This letter is in reference to an article that I read in the recent issue of your journal by Wang et al.1 Although the crux of their case report was conservative treatment of immature teeth with apical periodontitis through a revascularization procedure, my letter focuses on a different issue common to both cases presented in this article. In both cases, the reason for apical periodontitis was clearly not dental caries as evidenced by clinical and radiographic images shown in the article. In Case 1, the diagnosis was acute apical abscess in a lower premolar where endodontic treatment was initiated. The most probable reason for initiating the treatment on the caries-free premolar could be because of a pin-point pulp exposure resulting from a worn accessory cusp. However, in Case 2, the authors mentioned attrition of the central cusp in the lower premolar as a probable cause for the periapical lesion. Therefore, the supplementary central cusp, also referred to as dens evaginatus, needs to be considered as a potential cause for endodontic pathosis.
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