Professional Documents
Culture Documents
Endodontics &
Dental Traumatology
T. P. C. Sim
School Dental Service, Ministry ot Health,
Singapore, Repuhlic of Singapore
teeth (2), and fractute of the tuf)ercle itself. Eracture or alirilion e)f the tuf^ercle may lead to pulpal
necrosis, periapical inflammatory responses and
loss of vitality in caries free teeth (2). This will necessitate endodonlic proceditres stich as apexificatiejn e)f immalnre apices and snfiseqtient ofittnation, or renunal of the offending tootfi. Tfierefore
lhe prophylactic restoration c:>f these teeth would
be the preferred treatment cfioice.
f{\agiuated teetfi occur predoniinautf) iu persons of mongoloid ethnicity. T h e pathogenesis of
DE is uncertain, fjut e\icfence suggest a familial or
hereditary pattetti (6-7). T h e teporled differences
iu iucidence amongst tfie niongofoid sufjgroups,
lietween 1.01 % (8) and 4.3% (6), niavsuggest varying degrees of penetrance (6) allhougfi this is disputed by Yip (5).
The management of DE is based mainly on empirical evidence. A fiieiattire search fVoin 1936
show a paucity of coutreiffcnf cfiuicaf trials to CNalii-
137
Sim
138
Symptomatic'
Asymptomatic**
Totals (Cotutntis)
Treatment
Treatment
Treatment
Totals
C (Control)
(Rows)
59
11
[5.37%]
[0.52%]
[3.65%]
1039
191
290
1098
192
301
X'- = 9.595 (p<0,01)d1=2
71
1520
1591
Discussion
It would a])|:)eai- ihal the more coiisei-\'ati\-e
a|5|)rc)ach towards the management of Df\ h\ a
loreveutive resiu testoration (Crottp B) tnay be the
more appre)i5riate choice when coinj^arecl lo a
lined, aiiialgani occlusal cax'ity reste)ratioii (C.reiuii
A).
However it must he noted that the j5i'c^|:)orlie)ns
devele)|3iug puf]:)al signs aucf syiii|)toiiis are smafl
for either Irealnienl greiu]). The lenver value of)served for the control (Ciroup C) |3.t)5%] as coui]Dared to the jjiojihylaclic ainalgaiii method
(Group A) [5.37%)| may be altribuleel te) the fad
thai oiil\' small Itibercles whicli did not appear to
cause occfusal iiUerrereuces WCMC (iut iu this category. Moreover, the proj:ilt\laclic amalgani restoraticjii (Group A) was prefc-rred by operators h\ a ratio of 2.2: 1 conijjared to the olher two gi-oiij)s and
this may fiave fiacl an inllueuce ou ifie result.
There have been many alteinalixe trealittenl
nietfiods prope)sed to niauagc DE. f^a/.an (f5) lias
altein]3ted to stippori the tubercle with a li.ssurcsealant. This was to alfo\v l)oth the- material and
the tubercle- to abrade sle)wfy witfi time encouraging foi nialiou of seccjiidary deiiliu; aftfiougfi this
has been shown by Oehlers to he itnieliafile (16).
fiazan, in tfie same paper, fater reconiniended tfie
tise of a ceMiiposite resin instead of a fisstne sealant
for improNed sireiiglh. This method ajajieais to he
impractical es]:)ecially in leetfi witfi large tubercles
as tfic" occftisal build-np of couijiosite resin would
create occlusal iuterferences with opposing teeth.
A survey h\ fiedi (f 7) shows that 27% of dentists
in H o n g Kong tise the nielfiod desc rified h\ ^c)ng
(3). A fufl 67% of ifieni prefer ifie nielfiod of "judicious grinding of the tubercles" (16) at periodic
iutervafs soon after tootli eriqjtion lo enconrage
secondary cleiuin foruialion aiie;l obliteration of
the pulpal chamber within the tul^ercle (17). The
lilerattire appears to be against lliis lecfinic]tie (f),
(17, 18, 19).
Otlier niethods stufi as efective root canal ireatlneiit iiia\- be coiiiplicaied b\ immature apices and
itieeinipfete root foruialion necessitating apexification i)rocediu-es wilfi calcium fiycfroxicfe. filecli\e
reincnaf of ifie affected tootli sliould otih- he considered in conjuuciiou with orihodontic lhera|j\-.
1 he results of this sttid\' sfiottld encotirage the
wider acfoptiou of the selective euamopfast\--pre\-eiiti\-e resin resloratixc uielliod as a viafife wa\' lo
manage cfens exaginaUis.
f\.iie)\vledge of ifie Narious treatineiU modalities
and prc'Nalence data for dens evaginatus is iiiiportanl as there is an iticreasing global niigratiein of
j)cH)|ife e)l inoiig<)le)id c-tliiiicit)\ f he more recent
case reports afiont dens evaginaltis have originated fi-om the West. .Aff of these fia\e fjeeii on
the uianageinent of this anouialy in Asian iiniiiigrant populations (9-12).
139
Sim
tant as tfiere is an increasing migration of peojjle
with a predilection for tliis anomaly to many parts
of the world.
1975; J9.-()1.5-2r
9. M< ALLAN l . I l , n i K i i nos PA. D e n s E v a g i n a l t t s . C^asc- Re-port.
140
10:324-6
Br Dent I \984\
156:400-2
12. CIKLSI J R . D e n s Kvaginattis. ( ' a s e re-port a u d ic-\ic-w ol ihclite-raliit-c-. Orat Surg Oral Med Oral Pathol 1989; 6 7 ( 5 ) ; (1283\
I!'). I.IM S T, Yot NC. SI.. (liiiN Ml.. A revic-\v ol |ji-oph\laxis Ire-almeut ol dens e-vai^inattis. / //;/ .\ssoe Dent Child 1982; 13:
21-5
14. LAt KE. Sitigapotx- census ol po|3ttlatioti 1990; Rc-lit;ion,
cliildcare aud leistite activities. Census of Population Offiei'.
Dept. of Statistics. Siugapore, 1994.
15. BAZAN M T . DAWSCIN I.R. Prejteetion oldc-ns e-\-aginatus wilh
pit aud fissure- sealaul. ASDC/Dent Chiht 198:5; 5fA- :i()l-:!
U). OKIILLRS I'A( i, 1,I:L KVV. I.IK. K( i. Deiis evagiualtis (evagiualed odonlonic-) Its striic line- aud tespouse-s lo e-xlc-tiial
slimttli. Dent Prae Dent Ree 1967; //.- 239-44
17. Bt.ni R. PUTS N B . Deus evaginattts in the llotig Kong Chinese poptilation. I'/ndodDent 'Prauinatot 1988; 4: 104-7
18. Ri.,ic;iit;tfi- PA, Mt lAii D, SIIVVSLM M . Moiphologic Iindings
in dens evagiuatus. //)/ / Oreit Surg 1982; / /; 59-63
19. Goic) T. KA\VAIIARA K, KoNnen T. IMAII K, Kisiii K. Ft |IKI Y.
(Iliuical aud radiological stttely of deus evagiuattts. Dmtomaxillofae Radiol 1975; ,S'.- 78-83