Abstract
Dens evaginatus is an anomaly frequently observed in mandibular premolars. In affected patients with a fracture that occurs during the process of tooth eruption, treatments that induce root lengthening and apical root closure are crucial. During performance of such procedures, formation of a dentin bridge and apical root closure are mainly confirmed by dental radiography or with use of a file, though the latter technique provides less conclusive clinical findings.
We perform pulp treatment for immature mandibular secondary premolars with acute suppurative pulpitis secondary to fractured dens evaginatus. Dental pulp and apical root closure are examined by microscopy and dental cone beam computed tomography (CBCT). A patient came to our hospital with pain in the left mandibular premolars due to fractured dens evaginatus, which had been diagnosed by the referring physician. An intraoral examination revealed fractured dens evaginatus and a diagnosis of acute suppurative pulpitis was made. We performed tooth extraction under local anesthesia, though the apical pulp remained. We then conducted apexogenesis, which encouraged apical root closure and root lengthening as a result of dentin bridge-like hard tissue formation on the dental pulp section, confirmed by dental radiography observation. For the final restoration, we conducted close visual examinations using microscopy and CBCT after obtaining consent from the legal guardians. Finally, we performed composite resin treatment after confirming that the dental pulp section was sealed and the apical root was closed into a form that most resembled its normal shape, with consideration of the thickened dentin bridge-like hard tissue.
Our results suggest that visual examinations via microscopy and CBCT are important for root canal structural analysis following treatment of immature teeth among the wide range of available therapies.
