Case Study Report

Group 4: Brandy Dicke, Krista Prince, Shelby Holle

A 27 year old male visited the office for a routine checkup. When
taking his vital signs, all were found to be within normal limits and he
appeared to be in good health with no significant medical history findings. He
regularly attends dental checkups and routine restorative dental treatment.
No enlarged or palpable lymph nodes were found during the extra oral
examination of the head and neck and here were no abnormalities present in
the intra oral examination.
Based on the clinical examination periapical, bite wing, and panoramic
radiographs were ordered. After reviewing the periapical radiograph, the film
revealed a small radiopacity within the crown of the left maxillary lateral
incisor. Upon examination of this tooth, it appeared to be a peg lateral. No
other abnormalities were noted on the radiographs. After reviewing the
medical history and questioning the patient, he denied any symptoms or
pain in the area of the lateral incisor.
After further research, the five best possible outcomes are as follows.
Dens evaginatus is an accessory enamel cusp found on the occlusal tooth
surface. This developmental anomaly occurs most often on the mandibular
premolars and can happen either unilaterally or bilaterally. An extension of
pulp is usually present within the extra cusp therefor with cusp wear the pulp
is at a risk for exposure.

Dens invaginatus, also known as dens-in-dente is a tooth is a

developmental anomaly that results when the enamel organ invaginates into
the crown of a tooth before mineralization. This abnormality creates the
appearance of a tooth within a tooth and is most commonly seen in anterior
teeth, especially the maxillary lateral incisors. It appears as elongated bulb
or pear shaped mass of enamel seen within the dentin surrounding a
radiolucent area.
Taurodontism is a condition characterized by very large pyramid
shaped molars with large pulp chambers and short roots. It is a genetic
condition most frequently found among Native Americans. Clinically it is not
normally noted and is often accidentally found during radiographic
examination. It radiographically appears with short pointed roots with an
elongated pulp chamber.
Mesiodens is the most common supernumerary tooth found between
the maxillary central incisors. It is usually a small tooth and can be unerupted or erupted with the crown exhibiting a conical shape. It can appear
singly or in pairs and may be inverted when seen on a radiograph.
Regional odontodysplasia is a developmental problem in which one or
several teeth in the same quadrant. Radiographically it exhibits a marked
reduction in radiodensity and characteristic ghost like appearance giving it
the nickname of ghost teeth. Very thin enamel and dentin are present. On
occasion the enamel is not present on the radiograph. The pulp chambers

are very large and these teeth either stay impacted or only erupt partially. It
can affect both primary and permanent dentition and most often occurs in
anterior maxilla.
After thoroughly investigating this patients case and the possible
diagnoses, we have determined that this radiopacity is dens invaginatus or a
tooth within a tooth. We came to this conclusion from careful examination of
the radiograph and its appearance. The anomaly exhibits an enamel like
mass within the dentin surrounding the pulp. In addition it has occurred on
the maxillary lateral incisor which is the most common location for this
abnormal condition.
Treatment for dens invaginatus consist of preventive restorations to
seal any pulpal communication in the cingulum area. Endodontic treatment is
most often given to prevent present or existing pathology.

References
Myers, S., & Curran, A. (2014). General and oral pathology for dental hygiene
practice. Philadelphia: F.A. Davis.
Ibsen, O. (2009). Oral pathology for the dental hygienist (5th ed.). St. Louis,
Mo.: Saunders/Elsevier.