Dens evaginatus is a rare odontogenic developmental anomaly that is found in teeth where the outer surface appears to form an extra bump or cusp. Premolars are more likely to be affected than any other tooth. It could occur unilaterally or bilaterally. Dens evaginatus (DE) typically occurs bilaterally and symmetrically. This may be seen more frequently in Asians (including Chinese, Malay, Thai, Japanese, Filipino and Indian populations).The prevalence of DE ranges from 0.06% to 7.7% depending on the race. It is more common in men than in women, more frequent in the mandibular teeth than the maxillary teeth. Patients with Ellis-van Creveld syndrome, incontinentia pigmenti achromians, Mohr syndrome, Rubinstein-Taybi syndrome and Sturge Weber syndrome are at a higher risk of having DE. Signs and symptoms
It is important to diagnose DE early and provide appropriate treatment to help prevent periodontal disease, caries, pulpal complications and malocclusion. It occurs on the cingulum/occlusal surface of the teeth. The extra cusp can cause occlusal interference, displace of the affected tooth and/or opposing teeth, irritates the tongue when speaking and eating and decay the developmental grooves. Temporomandibular joint pain could be experienced secondarily due to occlusal trauma caused by the tubercle.This cusp could be worn away or fractured easily. In 70% of the cases, the fine pulpal extension were exposed which can lead to infection, pulpal necrosis and periapical pathosis. Associated anomalies
Additional tubercules
Aesthetic and/or occlusion problems
Agenesis
Bifid cingula
Exaggerated cusp of Carabelli
Gemination
Impaction
Labial drifting
Labial groove
Mesiodens
Megadont
Odontoma
Peg-shaped lateral incisor
Prominent marginal ridge
Shallow groove in the lateral incisor
Shovel-shaped incisor
Supernumerary

Cause
The cause of DE is still unclear.
In GAP, generalized bone destruction is present that ranges from mild crestal bone resorption to severe alveolar bone destruction, depending on the severity of the disease. There may be a combination of vertical and horizontal bone loss defects. Screening
Early diagnosis of aggressive periodontitis is important as it can cause rapid permanent destruction of the periodontal tissues. It is essential that all patients undergo a routine periodontal examination to screen for any form of periodontal disease during a dental checkup. Clinical examination
At the start of the clinical examination of the gingival and periodontal tissues, the dental practitioner would look at the appearance of the gingiva first. A healthy periodontium in a Caucasian would appear stippled and pink with a knife edge margin where it abuts the tooth (pigmentation may differ in other races). After that, gingival probing depths would be checked. This would normally be carried out using a basic periodontal probe (WHO CPI). On probing, patients with AgP should have evidence of significant periodontal pocket depths and loss of attachment (LOA). Dental practitioners should also be aware of false pocketing around erupting/newly erupted teeth in the mixed dentition phase and also in the presence of gingival inflammation. The presence of bleeding on probing (BOP) should be noted which is an indicator of active disease. Radiographs
Radiographic assessment should be carried out for patients with evidence of periodontitis to observe alveolar bone levels which can help to identify signs of AgP.