Pulp calcification
- 2. 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.
- 3. 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
- 4. ETIOLOGY Etiological factors for pulp stone formation are not well understood Pulp degeneration Inductive interactions between epithelium and pulp tissue Age Circulatory disturbances in pulp Orthodontic tooth movement Idiopathic factors Genetic predisposition
- 5. 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 derWoude syndrome
- 6. 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 calcificationThey 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.
- 8. 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
- 9. Based on location Embedded stones are formed in the pulp but with ongoing physiological dentine formation they become enclosed (sometimes fully) within the canal walls Adherent 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
- 12. How pulp stone forms Growth with time Pulp stone fibrosis Mineralization Nidus formation Local metabolic dysfunction Hyalinization of injured cells Trauma leads to vascular damage- calcification of thrombi phleboliths form
- 13. 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.
- 14. 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.