An enamel pearl, or enameloma, is a small white mass of ectopic enamel attached to a root surface near the cementoenamel junction (CEJ). It can contain enamel, dentin, and pulp. Enamel pearls are caused by the persistence of Hertwig's epithelial root sheath during root development, allowing it to form enamel. They range in size from 0.3 to 4 mm and commonly form on the maxillary and mandibular molars. Enamel pearls promote plaque retention and provide a niche for bacteria, which can lead to periodontal problems if left untreated.

1. Enamel Pearl – enameloma
Dr Randy Chance BMSC BDS

2. intro
• Ectopic enamel usually on the root
surface close to CEJ
• Most common ectopic enamel- other one
is enamel projection
• May contain enamel, dentin, pulp
• Histologically it is covered by a thin
layer of acellular cementum or reduced
enamel epithelium.

3. Many synonyms
• Enamel droplet,
• Enamel nodule,
• Enamel globule,
• Enamel knot,
• Enamel exostosis,
• Enameloma,
• Adamantoma.

5. etiology
• Persistence of Hertwig's epithelial root
sheath(or its remnants) during root development
allows it to differentiate into ameloblast and
lay down enamel.
• The intervening stellate reticulum facilitates
the differentiation to ameloblasts

6. Classification
• Free enamel pearl – enamel
• Composite enamel pearl- dentin-pulp
• Intra-dental enamel pearl- surrounded by
dentin
• External enamel pearl

7. Clinical features
• Prevalence ranges from 1.1 to 9.7 percent of
all patients
• Asians tend to be affected most often
• M>F
• Small white dome-shaped mass attached to a
root surface
• Maxillary, second and third molars are more
commonly involved than the first molars

8. • Most develop near the furcation area of
a tooth
• May occur singly(most instances) or in
multiples
• Enamel pearl often results in deep
pocket formation over time- deep probing
depths

9. Dimensions
• Varies from 0.3 mm to 4 mm in size
• Mean diameter reportedly 0.96 ±0.43mm
• Average distance to the CEJ was found to be
2.8 ± 1.00 mm.
• Distal proximal surfaces of the maxillary
molars and the buccal or lingual surfaces of
the mandibular molars are the preferred
sites.

10. On a premolar

11. Problems
• Promotes enhanced plaque retention and
protects oral microorganisms from the action
of salivary enzymes and oral hygiene
measures.
• Provides a niche for periodontopathogenic
bacteria
• Broken instrument tip during S&P
• Misdiagnosed as calculus and attempted
removal may lead to pulpal exposure

12. On the incisor

13. hemispherical dense opacities projecting
from the boundaries of root surface

16. Thank you for learning!
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