If the tooth involved is asymptomatic or small, no treatment is needed and a preventative approach should be taken. Preventative measures include: * Oral hygiene instruction * Scaling and polishing * Application of topical fluoride on reduced cusp * Application of fissure sealant * Frequent dental check-up, pay extra attention to fissures * Perform direct or indirect pulp capping in cases with pulpal extension, to try increase the rate of reparative dentin formation (but may result in obliteration of the canal) * Seal exposed dentin with microhybrid acid-etched flowable light-cured resin * Perform pulpotomy with MTA using a modified Cvek technique For teeth with normal pulp and mature apex, reduce the opposing occluding tooth. Reinforce the tubercle by applying flowable composite. Occlusion, restoration, pulp and periapex assessment should be done yearly. When there is adequate pulp recession, tubercle can be removed and tooth can be restored. For teeth with normal pulp and immature apex, reduce the opposing occluding tooth. Apply flowable composite to the tubercle. Occlusion, restoration, pulp and periapex assessment should be done every 3–4 months until the apex matures. When there are signs of adequate pulp recession, tubercle can be removed and tooth can be restored. For teeth with inflamed pulp and mature apex, conventional root canal treatment could be carried out and restored accordingly. For teeth with inflamed pulp and immature apex, shallow MTA pulpotomy could be performed and then restore with glass ionomer and composite. For teeth with necrotic pulp and mature apex, conventional root canal therapy could be done and restored. For teeth with necrotic pulp and immature apex, MTA root-end barrier could be carried out. Glass ionomer layer and composite could be used to restore the tooth. If there is occlusal interference, the opposing projection should be reduced. Make sure that the tubercle does not contact other teeth in all excursive movement. This is usually done over a few appointments, 6 to 8 weeks apart to allow the formation of reparative dentin to protect the pulp. Fluoride varnish should be applied onto the ground surface. Recall the patient for follow-up after 3, 6 and 12 months. In some cases, extraction could be considered (e.g. for orthodontic purposes, failed apexification)
Dens evaginatus
Dens invaginatus
Condylomata lata
Genu recurvatum
Torus palatinus
Mania errabunda
Trichostasis spinulosa
Corpora arenacea