pulp calcification

2. General pulp calcification:
Literature Review and case
report
Kallirroi Chaini
PRESENTED BY:-
DR. RAAZIA KHAN
JR- 3

3. Introduction

8. Classification

10. 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
Based On Location

11. Can occur as :-
Discrete calcified stone or diffuse form as
Free in pulp tissue
Embedded
Attached to dentin

12. True
False
Diffuse Or
Amorphou
Based On histological criteria:

13. TRUE DENTICLES:-
• Localized masses of calcified tissue
• Resembles dentin
• Lined by odontoblast
• Resembles more of secondary dentin
• More common in pulp chamber than in
root canal
• Seldom larger than a fraction of
• Located near the apical foramen.

14. FALSE DENTICLES:-
Formed from degenerating pulp cells that mineralize.
Do not exhibit dentinal tubules
Appear as lamellae deposited around a central nidus
Larger than true denticles
May fill entire pulp chamber

15. Sundell Schematic
Presentation
Local
Metabolic
Dysfunction
Trauma
Hyalinization of
injured cell
Vascular
Damage
Thrombosis
Vessel Wall
Damage
FibrosisMineralization
Growth
Pulp Stones

16.  believed to develop around
central nidus of pulp tissue
examples:
 collagen fibril
 ground substance
 formed within coronal portions
of pulp
Pulp Stones

17. ETIOLOGY
Etiological factors for pulp stone formation are not well understood:-
Age
Pulp degeneration
Inductive interactions between epithelium and pulp tissue
Circulatory disturbances in pulp
Orthodontic tooth movement
Idiopathic factors
Genetic predisposition

18. Long standing irritants
Trauma
Traumatic Occlusion
Periodontal Disease
Others

19. Most possible factors are
•Periodontal disease
•Carious teeth
•Restorative procedures
•Cardiac disease
•Kidney stones
Systemic or genetic diseases such as dentine dysplasia,
Dentinogenesis imperfecta
Certain syndromes such as ehlors danlos

23. 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.

24. 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.

25. Reference:-
1. A.-H. Hamasha and A. Darwazeh, “Prevalence of pulp stones in Jordanian adults,” Oral Surgery, Oral
Medicine, Oral Pathology, Oral Radiology, and Endodontics, vol. 86, no. 6, pp. 730–732, 1998.
[2] N. C ̧i c ̧ioglu, V. C ̧i c ̧ioglu, H. Vali, E. Turcott, and E. O. Kajander, “Sedimentary rocks in our mouth:
dental pulp stones made by nanobacteria,” in Instruments, Methods, and Missions for Astrobiology, vol. 3441
of Proceedings of SPIE, pp. 130–137, July 1998.
[3] E.-A. Holtgrave, W. Hopfenmu ̈ller, and S. Ammar, “Abnormal pulp calci cation in primary molars a er
uoride supplemen- tation,” Journal of Dentistry for Children, vol. 69, no. 2, pp. 201– 206, 2002.
[4] O. Bauss, D. Neter, and A. Rahman, “Prevalence of pulp calci- cations in patients with Marfan syndrome,”
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 106, no. 6, pp. e56–
e61, 2008.
[5] J. R. Sundell, H. R. Stanley, and C. L. White, “ e relationship of coronal pulp stone formation to
experimental operative procedures,” Oral Surgery, Oral Medicine, Oral Pathology, vol. 25, no. 4, pp. 579–
589, 1968.
[6] N. P. Chandler, T. R. Pitt Ford, and B. D. Monteith, “Coronal pulp size in molars: a study of bitewing
radiographs,” Interna- tional Endodontic Journal, vol. 36, no. 11, pp. 757–763, 2003.
[7] A. C. Edds, J. E. Walden, J. P. Scheetz, L. J. Goldsmith, C. L. Drisko, and P. D. Eleazer, “Pilot study of
correlation of pulp stones with cardiovascular disease,” Journal of Endodontics, vol. 31, no. 7, pp. 504–506,
2005.