Outcomes and Predisposing Factors of Two Prophylactic Treatments in Dens Evaginatus Premolars: A Retrospective Study

Prevalence and prophylactic management of premolars with dens evaginatus in singaporean school children: a retrospective cohort study

PURPOSE

Dens evaginatus (DE) is characterised by the presence of a tubercle projection, which when fractured may lead to pulpal pathology. The aim of this study was to assess prevalence of DE in the local population and the long-term outcomes of asymptomatic DE premolars managed with tubercle grinding and composite overlay.

METHODS

This is a retrospective cohort study of 9-year-old Singaporean children. The primary outcome was the success of prophylactic management of asymptomatic DE premolars with a single session of tubercle grinding and composite overlay, as determined by the absence of clinical signs or symptoms. The factors associated with survival of DE premolars treated were evaluated using Cox proportional hazard regression.

RESULTS

The prevalence of DE among Singaporean children was 7.1% (12,677/178,801). DE premolars were more prevalent among females (56.1%) and those of Chinese ethnicity (87.1%). At the tooth level, 26,875 asymptomatic DE premolars were prophylactically managed with tubercle grinding and composite overlay and 2471 DE premolars did not receive any intervention. The mean review period was 46.2 ± 20.2 months. The success rate for DE premolars that received the intervention was significantly higher (p  < 0.001) at 98.9% versus 94.1% in untreated DE premolars. Cox proportional hazard regression revealed that mandibular second premolars (p  < 0.001), DE premolars with fractured tubercles at the time of diagnosis (p  < 0.001) and children of Chinese ethnicity (p  = 0.002) were significantly associated with a higher risk of failures.

CONCLUSION

The prophylactic management of asymptomatic DE premolars with a single-session tubercle grinding and composite overlay is a successful treatment option.

Current Management of Dens Evaginatus Teeth Based on Pulpal Diagnosis

INTRODUCTION

Dens evaginatus (DE) is a dental anomaly with a supernumerary tubercle projection that typically contains dentin and pulp tissue. However, the tubercle projection can fracture, exposing the dentin and potentially the dental pulp, which induces pulpal diseases. Managing DE should be primarily based on the clinical diagnosis of the pulp.

METHODS

The literature search in prevalence, prophylaxis, and management of dens evaginatus was performed in PubMed database as well as by manual search, in which the related contents were collected and descriptively analyzed.

RESULTS

Of the 264 searched literatures, 62 articles were included for this scoping review. The prophylactic management of the tubercle of DE teeth with a normal pulp should be performed as early as possible by the prep-and-fill technique or the reinforcement technique to preserve tooth vitality and continued root development, with the former reported to be superior compared with the latter. Furthermore, DE teeth with reversible pulpitis should be managed with the prep-and-fill technique. For DE teeth with irreversible pulpitis, vital pulp therapy, ie, partial or full/coronal pulpotomy, should be considered when the pulpal inflammation is limited to the coronal pulp to preserve the vitality of the radicular pulp that induces apexogenesis. A pulpectomy should be performed if the pulpal inflammation has progressed into the radicular pulp. For DE teeth with pulpal necrosis (or after pulpectomy) and immature roots, mineral trioxide aggregate apexification or regenerative endodontic procedures are the treatment options. For DE teeth with pulpal necrosis and complete root formation, nonsurgical root canal treatment is the treatment of choice. A flow chart of the decision-making for managing DE teeth based on pulpal diagnosis is proposed.

CONCLUSION

DE teeth should be properly managed, by prophylaxis or treatment, depending on pulpal diagnosis and related factors.