[Causes, diagnosis and treatment strategies for dental pulp calcification].

Dental pulp calcification can lead to root canal stenosis or obliteration. It is usually difficult to negotiate the root canal if the affected tooth needs to be treated and intraoperative complications are easily brought about during the root canal treatment. The etiologies of dental pulp calcification are complicated and careful considerations should be given to the diagnosis and treatment. Only by weighing the advantages and disadvantages can appropriate treatment plan be chosen. Based on the literature and authors' clinical experiences, the present article summarizes the causes, pathogenesis, diagnosis and treatment strategies of dental pulp calcification, in order to provide some references in diagnosis and treatment for the dental clinicians.

Prevalencia y distribución de cálculos pulpares en un grupo de adultos peruanos: un estudio mediante tomografías de haz cónico / Prevalence and Distribution of Pulp Stones in a Group of Peruvian Adults: a Cone Beam Computed Tomography Study

Resumen: El objetivo de este estudio fue evaluar la prevalencia y distribución de cálculos pulpares en un grupo de adultos peruanos mediante tomografía de haz cónico (CBCT). Materiales y métodos: Se analizaron 67 tomografías de haz cónico seleccionadas aleatoriamente de un centro tomográfico en Lima, Perú. Fueron evaluadas 1263 imágenes de piezas dentarias mediante el tomógrafo Point 3D Combi 500 S. El análisis de las imágenes se realizó con el software Real Scan y todas las piezas dentarias fueron evaluadas en las vistas sagital, axial y coronal. Todas las medidas fueron sometidas a prueba de chi cuadrado. (p<0.05). Resultados: De un total de 67 pacientes, un 83,58% presentaron calcificaciones y de 1263 piezas dentarias, un 30.8% a través de la CBCT. La prevalencia de calcificaciones fue mayor en el sexo femenino que masculino. Los molares maxilares y mandibulares fueron los grupos de dientes con mayor frecuencia de cálculos pulpares. Se encontró significancia entre los cálculos pulpares y el género, rango de edad, tipo y estado de pieza dentaria. Conclusiones: La primera molar maxilar tuvo mayor prevalencia de calcificaciones pulpares que la mandibular. La presencia de caries aumentó la posibilidad de aparición de estas calcificaciones, específicamente en maxilar. La CBCT podría ser una herramienta sensible para detectar cálculos pulpares. El conocimiento de la distribución de cálculos pulpares puede ayudar a los dentistas en el tratamiento clínico de endodoncia.

Abstract: The aim of this study was to evaluate the prevalence and distribution of pulp stones in a group of Peruvian adults using cone beam tomography (CBCT). Materials and methods: 60 randomly selected CBCT from a tomographic center in Lima, Peru were analyzed. A total of 1263 images of teeth using the Point 3D Combi 500 S tomograph were evaluated. Images analysis was performed with Real Scan software and all teeth were evaluated in sagittal, axial and coronal views. All measurements were subjected to a chi square test. (p<0.05). Results: Of the 1263 teeth, 30.8% presented pulp calcifications through the CBCT. The prevalence of calcifications was higher in women than in men. The maxillary and mandibular molars were the groups of teeth with the highest frequency of pulp stones. There was significance between the pulp stones and the gender, age range, type and state of the tooth. Conclusions: The maxillary first molars had a higher prevalence of pulp calcifications than the mandibular ones. The presence of caries increased the possibility of the appearance of these calcifications, specifically in the maxillary teeth. CBCT could be a sensitive tool to detect pulp stones. Knowledge of the distribution of pulp stones can help dentists in the clinical treatment of endodontics.

Pulp Calcification in Traumatized Primary Teeth - Classification, Clinical And Radiographic Aspects.

OBJECTIVE: The aim of this study was to standardize the nomenclature of pulp alteration to pulp calcification (PC) and to classify it according to type, quantity and location, as well as relate it to clinical and radiographic features. STUDY DESIGN: The dental records of 946 patients from the Research and Clinical Center for Dental Trauma in Primary Teeth were studied. Two hundred and fifty PC-traumatized upper deciduous incisors were detected. RESULTS: According to radiographic analysis of the records, 62.5% showed diffuse calcification, 36.3% tube-like calcification, and 1.2% concentric calcification. According to the extension of pulp calcification, the records showed: 80% partial calcification, 17.2% total coronal calcification and partial radicular calcification, and 2.8 % total coronal and radicular calcification. As for location, only 2.4% were on the coronal pulp, 5.2% on the radicular pulp and 92.4% on both radicular and coronal pulp. Regarding coronal discoloration, 54% were yellow and 2% gray. In relation to periradicular changes, 10% showed widened periodontal ligament space, 3.1% internal resorption, 10% external resorption, 10.4% periapical bone rarefaction. CONCLUSIONS: Since PC is a general term, it is important to classify it and correlate it to clinical and radiographic changes, in order to establish the correct diagnosis, treatment and prognosis of each case.

[Multiple pulp stones: report of a case and literature review].

Pulp stones were denaturation of pulp tissue, which were usually found in the pulp chamber. Generally, they were associated with caries and pulposis, and the occurrence of pulp stone increased with age. Pulp stones were frequently found by radiographic examination, and appeared as radiopaque lesions which were round or ovoid in shape. We reported an unusual case of multiple pulp stones with normal clinical crowns in a young female patient and analyzed the possible etiology.

Apical plug technique in a calcified immature tooth: a case report.

Traumatic injury to an immature tooth may result in pulpal necrosis secondary to pulp canal obliteration, which makes the management of the tooth a clinical challenge for dentists. The present case report describes an innovative apical plug technique with mineral trioxide aggregate in a calcified immature tooth using an ultrasonic tip and long, thin, tapered fissure burs. The technique was proven to be successful clinically and radiographically at 2 years postobturation.

Nephrocalcinosis associated with continuous enamel hypoplasia and severe alveolar bone loss: a case report and literature review.

Enamel-renal syndrome (ERS) is a rare manifestation of nephrocalcinosis that has been associated with generalized enamel hypoplasia. The purpose of this paper was to describe, for the first time, the association of enamel-renal syndrome with severe localized periodontal bone loss. A 13-year-old boy presented with: generalized hypoplastic enamel; intrapulpal calcifications; retention of primary teeth; delayed eruption of permanent teeth; enlarged dental-follicles; misshaped roots of permanent teeth; gingival overgrowth; severe localized alveolar bone loss; and severe malocclusion. His parents were first cousins, suggesting autosomal recessive inheritance. Further studies are necessary to clarify whether the etiology of the oral disturbances relates to the genetic defect in the dental tissue or to the continuous metabolic distress associated with renal dysfunction. Nevertheless, since nephrocalcinosis is often asymptomatic, dentists should refer children with generalized enamel hypoplasia or/and multiple intrapulpal calcifications to nephrologists.

Are referred inaccessible human primary molar teeth really inaccessible?

Despite a body of compelling evidence pertaining to the root canal accessibility of primary teeth, the number of referrals for inaccessibility of primary molars is considerable. The aim of the present study was to evaluate the prevalence of true and false primary molar inaccessibility among subjects who had been referred by general and pediatric dentists. We examined 199 primary molars in 156 patients (87 males, 69 females) aged 3-7 years who were referred by 215 general and 35 pediatric dentists. Problems related to inaccessibility were recorded for each tooth and any individual canal. One hundred seventy-five inaccessible teeth (87.9%) were successfully rehabilitated to accessible status (P < 0.001). The most frequent cause of inaccessibility was an inappropriate access cavity (42.3%), followed by difficult canals (32.6%) and orifice calcification (25.2%). The tooth most frequently reported as inaccessible was the maxillary first molar (40.2%), and that least frequently reported was the mandibular second molar (11.6%). The distobuccal canal of the maxillary first molar and the mesiolingual canal of the mandibular first molar were the most commonly inaccessible canals (P < 0.001). Only 1 out of 8 teeth referred as inaccessible was truly inaccessible. It seems that root canal inaccessibility is mostly attributable to lack of expertise among individual practitioners.

Pulp canal obliteration: an endodontic diagnosis and treatment challenge.

AIM: To review the literature on pulp chamber and root canal obliteration in anterior teeth and to establish a clear protocol for managing teeth with fine, tortuous canal systems. SUMMARY: Pulp canal obliteration (PCO) occurs commonly following traumatic injuries to teeth. Approximately 4-24% of traumatized teeth develop varying degrees of pulpal obliteration that is characterized by the apparent loss of the pulp space radiographically and a yellow discoloration of the clinical crown. These teeth provide an endodontic treatment challenge; the critical management decision being whether to treat these teeth endodontically immediately upon detection of the pulpal obliteration or to wait until symptoms or signs of pulp and or periapical disease occur. The inevitable lack of responses to normal sensibility tests and the crown discoloration add uncertainty to the management; however, only approximately 7-27% of teeth with PCO will develop pulp necrosis with radiographic signs of periapical disease. Root canal treatment of teeth with pulpal obliteration is often challenging. This article discusses the various management approaches and highlights treatment strategies for overcoming potential complications. KEY LEARNING POINTS: Up to 25% of traumatized anterior teeth can develop pulp canal obliteration; Discolouration is a common clinical finding in teeth with pulp canal obliteration; Up to 75% of teeth with pulp canal obliterations are symptom-free and require no treatment other than radiographic monitoring; Routine pulp sensibility tests are unreliable in the presence of pulp canal obliteration; Teeth with pulp canal obliteration in need of root canal treatment pose particular diagnostic and treatment challenges.

Generalized pulp stones: report of a case with 6-year follow-up.

AIM: To present a mildly mentally retarded patient with generalized pulp stone formation and the six-year follow-up and to discuss the differential diagnosis of the case. SUMMARY: Pulp stones were radiographically detected in the pulp chamber of all permanent teeth in a 25-year-old woman with mild mental retardation who presented for endodontic treatment on tooth no 11 (FDI). The patient's medical, dental and family history was noncontributory. The pulp stone in the pulp chamber of tooth no 11 was removed during canal filing, and root canal treatment completed uneventfully. Six years later, the patient was re-evaluated and the pulp stones were unchanged radiographically. The patient's family history, facial phenotype and karyotype as well as the radiographic, laboratory and physical examination were not consistent with any of the known genetic syndromes associated with generalized pulp stones. Molecular analysis for the DSPP gene proved negative. The aetiology of this case remains unknown. KEY POINTS: Generalized pulp stones occur rarely; Such patients should be referred for genetic evaluation because pulp stones are mostly associated with genetic dentine defects; Pulp stones may hinder root canal treatment; Pulp stones may remain unchanged overtime.

Dental magnetic resonance imaging: making the invisible visible.

INTRODUCTION: Clinical dentistry is in need of noninvasive and accurate diagnostic methods to better evaluate dental pathosis. The purpose of this work was to assess the feasibility of a recently developed magnetic resonance imaging (MRI) technique, called SWeep Imaging with Fourier Transform (SWIFT), to visualize dental tissues. METHODS: Three in vitro teeth, representing a limited range of clinical conditions of interest, imaged using a 9.4T system with scanning times ranging from 100 seconds to 25 minutes. In vivo imaging of a subject was performed using a 4T system with a 10-minute scanning time. SWIFT images were compared with traditional two-dimensional radiographs, three-dimensional cone-beam computed tomography (CBCT) scanning, gradient-echo MRI technique, and histological sections. RESULTS: A resolution of 100 µm was obtained from in vitro teeth. SWIFT also identified the presence and extent of dental caries and fine structures of the teeth, including cracks and accessory canals, which are not visible with existing clinical radiography techniques. Intraoral positioning of the radiofrequency coil produced initial images of multiple adjacent teeth at a resolution of 400 µm. CONCLUSIONS: SWIFT MRI offers simultaneous three-dimensional hard- and soft-tissue imaging of teeth without the use of ionizing radiation. Furthermore, it has the potential to image minute dental structures within clinically relevant scanning times. This technology has implications for endodontists because it offers a potential method to longitudinally evaluate teeth where pulp and root structures have been regenerated.

Prevalence of soft tissue calcifications in cone beam computed tomography images of the mandible / Prevalência de calcificações em tecido mole na região mandibular avaliadas por dois sistemas de tomografia computadorizada por feixe cônico

PURPOSE: To determine the prevalence of soft tissue calcifications in the mandible in cone beam computed tomography (CBCT) scans. METHODS: The sample was composed by 246 CBCT scans of the mandible; 163 were acquired by the NewTom 3G® system, and 83 were acquired by the Classic i-Cat® system. When the presence of soft tissue calcification was confirmed in the mandible, the anatomical location and the type of calcification (single or multiple) were determined. Elongated styloid process and ossification of the stylohyoid ligament were excluded. Data were analyzed by using Fisher's exact test and chi-square tests. RESULTS: A total of 37 out of 246 scans showed soft tissue calcifications in the mandible (prevalence of 15%). Soft tissue calcification is predominant at posterior region of the mandible (18.9%), with no relation to gender and age. From the total of patients with soft tissue calcification, 73% were aged 35-55 year-old. There was no significant difference of diagnostic quality of the images between the CBCT systems (P > 0.05). CONCLUSION: The prevalence of soft tissue calcifications was high in this sample using CBCT images for diagnosis in the mandibular region.

OBJETIVO: Determinar a prevalência de calcificações em tecido mole na região mandibular por meio de análise de imagens axiais provenientes de dois sistemas de tomografia computadorizada por feixe cônico (TCFC), NewTom 3G® e Classic i-Cat®. MÉTODO: Foram avaliadas 246 imagens da região mandibular. Destas, 163 foram adquiridas no aparelho NewTom 3G® e 83 no aparelho Classic i-Cat®. A análise estatística foi baseada no teste exato de Fisher e no teste Qui-quadrado para comparação das proporções. RESULTADOS: Das 246 imagens, 37 apresentaram calcificações em tecido mole. Não houve diferença significativa entre gêneros em termos de prevalência. Pacientes entre 40-65 anos foram os mais afetados. A prevalência de calcificações em tecido mole na região mandibular foi de 15%, não havendo diferença significante entre os dois sistemas de TCFC quanto à qualidade das imagens para o diagnóstico (P > 0,05). CONCLUSÃO: Os sistemas de TCFC avaliados mostraram-se ferramentas valiosas na identificação de calcificações em tecido mole, embora as imagens não permitam exata localização destas calcificações.

Identify and define all diagnostic terms for pulpal health and disease states.

INTRODUCTION: Consensus Conference Subcommittee 2 was charged with the identification and definition of all diagnostic terms for pulpal health and disease states by using a systematic review of the literature. METHODS: Eight databases were searched, and numerous widely recognized endodontic texts were consulted. For each reference the level of evidence was determined, and the findings were summarized by members of the subcommittee. Highest levels of evidence were always included when available. Areas of inquiry included quantification of pulpal pain, the designation of conditions that can be identified in the dental pulp, diagnostic terms that can best represent pulpal health and disease, and metrics used to arrive at such designations. RESULTS AND CONCLUSIONS: On the basis of the findings of this inquiry, specific diagnostic terms for pulpal health and disease are suggested. In addition, numerous areas for further study were identified.

Calcificación pulpar y endodoncia: estado actual, diagnóstico y posibilidades de tratamiento / Pulp calcification and endodontics: an approach to diagnosis and treatment possibilities

La calcificación progresiva de la pulpa se produce como reacción a diferentes estímulos externos o como consecuencia de un traumatismo no demasiado severo. En los casos de traumatismos, se la detecta radiográficamente un tiempo después de ocurrido el accidente. Desde el punto de vista clínico, la corona dentaria puede adoptar una coloración amarillenta a oscura, y en las radiografías de control a distancia se puede observar que progresivamente se van perdiendo la luz del espacio de la cámara pulpar y la línea del conducto radicular. El cuadro histológico demuestra la aposición de diferentes proporciones de tejido clacificado, la mayor parte de las veces coexistente con un temido fibroso sano, con progresivo aumento del colágeno y muy pocas veces invadido por infiltrado inflamatorio. La opinión de diferentes investigadores con respecto a la conducta terapéutica más apropiada a seguir en los casos de calcificación pulpar se encuentra aún en discusión. A causa del bajo porcentaje de lesiones perirradiculares observadas como consecuencia de estas alteraciones, la mayoría de los investigadores y especialistas no indican el tratamiento endodóntico, por lo menos hasta que que estas lesiones se manifiesten. Esta conducta requiere sin embargo, el control clínico y radiográfico periódico de los pacientes, a veces durante varios años, para decidir la realización del tratamiento endodóntico no bien se observe la reducción del espacio del conducto radicular.

Calcificación pulpar y endodoncia: estado actual, diagnóstico y posibilidades de tratamiento / Pulp calcification and endodontics: an approach to diagnosis and treatment possibilities

La calcificación progresiva de la pulpa se produce como reacción a diferentes estímulos externos o como consecuencia de un traumatismo no demasiado severo. En los casos de traumatismos, se la detecta radiográficamente un tiempo después de ocurrido el accidente. Desde el punto de vista clínico, la corona dentaria puede adoptar una coloración amarillenta a oscura, y en las radiografías de control a distancia se puede observar que progresivamente se van perdiendo la luz del espacio de la cámara pulpar y la línea del conducto radicular. El cuadro histológico demuestra la aposición de diferentes proporciones de tejido clacificado, la mayor parte de las veces coexistente con un temido fibroso sano, con progresivo aumento del colágeno y muy pocas veces invadido por infiltrado inflamatorio. La opinión de diferentes investigadores con respecto a la conducta terapéutica más apropiada a seguir en los casos de calcificación pulpar se encuentra aún en discusión. A causa del bajo porcentaje de lesiones perirradiculares observadas como consecuencia de estas alteraciones, la mayoría de los investigadores y especialistas no indican el tratamiento endodóntico, por lo menos hasta que que estas lesiones se manifiesten. Esta conducta requiere sin embargo, el control clínico y radiográfico periódico de los pacientes, a veces durante varios años, para decidir la realización del tratamiento endodóntico no bien se observe la reducción del espacio del conducto radicular.(AU)

Hypocalcified type of amelogenesis imperfecta in a large family: clinical, radiographic, and histological findings, associated dento-facial anomalies, and resulting treatment load.

OBJECTIVE: The purpose of this study was to report on the clinical, radiographic, and histological dental findings and the resulting treatment load in a five-generation family with amelogenesis imperfecta (AI). MATERIAL AND METHODS: Thirteen affected and 15 unaffected individuals were examined clinically and radiographically. In addition, four exfoliated deciduous teeth were examined by scanning electron microscopy and microradiography. RESULTS: The mode of inheritance of AI was autosomal-dominant. At eruption, most of the tooth enamel was yellow, lacking translucency, and prone to gradual loss in subjects with AI. Post-eruptive breakdown of enamel was extensive in accordance with the histological observations of hypomineralized and porous enamel. Extensive enamel loss and discoloration were observed in older affected individuals. The treatment need had been extensive: 76.2% of the total number of teeth present in affected individuals had been treated with partial or full coverage compared to 1.7% of the teeth in unaffected relatives. Unaffected individuals had more endodontically treated teeth than AI-affected relatives. Adjunctive findings, e.g. tooth agenesis, tooth impaction, pulp stones, enlarged follicular space, and taurodontism, were rare in both groups. CONCLUSIONS: Affected family members had the hypocalcified type of AI, which is characterized by severe hypomineralization, extensive post-eruptive loss, and discoloration of the enamel. Adjunctive findings were rare. Individuals with the hypocalcified type of AI have an extensive restorative treatment load compared to unaffected relatives.

[A retrospective study of pulp healing after luxation injuries].

OBJECTIVE: To evaluate the prognosis of luxated permanent teeth and analyze the associated factors of pulp healing after luxation injuries. METHODS: The dental records of patients presented for treatment due to luxation injuries at the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology from January 2000 to December 2006 were collected, and the follow-up period was not shorter than six months. The following information was recorded, age and gender; type of injury; location of injured tooth; stage of root development; time elapsed between the injury and the first dental care; emergency treatment or not; pulp healing. Logistic regression was used to compare qualitative data and determine the associated factors of pulp healing after luxation injuries. RESULTS: The study was comprised of 157 patients with 238 luxated permanent teeth. The frequency of pulp necrosis was 16.0%, dental pulp calcification 2.1% and pulp survival 81.9%. The frequency of pulp necrosis was highest in intrusion (66.7%). The factors significantly affecting pulp healing were stage of root development and type of injury. CONCLUSIONS: The risk of pulp necrosis was greatest in intrusion. The stage of root development and the type of injury were significant factors related to pulp healing after luxation injuries.

Pulp stones: a review.

Pulp stones are a frequent finding on bitewing and periapical radiographs but receive relatively little attention in textbooks. A review of the literature was therefore performed, initially using the PubMed database and beginning the search with 'pulp calcifications' and 'pulp stones'. Each term provided more than 400 references, many of which related to pulp calcification in general rather than pulp stones, and focussed largely on the problems these changes presented to clinicians. A manual search using references from this source was carried out. Contemporary textbooks in endodontology were also consulted, and an historic perspective gained from a number of older books and references. The factors involved in the development of the pulp stones are largely unknown. Further research may determine the reasons for their formation, but with current endodontic instruments and techniques this is unlikely to alter their relevance to clinicians.

Asociación entre el diagnóstico clínico e histopatológico de las pulpopatías / Association between clinical and histopathologic diagnosis of pulp diseases

Se realizó un estudio experimental, con el objeto de determinar la asociación del diagnóstico clínico de las pulpopatías con los hallazgos histopatológicos que se producen en el órgano dentinopulpar. Esta investigación analizó, bajo determinados criterios clínicos e histopatológicos, 51 piezas dentarias humanas, incluyendo dientes sanos y dientes con diferentes grados de compromiso del órgano pulpar. Las piezas dentarias fueron fijadas y descalcificadas, para posteriormente ser procesadas, obteniéndose diferentes cortes histológicos, los que fueron teñidos y observados al microscopio óptico. Como resultados, se obtuvo un alto porcentaje de asociación (84.4 por ciento) entre los hallazgos histopatológicos y los criterios clínicos utilizados para el diagnóstico. Fue interesante observar el compromiso parcial, en estados pulpares diagnosticados clínicamente como irreversibles y la falta evidente de relación entre la sintomatología dolorosa y la extensión del compromiso pulpar. Además, alrededor de un 21.6 por ciento de las muestras presentaron trastornos regresivos que corresponden a una respuesta del tejido conjuntivo vascular de la pulpa frente a un estímulo de larga data