Dens evaginatus: a diagnostic and treatment challenge.

BACKGROUND: Dens evaginatus, or DE, is an uncommon dental anomaly, in which an extra cusp or tubercle protrudes from the occlusal surface of posterior teeth, as well as the lingual surface of anterior teeth. Tubercles frequently are susceptible to fractures and pulpal complications. CASE DESCRIPTION: A 9-year-old Hispanic girl presented for six emergency visits over a five-week period. Her chief complaint was of pain associated with a maxillary primary second premolar. Clinically, the tooth appeared to be noncarious, but it had an abnormal-appearing root. It was extracted after the patient presented with a left facial cellulitis. CLINICAL IMPLICATIONS: DE often challenges the practitioner with its frequent and early pulpal complications. The signs and symptoms in this case resulted in a difficult diagnosis and limited treatment options.