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.