ABSTRACT
Calcific Metamorphosis (CM) is a pulpal response to dental trauma characterized by a deposition of hard tissue within the canal space. A tooth with CM usually presents a discoloration and a partial or total obliteration of the pulp canal space, and its vital pulp tests and symptoms are difficult. Since pulp necrosis cannot be supposed even the negative responses, the periradicular status is the only reliable criterion. Two permanent teeth diagnosed as CM and pathological root resorption, extracted from two males (22 and 53 years of age) due to severe mobility were prepared and sectioned for histological and histometrical evaluation. Images were captured, processed and measured in a total mapping of each specimen with software Pinnacle Studio 9.4® (Pinnacle Systems Inc.), Adobe® Photoshop® (CS 8.0.1, Adobe Systems Inc.) and Image J® (National Institute of Health, Bethesda, MD, USA). The images showed the simultaneous occurrence of CM and root resorption. The means of the total measurements showed that the area of radicular affection (R) was higher than the coronal affection (C), both in quantity (R: 13.75 mm2 -28.75%-/C: 4.7 mm2 -5.47%-) and quality (R: absence of CM / C: presence of CM). CM showed a fibrotic pattern, a cortical bone-like pattern and a cancellous bone-like pattern, representing a kind of reparative reaction probably initiated by the resorption process. Concurrent CM and pathological root resorption are uncommon in the same tooth, and the possibility to obtain specimens of permanent teeth to make histological and histometric evaluations of them represents a situation even more infrequent. This morphohistometric evaluation can expand the spectrum of useful variables to make clinical and therapeutic odontological decisions.
La Metamorfosis Calcificante (MC) es una respuesta pulpar a traumatismos dentales, caracterizada por un depósito de tejido duro dentro del canal pulpar. Un diente con MC usualmente presenta un cambio en el color y una obliteración parcial o total del espacio del canal pulpar, y sus respuestas a las pruebas de vitalidad y los mismos síntomas suelen ser de difícil diagnóstico. Dado que la necrosis pulpar no puede ser supuesta aún con respuestas negativas, el estado periradicular es el único criterio diagnóstico confiable. Dos dientes permanentes de dos pacientes masculinos (de 22 y 53 años) diagnosticados con MC asociada a reabsorción patológica de la raíz, extraídos por movilidad severa fueron preparados y seccionados para evaluación histológica e histométrica. Las imágenes fueron capturadas, procesadas y medidas en un mapeo total para cada espécimen utilizando software Pinnacle Studio 9.4® (Pinnacle Systems Inc.), Adobe® Photoshop® (CS 8.0.1, Adobe Systems Inc.) e Image J® (National Institute of Health, Bethesda, MD, USA). Las imágenes demostraron la concurrencia de MC y reabsorción radicular. Las medias de las mediciones totales expusieron que la superficie de afección radicular (R) fue mayor que la de afección coronaria (C), tanto en cantidad (R: 13,75 mm2 -28,75%-/C: 4,7 mm2 -5,47%-) como en calidad and (R: ausencia de MC / C: presencia de MC). La MC mostró patrones de fibrosis, de tejido similar a un hueso cortical y a un hueso esponjoso, representando una forma de reacción reparativa iniciada probablemente en el proceso de reabsorción. La concurrencia entre MC y reabsorción patológica radicular es rara en el mismo diente, y la posibilidad de obtener especímenes de dientes permanentes para evaluarlos histológica e histométricamente es aún menos frecuente. Esta evaluación histométrica permitiría expandir el espectro de variables útiles para la toma de decisiones clínicas y terapéuticas odontológicas.
Subject(s)
Humans , Male , Adult , Middle Aged , Dental Pulp Calcification/pathology , Dentition, Permanent , Root Resorption/pathologyABSTRACT
Pulp calcifications are a frequent finding on bitewing and periapical radiographs in older age-groups but their occurrence in the entire dentition in young subjects is unusual. We report such an unusual occurrence of generalized pulp calcification in a 13-year-old Indian female. Radiographic examination of the dentition revealed pulp calcifications in all permanent teeth, located mostly in the pulp chamber but with some in the root canals. The patient's dental, medical, and family history was noncontributory. Biochemical analysis of the removed pulp calcification from one of the teeth during endodontic treatment showed large amounts of calcium, phosphorus, and carbonate. However, metabolic evaluation of patient through liver and kidney function tests and other blood investigations did not reveal any metabolic disorder. The patient was also evaluated for any systemic, syndromic, or genetic involvement but this was also noncontributory. Therefore, we propose that this unusual case of generalized pulp calcification is of idiopathic origin. In this work, histopathological and biochemical evaluations of the pulp calcification was done to try and understand the initiation and progress of calcifications in pulpal tissue.