Restor Dent Endod.  2024 Aug;49(3):e28. 10.5395/rde.2024.49.e28.

Endodontic characteristics of mandibular premolar with dens evaginatus: a retrospective study

• Kim M
• Jeon S
• Seo MS

• KMID: 2559741
• DOI: http://doi.org/10.5395/rde.2024.49.e28

Abstract

Objectives
This study aimed to investigate the endodontic characteristics of mandibular premolars with dens evaginatus (DE) that require endodontic treatment.
Materials and Methods
Patients who underwent endodontic treatment were enrolled. The inclusion criteria were patients who underwent root canal treatment in the lower permanent teeth with DE and were followed up for at least 1 year. Preoperative clinical and radiographic variables were obtained. The frequency distribution of the preoperative variables was compared using the χ² or Fisher’s exact tests. The significance of the change in periapical health index (PAI) and root development stages before and after treatment was examined using the Wilcoxon signed-rank test.
Results
A total of 150 teeth of 134 patients with an average age of 15.3 years were included. The percentage distribution comparison of the preoperative variables and obturation techniques revealed significant differences in pulpal and periapical diagnosis, and percussion, and especially regarding age, root development stage, and PAI. Age was the only statistically significant preoperative variable associated with root growth (p < 0.05).
Conclusions
Approximately, 60% of DEs requiring endodontic treatment had immature roots. Age being the most significant predisposing factor, early treatment provides the greatest opportunity for full root development.

Keyword

Bicuspid; Dental pulp; Endodontics; Humans; Periapical peridontitis; Retrospective studies

Figure

• 

  Figure 1 Periapical radiographs of tooth #35. (A) Preoperative radiograph reveals tooth #35 with an open apex and is diagnosed as symptomatic apical periodontitis with pulpal necrosis. (B) Preoperative radiograph obtained after image alignment correction using TurboReg plug-in of Image J (version 1.53e, Wayne Rasband, National Institutes of Health, Bethesda, MD, USA). (C) Final radiograph obtained at follow-up, 32 months postoperatively.

Reference

1. Levitan ME, Himel VT. Dens evaginatus: literature review, pathophysiology, and comprehensive treatment regimen. J Endod. 2006; 32:1–9. PMID: 16410059.

2. Yip WK. The prevalence of dens evaginatus. Oral Surg Oral Med Oral Pathol. 1974; 38:80–87. PMID: 4525999.

3. Reichart P, Tantiniran D. Dens evaginatus in the Thai. An evaluation of fifty-one cases. Oral Surg Oral Med Oral Pathol. 1975; 39:615–621. PMID: 1054469.

4. Arunyanart O. Dens evaginatus in Bangkok metropolitan schoolchildren in Bangkhaen District. J Dent Assoc Thai. 2002; 52:120–125.

5. Temilola DO, Folayan MO, Fatusi O, Chukwumah NM, Onyejaka N, Oziegbe E, et al. The prevalence, pattern and clinical presentation of developmental dental hard-tissue anomalies in children with primary and mix dentition from Ile-Ife, Nigeria. BMC Oral Health. 2014; 14:125. PMID: 25323952.

6. Uslu O, Akcam MO, Evirgen S, Cebeci I. Prevalence of dental anomalies in various malocclusions. Am J Orthod Dentofacial Orthop. 2009; 135:328–335. PMID: 19268831.

7. Lin CS, Llacer-Martinez M, Sheth CC, Jovani-Sancho M, Biedma BM. 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; 3:118–122. PMID: 32161867.

8. Law AS. Considerations for regeneration procedures. J Endod. 2013; 39:S44–S56. PMID: 23439044.

9. Alobaid AS, Cortes LM, Lo J, Nguyen TT, Albert J, Abu-Melha AS, et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. J Endod. 2014; 40:1063–1070. PMID: 25069909.

10. Shabahang S. Treatment options: apexogenesis and apexification. J Endod. 2013; 39:S26–S29. PMID: 23439042.

11. Silujjai J, Linsuwanont P. Treatment outcomes of apexification or revascularization in nonvital immature permanent teeth: a retrospective study. J Endod. 2017; 43:238–245. PMID: 28132710.

12. Lin J, Zeng Q, Wei X, Zhao W, Cui M, Gu J, et al. Regenerative endodontics versus apexifcation in immature permanent teeth with apical periodontitis: a prospective randomized controlled study. J Endod. 2017; 43:1821–1827. PMID: 28864219.

13. Chan EK, Desmeules M, Cielecki M, Dabbagh B, Ferraz Dos Santos B. Longitudinal cohort study of regenerative endodontic treatment for immature necrotic permanent teeth. J Endod. 2017; 43:395–400. PMID: 28110920.

14. Nolla CM. The development of the permanent teeth. J Dent Child. 1960; 27:254–266.

15. Moorrees CF, Fanning EA, Hunt EE Jr. Age variation of formation for ten permanent teeth. J Dent Res. 1963; 42:1490–1502. PMID: 14081973.

16. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol. 1992; 8:45–55. PMID: 1521505.

17. Abbott PV, Yu C. A clinical classification of the status of the pulp and the root canal system. Aust Dent J. 2007; 52:S17–S31. PMID: 17546859.

18. American Association of Endodontists. Guide to clinical endodontics. 6th ed. Chicago, IL: American Association of Endodontists;2013. p. 16.

19. Miller SC. Textbook of periodontia. 3rd ed. Philadelphia, PA: The Blakeston Co.;1950. p. 125.

20. Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod. 2009; 35:1343–1349. PMID: 19801227.

21. Tsilingaridis G, Malmgren B, Andreasen JO, Wigen TI, Maseng Aas AL, Malmgren O. Scandinavian multicenter study on the treatment of 168 patients with 230 intruded permanent teeth - a retrospective cohort study. Dent Traumatol. 2016; 32:353–360. PMID: 26940373.

22. Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986; 2:20–34. PMID: 3457698.

23. Chrepa V, Joon R, Austah O, Diogenes A, Hargreaves KM, Ezeldeen M, et al. Clinical outcomes of immature teeth treated with regenerative endodontic procedures-a San Antonio study. J Endod. 2020; 46:1074–1084. PMID: 32560972.

24. Chueh LH, Ho YC, Kuo TC, Lai WH, Chen YH, Chiang CP. Regenerative endodontic treatment for necrotic immature permanent teeth. J Endod. 2009; 35:160–164. PMID: 19166764.

25. Estefan BS, El Batouty KM, Nagy MM, Diogenes A. Influence of age and apical diameter on the success of endodontic regeneration procedures. J Endod. 2016; 42:1620–1625. PMID: 27623497.

26. Cheng J, Yang F, Li J, Hua F, He M, Song G. Treatment outcomes of regenerative endodontic procedures in traumatized immature permanent necrotic teeth: a retrospective study. J Endod. 2022; 48:1129–1136. PMID: 35398440.

27. Oehlers FA, Lee KW, Lee EC. Dens evaginatus (evaginated odontome). Its structure and responses to external stimuli. Dent Pract Dent Rec. 1967; 17:239–244. PMID: 5226881.

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

29. Reynolds K, Johnson JD, Cohenca N. Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report. Int Endod J. 2009; 42:84–92. PMID: 19125982.

30. Curzon ME, Curzon JA, Poyton HG. Evaginated odontomes in the Keewatin Eskimo. Br Dent J. 1970; 129:324–328. PMID: 5278358.

31. Sang EJ, Song JS, Shin TJ, Kim YJ, Kim JW, Jang KT, et al. Ratio and rate of induced root growth in necrotic immature teeth. J Korean Acad Pediatr Dent. 2018; 45:225–234.

32. Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature - part 1. Effects of study characteristics on probability of success. Int Endod J. 2007; 40:921–939. PMID: 17931389.

33. Swift EJ Jr, Trope M, Ritter AV. Vital pulp therapy for the mature tooth – can it work? Endod Topics. 2003; 5:49–56.

34. Nicoloso GF, Pötter IG, Rocha RO, Montagner F, Casagrande L. A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis. Int J Paediatr Dent. 2017; 27:217–227. PMID: 27529749.

35. Rojas-Gutiérrez WJ, Pineda-Vélez E, Agudelo-Suárez AA. Regenerative endodontics success factors and their overall effectiveness: an umbrella review. Iran Endod J. 2022; 17:90–105. PMID: 36704087.