Bolk´s cusp: an uncommon dental morphological variant

¹Department of Pediatric and Preventive Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe University, Sawangi, India

^&Corresponding author
Rutuja Patil, Department of Pediatric and Preventive Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe University, Sawangi, India

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An 11-year-old Indian male patient presented to the Department of Pedodontics with a chief complaint of carious teeth in the upper anterior region. Intraoral hard tissue examination showed mixed dentition and revealed proximal caries in the right first deciduous molar. An incidental finding was the presence of prominent bilateral accessory cusps diagnosed as Bolk's cusps projecting from the oblique ridge of the maxillary first permanent molars, with a rhomboidal base (A). An accessory cusp was also present on the maxillary right deciduous molar, suggesting a developmental relationship between primary and permanent dentitions. Grooves separated the accessory cusps, were out of occlusion, and were asymptomatic. No comparable findings were reported in the mandibular molars. Similarly, another case showed comparable findings: a 5-year-old Indian female patient reported to pedodontics with pain along with multiple carious teeth. Clinical examination showed several carious lesions involving the deciduous dentition. An incidental finding reported was the presence of bilateral Bolk's cusps on the maxillary second primary molars (B). Each cusp was distinctly separated by a developmental groove and was smaller than the principal cusps, thereby not involved in occlusion. The child is under follow-up to observe whether similar morphological traits appear in the permanent successors. Differential diagnosis includes the cusp of Carabelli and enamel pearl. If the cusps were asymptomatic and out of occlusion, no intervention would be required. Preventive sealants advised. Sometimes it causes caries, occlusal issues, and pulp problems; at that time, selective grinding and pulp therapies can be advised.

Figure 1: A) maxillary arch showing Bolk's cusp with #16, #26, and #55; B) maxillary arch showing Bolk's cusp with #55 and #65