Dens evaginatus: a cause of periapical pathology in caries-free teeth




Dens evaginatus, Pulp necrosis, Case report, Morphological variation


There are morphological variations reported in both primary and permanent dentition. This case report describes the presentation of dens evaginatus causing periapical pathology in a caries-free mandibular second premolar. The tubercle-like presentation of dens evaginatus interferes with the occlusion of posterior teeth. Occlusal wear caused exposure of the pulp within the cusp resulting in pulpal necrosis and, eventually, periapical pathology. Proper diagnosis and management by root canal treatment resulted in the resolution of the symptoms and complete healing.


Metrics Loading ...


Oehlers FA, Lee KW, Lee EC. Dens evaginatus (evaginated odontome). Its structure and responses to external stimuli. Dent Pract Dent Rec. 1967;17(7):239-44.

Dankner E, Harari D, Rotstein I. Dens evaginatus of anterior teeth—literature review and radiographic survey of 15,000 teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(4):472-5.

Senia E, Regezi J. Dens evaginatus in the etiology of bilateral periapical involvement in caries-free premolars. Oral Surg Oral Med Oral Pathol. 1974;38(3):465-8.

Hattab F, Yassin O, Al-Nimri K. Talon cusp in permanent dentition associated with other dental anomalies: review of literature and reports of seven. ASDC J Dent Child. 1996;63(5):368-76.

Hill F, Bellis W. Dens evaginatus and its management. Br Dent J. 1984;156(11):400-2.

Levitan ME, Himel VT. Dens evaginatus: literature review, patho-physiology, and comprehensive treatment regimen. J Endod. 2006;32(1):1-9.

Echeverri EA, Wang MM, Chavaria C, Taylor DL. Multiple dens evaginatus: diagnosis, management, and complications: case report. Pediatr Dent. 1994;16(4):314-7.

Gupta SK, Saxena P, Jain S, Jain D. Prevalence and distribution of selected developmental dental anomalies in an Indian population. J Oral Sci 2011;53(2):231-8.

Siqueira V, Braga T, Martins MA, Raitz R, Martins MD. Dental fusion and dens evaginatus in the permanent dentition: literature review and clinical case report with conservative treatment. J Dent Child (Chic). 2004;71(1):69-72.

Kocsis G, Marcsik A, Kokai E, Kocsis K. Supernumerary occlusal cusps on permanent human teeth. Acta Biol Szeged. 2002;46:71-82.

Yong SL. Prophylactic treatment of dens evaginatus. ASDC J Dent Child. 1974;41(4):289-92.

Stecker S, DiAngelis AJ. Dens evaginatus: a diagnostic and treatment challenge. J Am Dent Assoc. 2002;133(2):190-3.

Chu FC, Sham AS, Yip KH. Fractured dens evaginatus and unusual peri-apical radiolucency. Dent Traumatol. 2002;18(6):339-41.

Lin CS, Llacer-Martinez M, Sheth CC, Jovani-Sancho M, Biedma B. Prevalence of premolars with Dens Evaginatus in a Taiwanese and Spanish population and related complications of the fracture of its tubercle. Eur Endod J. 2018;3(2):118-22.






Case Reports