Diagnosis of DE can be difficult when there is no signs and symptoms of necrotic or infected pulp. It is a challenging task to differentiate between a true periapical lesion and a normal periapical radiolucency of a dental follicle of an immature apex. * Pulp tests (test results of immature teeth can be misleading, as they are known to give unreliable results) * Check and see if there is ant elevated, flat wear facet on the occlusal surface of the tooth * Test cavity which has an absence of pain sensation and has an empty pulp chamber/ canal. * Radiographs (usually periapical) - a V-shaped radiopaque structure could be seen superimposing on top of the affected crown. It could detect DE before tooth eruption. However, DE presentation on the radiograph can be quite similar to a mesiodens or a compound odontoma. Classification The anterior DE tubercles have an average width of 3.5mm and length of 6.0mm, while posterior tubercles have an average 2.0mm in width and length of up to 3.5mm. If the cusp of Carabelli is present, the tooth associated are often larger mesiodistally and it is not uncommon that a DE involved tooth has an abnormal root pattern. There are 4 different ways to classify/ categorize DE involved teeth. # Schulge (1987) classification, teeth falls into 5 categories according to the location of the tubercles #* #* Tubercle on the inclined plane of the lingual cusp #* Cone-like enlargement of the buccal cusp #* Tubercle on the inclined plane of the buccal cusp #* Tubercle arising from the occlusal surface obliterating the central groove # Lau's classification, divide teeth into groups according to their anatomical shape #* Smooth #* Grooved #* Terraced #* Ridged # Oehlers classification, teeth categorized depending on the pulp contents within the tubercle (histological appearance of the pulps were examined) #* Wide pulp horns (34%) #* Narrow pulp horns (22%) #* Constricted pulp horns (14%) #* Isolated pulp horn remnants (20%) #* No pulp horn (10%) # Hattab et al. classification #*Anterior teeth #** Type 1 - Talon, a well defined additional cusp that projects palatally and extends at least half the distance from the cementoenamel junction (CEJ) to the incisal edge #** Type 2 - Semitalon, an additional cusp that extends less than half the distance from the CEJ to the incisal edge #** Type 3 - Trace talon, prominent cingula #* Posterior teeth #** Occlusal DE #** Buccal DE #** Palatal DE/ Lingual DE
Dens evaginatus
Dens invaginatus
Condylomata lata
Genu recurvatum
Torus palatinus
Mania errabunda
Trichostasis spinulosa
Corpora arenacea