Pulp management in dens evaginatus.

A 12-yr-old Guamanian girl presented with seven premolars displaying dens evaginatus. The pulp of one tooth was necrotic secondary to fracture of the evagination. Calcium hydroxide treatment was used to induce closure of this root apex, and subsequent routine canal obturation resulted in clinical success. Three teeth had fractured evaginations and compromised coronal pulps, but the radicular pulp tissue was vital. Coronal calcium hydroxide pulpotomy procedures were performed, and root development continued on all three teeth. In one of these teeth, endodontic treatment was completed, and in the other two the radicular pulp remained vital. Three teeth had intact evaginations and vital pulps. In an attempt to protect these evaginations from trauma, composite reinforcements were placed around the evaginations. These pulps remained vital and the roots completed normal development. Early diagnosis and treatment should be sought in cases of dens evaginatus to provide the greatest opportunity for complete root development.