DENS EVAGINATUS

Question 1

DEFINE DENS EVAGINATUS

Answer 1

Developmental anomaly due to the invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues (Hulsmaan 1997).

invagination of enamel organ –> dental papilla before calcification

Other names:
• Dens in dente (Busch 1897)
• Dilated composite odontome (Hunter 1951)
• Gestant anomaly (Colby 1956)

Question 2

CLASSIFICATION OF DENS EVAGINATUS

Answer 2

Oehlers (1957a)- categorizes invaginations into three classes as determined by how far they extend radiographically from the crown into the root.

Type I: The invagination is minimal and enamel-lined, it is confined within the crown of the tooth and does not extend beyond the level of the external amelo-cemental junction.

Type II: The invagination is enamel-lined and extends into the pulp chamber but remains within the root canal with no communication with the periodontal ligament.

Type IIIA: The invagination extends through the root and communicates laterally with the periodontal ligament space through a pseudo-foramen. There is usually no communication with the pulp, which lies compressed within the root.

Type IIIB: The invagination extends through the root and communicates with the periodontal ligament at the apical foramen. There is usually no communication with the pulp.

Question 3

PREVALENCE OF DENS EVAGINATUS

Answer 3

Prevalence using Oehlers’ Classification (Ridell et al. (2001) :
TYPE I – 79%
TYPE II – 15%
TYPE III – 5%
*0.3% to 10% of adult teeth are affected by Dens Invaginatus, with the problem observed in 0.25% to 26.1% of individuals examined
Lateral incisors most commonly affected (Hulsmaan 1997)

Question 4

ETIOLOGY OF DENS EVAGINATUS

Answer 4

• Unknown;
• Growth pressure of dental arch (Euler 1939, Atkinson 1943).
• Focal failure of growth of the internal enamel epithelium while the surrounding normal epithelium continues to proliferate and engulfs the static area (Kronfeld 1934)
• Rapid and aggressive proliferation of a part of the internal enamel epithelium invading the dental papilla. He regarded this as a “benign neoplasma of limited growth” (Rushton 1937)
• Distortion of the enamel organ during tooth development and subsequent protrusion of a part of the enamel organ will lead to the formation of an enamel-lined channel ending at the cingulum or occasionally at the incisal tip. (Oehlers 1957)
• Infection ( Fischer,1936 and Sprawson 1937)
• Trauma (Gustafson & Sundbery 1950)