pulp calcification
TRANSCRIPT
Pulp calcification
Pulp stones are primarily a physiological manifestation (as are most other pulpal calcifications) and may increase in number and/or size due to local or systemic pathology.
The aetiological factors involved in their formation are still not fully apparent.
AGE CHANGES IN PULP
Pulp spaces of teeth decrease in size through the deposition of secondary and tertiary dentine.
Increase in the number of collagenous bundles in old coronal pulps occur
As a result of calcification of the blood vessels and nerves in the pulp, their numbers decrease
As part of the pulp ageing process there is also a considerable decrease in the number of cells -fibroblasts, odontoblasts and mesenchymal cells
Fat deposits occur in the pulp with age
ETIOLOGY Etiological factors for pulp stone formation are not
well understoodPulp degeneration Inductive interactions between epithelium and pulp tissueAgeCirculatory disturbances in pulpOrthodontic tooth movementIdiopathic factorsGenetic predisposition
Most possible factors are•Periodontal disease•Carious teeth•Restorative procedures•Fluoride prophylaxsis•Cardiac disease•Kidney stones
Systemic or genetic diseases such as dentine dysplasia,
Dentinogenesis imperfecta
Certain syndromes such as Van der Woude syndrome
Types of calcified bodies
• Central cavity filled with epithelial remnants and surrounded peripherally by odontoblasts
DENTICLES
• Compact degenerative masses of calcified tissuesPULP
STONES
Diffuse calcifications- amorphous and un organized linear strands of calcification They appear as amorphous irregular calcific deposits in the pulp tissue, usually following collagen fiber bundles or blood vessels. They are usually found in root canals and less often in the coronal area.
Based on morphology
TRUE DENTICLES Localized masses of
calcified tissue that resembles dentin
Resembles more of secondary dentin
More common in pulp chamber than in root canal
Seldom larger than a fraction of millimeter
usually located near the apical foramen.
FALSE DENTICLES Do not exhibit dentinal
tubules Appear as lamellae
deposited around a central nidus
Larger than true denticles May fill entire pulp
chamber
Based on location
Embedded stones are formed in the pulp but with ongoing physiological dentine formation they become enclosed (sometimes fully) within the canal wallsAdherent pulp stones are simply less attached to dentine than embedded pulp stones
Free pulp stones are found within the pulp tissue proper and are the most commonly seen type on radiographs
How pulp stone forms
Growth with timePulp stone
fibrosis
Mineralization Nidus formation
Local metabolic dysfunction
Hyalinization of injured cellsTrauma leads to vascular
damage-calcification of thrombi phleboliths form
What does stone contain
The stones were composed of two major elements: calcium and phosphorus. The average concentrations were 32.1% and 14.7%, respectively, resulting in a calcium/phosphorus weight ratio of 2.19
Other elements included fluorine (0.88%), sodium (0.75%) and magnesium (0.51%). Potassium, chlorine, manganese, zinc and iron in trace concentrations.
Clinical implications
May block access to canal orifices and alter the internal anatomy
Attached stones may deflect or engage the tip of exploring instruments
Ultrasonic instrumentation with the use of special tips makes their removal far easier
Should a stone be attached to the canal wall and a file can be passed alongside the stone, it may be removed by careful instrumentation
Pulp stones present little clinical difficulty during root canal treatment when magnification, good access and appropriate instruments are employed.