. DESCRIÇÃO DO CASO: Um paciente de 18 anos, sexo masculino, relatou com queixa de apinhamento dos dentes anteriores superiores. Ao exame intraoral observou-se dentição permanente com má oclusão Classe I com apinhamento anterior. O dente 12 mostrou uma invaginação radiopaca lingual, confinada à coroa do dente. Esta invaginação era aproximadamente circular, com um núcleo central de radioluscência, que foi compatível com o diagnóstico de dens invaginatus tipo I. O dente 22 apresentou uma cúspide talon como um cone invertido típico com esmalte e dentina em camadas. A cúspide talon foi tratada por ameloplastia profilática para evitar acúmulo de placa, a fissura lingual foi selada com resina composta e foram aconselhados controles clínicos e radiográficos. O paciente foi encaminhado para tratamento ortodôntico para corrigir o apinhamento dos dentes anteriores superiores. CONCLUSÃO: Enfatizamos o fato de que o exame clínico e radiográfico detalhado dos incisivos laterais superiores é vital para evitar complicações.

Dens evaginatus: revisión de la literatura, fisiopatología y régimen de tratamiento completo / Dens evaginatus: literature review, pathophysiology, and comprehensive treatment regimen

El dens evaginatus (DE) es una anomalía dental rara que se ha documentado desde 1925. Sucede primariamente en personas de ascendencia asiática y se presenta como una protrusión de un tubérculo desde las superficies oclusales de los dientes posteriores y las superficies linguales de los dientes anteriores. Los tubérculos tienen una capa de esmalte que cubre un núcleo de dentina que contiene una extensión de la pulpa. Estas protrusiones de tipo cuspideo son susceptibles de producir exposición pulpar por desgaste o fractura debida a la maloclusión, lo que produce complicaciones pulpares al poco tiempo de la erupción. La intervención endodóncica en dientes permanentes con raices inmaduras es poco predecible para las pulpas inflamadas y deja al diente con una estructura radicular comprometida cuando se tratan pulpas necróticas. Los esfuerzos para asegurar una madurez radicular han incluido tratamiento profiláctico o preventivo con varios grafos de invasividad pulpar. Las opciones de tratamiento han cambiado a medida que los materiales y la tecnología han mejorado. El objetivo es revisar la literatura y la patofisiología respecto al DE, y presentar un régimen de tratamiento completo, incluyendo un enfoque verdaderamente profiláctico, sin invasión pulpar. Se documenta un estudio de un mestizo con DE. El tratamiento de cuatro premolares inferiores afectados con tres categorías diagnósticas distintas ilustrará varios aspectos del protocolo de tratamiento presentado, y la morfología dental de anomalía se presenta, para ayudar a la identificación clínica (J Endod 2006; 32: 1-9)

Dens evaginatus (DE) is an uncommon dental anomaly, having been well documented since 1925. It occurs primarily in people of Asian descent and is exhibited by protrusion of a tubercle from occlusal surfaces of posterior teeth, and lingual surfaces of anterior teeth. Tubercles have an enamel layer covering a dentin core containing a thin extension of pulp. These cusp-like protrusions are susceptible to pulp exposure from wear or fracture because of malocclusion, leading to pulpal complications soon after eruption. Endodontic intervention of permanent teeth with immature roots is unpredic for inflamed pulps, and leaves a tooth with compromised root structure when treating necrotic pulps. Efforts to ensure root maturity have involved preventive or prophylactic treatment with varying degrees of pulp invasiveness. Treatment options have changed as technology and materials have improved. The goal is to review the literature and pathophysiology regarding DE, and present a new comprehensive treatment regimen, including a truly prophylactic approach without pulpal invasiveness. A case study of a mestizo with DE is documented. Treatment of four affected mandibular premolars exhibiting three distinct diagnostic categories will illustrate various aspects of the treatment protocol presented, and tooth morphology of the anomaly is shown to aid clinical recognition (J Endod 2006;32:1-9)

Vital root canal treatment of a dens in dente.

A case of dens invaginatus is presented in which a greatly enlarged mandibular lateral incisor radiographically appeared to have a tooth within a tooth (dens in dente). The dens was treated endodontically without violating the integrity of the pulp.