Pulp calcification

pulp stones and their types

1. 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 P ulp spaces of teeth decrease in size through the deposition of secondary and tertiary dentine. I ncrease in the number of collagenous bundles in old coronal pulps occur A s a result of calcification of the blood vessels and nerves in the pulp, their numbers decrease A s 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 E tiological factors for pulp stone formation are not well understood P ulp degeneration Inductive interactions between epithelium and pulp tissue Age C irculatory disturbances in pulp O rthodontic tooth movement I diopathic factors G enetic predisposition

5. Most possible factors are Periodontal disease Carious teeth Restorative procedures Fluoride prophylaxsis Cardiac disease Kidney stones S ystemic or genetic diseases such as dentine dysplasia, D entinogenesis imperfecta C ertain syndromes such as Van der Woude syndrome

6. Types of calcified bodies 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 .

7. 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

8. 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

9. How pulp stone forms

10. 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 .

11. Clinical implications May block access to canal orifices and alter the internal anatomy Attached stones may deflect or engage the tip of exploring instruments U ltrasonic 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.