Clinical study of dens evaginatus cases with pulpal involvement.

The objective of the present study was to investigate the incidence, clinical findings, diagnosis and treatment of evaginated teeth with pulpal involvement. Five hundred and three cases requiring endodontically treated premolars were studied at Kaohsiung Medical College Hospital. We observed 23 (4.6%) evaginated teeth with pulpal involvement out of the 503 samples studied here. Of the 23 teeth, mandibular second premolars comprise the largest portion. Clinically, all tubercles of pulpally involved evaginated teeth had been worn down by attrition and all these teeth showed negative response in vitality tests. The study indicated that 17 cases had sinus tracts, 1 tooth had discoloration in crown portion, 1 case had facial asymmetry and 6 teeth had a painful history. Radiographs confirmed that 21 cases had apical or lateral rarefaction, 1 tooth had thickened periodontal ligament and 8 teeth had incomplete root formation. Clinical diagnosis included pulp necrosis (23 cases), acute apical periodontitis (3 cases), chronic apical periodontitis (4 cases), suppurative apical periodontitis (17 cases)and Garrer' osteomyelitis (1 case). After the treatment, 13 teeth showed satisfactory results. The treatment on 2 teeth was failed, 1 tooth had root fracture and 7 teeth had loss of follow-up. We conclude that the evaginated teeth can hence be preserved even if they are pulplly infected and have an incomplete root apex.