Prevalence of Cervical Enamel Projections and Enamel Pearls in Saudi Adults: A Cone-Beam Computed Tomography Study

Background/Objectives: To determine the prevalence and distribution of cervical enamel projections (CEPs) and enamel pearls (EPs) in Saudi adults using cone-beam computed tomography (CBCT). Methods: In this retrospective cross-sectional study, CBCT scans of 1376 consecutive patients attending postgraduate periodontics clinics between January 2024 and February 2025 were screened. After applying eligibility criteria, 153 patients (732 first and second molars) were included. Three calibrated examiners independently assessed each molar for CEPs and EPs. Inter-rater agreement was quantified using Fleiss’s kappa. Prevalence was reported at the patient and tooth levels with 95% confidence intervals, and bivariate associations with age, gender, and medical history were tested using chi-square, Fisher’s exact, and Mann–Whitney U tests. Results: Of 732 molars in 153 patients, the patient-level prevalence was 29.4% for CEPs and 3.3% for EPs; tooth-level prevalence was 7.7% and 0.7%, respectively. Grade I CEPs were the most common, and mandibular first molars were most affected. Inter-rater agreement was excellent (Fleiss’s κ = 0.86 for CEPs; κ = 1.00 for EPs). Neither dental anomaly was associated with age, gender, or medical history. Conclusions: CEPs are common in Saudi adults, while EPs are uncommon. Neither dental anomaly is associated with patient demographics or systemic health, supporting their developmental rather than acquired origin.