Current Management of Dens Evaginatus Teeth Based on Pulpal Diagnosis

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.

Endodontic treatment of a two-rooted mandibular first premolar with four root canals: a case report

Background

Mandibular first premolar has a complex and variable anatomy of the root canal system, which often leads to failure of endodontic treatment due to missing root canals. Identifying the complete structure of the root canal system to ensure that all root canals are perfectly cleared and filled becomes critical to the success of root canal therapy. This report introduced a unique case of endodontic treatment of a two-rooted mandibular first premolar in the buccolingual direction with a total of four canals.

Case presentation

An adult male patient with a lower left first premolar was diagnosed with acute apical periodontitis and treated with open pulp drainage in a general hospital. One day later, due to the complexity of the root canal structure, the patient was referred to our clinic for subsequent treatment. The tooth #34 was diagnosed with abnormal central cusp, apical periodontitis, and incomplete fracture through clinical and x-ray examinations. Cone-beam Computed Tomography (CBCT) results showed that the tooth #34 processed two roots with a buccolingual bifurcation and a total of 4 root canals: 1 lingual canal, 2 mesiobuccal canals, and 1 distobuccal canal. Notably, the buccal root presented a C-shaped configuration, and the mesiobuccal canals were of 2-1 type. The tooth was treated with microendodontics and crown restoration. One year after the treatment, the follow-up results showed that the tooth #34 was functioning normally without any abnormalities.

Conclusion

This report enhances our understanding of the anatomical variations in the root canal system of the mandibular first premolar and emphasizes the importance of CBCT in identifying anatomical variations within the root canal system. Clinicians must be aware of such changes in the mandibular first premolar during treatment to ensure a perfect treatment and better prognosis in clinical practice.

ResNet-Transformer deep learning model-aided detection of dens evaginatus

BACKGROUND

Dens evaginatus is a dental morphological developmental anomaly. Failing to detect it may lead to tubercles fracture and pulpal/periapical disease. Consequently, early detection and intervention of dens evaginatus are significant to preserve vital pulp.

AIM

This study aimed to develop a deep learning model to assist dentists in early diagnosing dens evaginatus, thereby supporting early intervention and mitigating the risk of severe consequences.

DESIGN

In this study, a deep learning model was developed utilizing panoramic radiograph images sourced from 1410 patients aged 3-16 years, with high-quality annotations to enable the automatic detection of dens evaginatus. Model performance and model's efficacy in aiding dentists were evaluated.

RESULTS

The findings indicated that the current deep learning model demonstrated commendable sensitivity (0.8600) and specificity (0.9200), outperforming dentists in detecting dens evaginatus with an F1-score of 0.8866 compared to their average F1-score of 0.8780, indicating that the model could detect dens evaginatus with greater precision. Furthermore, with its support, young dentists heightened their focus on dens evaginatus in tooth germs and achieved improved diagnostic accuracy.

CONCLUSION

Based on these results, the integration of deep learning for dens evaginatus detection holds significance and can augment dentists' proficiency in identifying such anomaly.

Bilateral dens evaginatus and associated cystic pathology: An unusual case report

Dens evaginatus (DE) presents a clinical conundrum due to its fragility and propensity to cause pulpal and periapical complications. Clinicians should heed the presence of DE during clinical examinations and avoid unnecessary intervention.