Tooth Development Defects: Peg laterals Teeth, Dens In Dente and Dens Evaginatus

September 1st, 2020 Andrew Chang

Why tooth development defects are important and Clinical Implications for Dentists (and patients)

Dr Andrew Chang and Dr Diane Tay discuss the more common tooth development defects of peg laterals (small/narrow upper 2nd front teeth), dens in dente and dens evaginatus. 

Common hallmarks of each of the tooth development defects are described, and what to do when seeing teeth like these at the initial examinations.

Dens in dente and dens evaginatus can both benefit from early identification and the implications of this and management options for each are discussed.

Tooth Development Defects

These can be developmental defects of colour, number, shape, structure. We have previously talked about weak enamel defects in molar teeth in an earlier podcast.

  • For dentists, this is relevant in clinical dentistry especially in paediatric dentistry as many can be detected in early childhood and managed appropriately. Treatment also often requires multidisciplinary management and will require short and long-term treatment plans.  
  • The more common defects of peg laterals, Dens in dente, Dens Evaginatus would be discussed.

Peg Laterals

  • Presentation: Small, conical shape (variation in size), can be unilateral or bilateral. May be missing sometimes on the contralateral side. Sometimes delayed or ectopic eruption of these teeth or the adjacent canine teeth are noted.
    • Generally causes aesthetic issues.
    • Considerations: Shape, aesthetic concerns (if any), occlusion, lip/smile line, if contra lateral canine missing?, any other dental anomalies
  • Management: Usually requires multidisciplinary approach, esp orthodontics. Timing is important. 
    • Either leave/no treatment till older
    • Build up and match adjacent teeth (but difficult to achieve emergence profile)
    • Canine substitution and camouflage.
    • Unilateral peg laterals decision making more challenging than bilateral
  • Considerations
  1. Gum heights of 3’s Vrs 4’s.
  2. Crown width of 3’s versus 4’s.
  3. Clinical crown heights.
  4. Colour  
  • Peg lateral: Sensitive teeth, missing other 2's . Variations in shape of peg lateral.
    • Usually sound root length.

Dens In Dente (Dens Invaginatus)

  • Dens In Dente (Dens Invaginatus) = developmental invagination of the cingulum pit resulting a thin layer of hard tissue between the pulp and oral cavity. 
    • Clinical presentation: Pulp necrosis often occurs and sometimes can be spontaneous- so look out for it. May also see a deep palatal pit.
    • Update parents on findings, take periapical x-ray to check morphology, monitor closely, if palatal pit (seal) and if pulp morphology complex, will always need endodontic management. Check opposing tooth for Peg lateral/Missing tooth.
    • Management Considerations: depends on clinical presentation, shape of tooth, endo complexity, prognosis in the long term, occlusion (if crowding- exo?), open/close apex of root

Dens Evaginatus (enamel tubercle)

  • Usually premolars affected- often have prominent pulp horn and wear, leads to periapical abscess. Good interocclusal interdigitation can be difficult to achieve orthodontically.
    • Rx: refer Endo/dentist for opinion. CBCT to diagnose?
    • Protective resin covering?