McCulloch K J, Mills C M, Greenfeld R S, Coil J M
Faculty of Dentistry, University of Washington, Seattle, USA.
J Can Dent Assoc. 1998 Feb;64(2):104-6, 110-3.
Dens evaginatus (DE) presents as an innocuous looking tubercle of enamel on the occlusal surface of a tooth, most commonly a bicuspid. Problems can arise when the tubercle is either worn, ground, or fractured off, resulting in pulpal exposure and possible loss of vitality of the tooth. Dentists who perform orthodontic treatment should be aware of this dental anomaly, which occurs in at least two per cent of the Asian and Native Indian populations. Bicuspid extraction cases should involve the extraction of the anomalous premolars rather than the normal ones. In addition, the dentist should be mindful of occlusal changes that may occur during treatment or occlusal equilibration, both of which can jeopardize the vitality of teeth with DE. Pulp capping or partial pulpotomy has been postulated to be one of the most reliable forms of vital tooth treatment when pulp exposure is encountered following the sterile removal of the tubercle. When pulp exposure is not encountered, preventive resin composite sealing of the dentin or class I amalgam cavity preparation seems to be the treatment of choice.
畸形中央尖（DE）表现为牙齿咬合面上看似无害的釉质结节，最常见于双尖牙。当结节被磨损、磨除或折断时，就会出现问题，导致牙髓暴露，牙齿可能失去活力。进行正畸治疗的牙医应了解这种牙齿异常情况，在亚洲人和印度原住民中，至少有2%的人会出现这种情况。双尖牙拔除病例应拔除异常的前磨牙，而不是正常的前磨牙。此外，牙医应注意治疗或咬合平衡过程中可能发生的咬合变化，这两者都可能危及患有畸形中央尖的牙齿的活力。当在无菌去除结节后遇到牙髓暴露时，牙髓盖髓术或部分牙髓切断术被认为是保存活髓治疗最可靠的方法之一。当未遇到牙髓暴露时，预防性树脂复合体封闭牙本质或I类银汞合金洞形预备似乎是首选治疗方法。
