Regressive alterations pulp stones ppt..pptx

about pulp calcifications

1. Regressive alterations – Pulp calcification , Hypercementosis 1

2. Pulp calcifications 2 Masses of calcified tissue present on pulp chamber and roots of teeth Common phenomenon occurs with increasing age Classified Based on morphologic forms - Discrete pulp stones - Diffuse calcifications Based on location - Free - Attached - Embedded

3. Pulp stones (Denticles) Nodular,  calcified  masses appearing in either or both the coronal and root portion of the  pulp  organ in teeth Seen in functional as well as unerupteed embedded teeth Noted in with systemic or genetic diseases – dentine dysplasia, dentinogenesis imperfecta and Van der Woude syndrome Exact cause unknown 3

4. Types of denticles True denticles - made up of dentine that is lined by odontoblast. - more common in pulp chamber than in root False denticles - composed of localized masses of calcified material - arranged in concentric layers or lamellae deposited around a central nidus 4

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6. 6 Free – entirely surrounded by pulp tissue Attached – partly fused with dentin Embedded – entirely surrounded by dentin Based on location

7. Diffuse Calcifications Most commonly seen in root canals of teeth Resemble calcification seen in other tissues of the body following degeneration. Also termed as calcific degeneration Usually seen as amorphous, unorganized linear strands or columns paralleling the blood vessels and nerves of pulp . 7

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9. Etiology of Pulp Calcification Pulp degeneration Increasing age Circulatory disturbances within the pulp , long standing local irritants such as  dental caries ,  pulp-capping procedures , healed tooth fractures, tooth injury restorations and  periodontal diseases Orthodontic tooth movements Trauma 9

10. Mechanism 10 Local metabolic dysfunction Trauma Hyalinization of injured cells Vascular damage ( Thrombosis,Vessel wall damage) Fibrosis Mineralization (Nidus formation) Pulp stone Growth with time

11. Hypercementosis 11

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14. Etiology Variety of circumstances favour deposition of excessive amounts of cementum. Include : Accelerated elongation of a tooth Inflammation about tooth Tooth repair Osteitis deformans or paget’s disease of bone Spike formation of cementum 14 Local factors

15. Clinical featurs No clinical signs and symptoms No visible signs No remarked tooth sensitivity on percussion Tooth with hypercementosis extracted –roots appear larger in diameter than normal with rounded apices. 15

16. Radiographic features Thickening and apparent blunting of root with rounding of apex Apex appears bulbous Lamina dura will follow the outline of teeth in normal periodontal ligament space Irregular accumulation of cementum that is accommodated by related area of bone resorption 16

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18. Histologic features Microscopic appearance – excessive amount of secondary or cellular cementum deposited directly over the thin layer of primary cementum Involved area – entire root or a portion mainly apical region Secondary cementum – osteocementum because of its cellular nature and its resemblance to bone 18

19. Cementum – arranged in concentric layers around root and frequently shows numerous resting lines, indicated by deeply staining hematoxyphilic lines parallel to root surface 19

20. Treatment No treatment 20

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22. Types of cementicles Free Cementicles – lamellated cemental bodies that lie freely in PDL Attached Cementicles – cemental bodies which are attached to root surface 22

23. Resorption of teeth Tooth resorption – process where all or part of tooth structure lost due to activation of body’s innate capacity to remove mineralization tissue as mediated by cells such as osteoclasts Physiological or pathological 23

24. Physiological tooth resorption – affects deciduous teeth results into loosening and shedding off due to pressure arising from the underlying successors Pathological tooth resorption – resorption of permanent teeth 24

25. External resorption Resorption occurring in PDL (external surface) Extremely common Many local factors are involved in external resorption 25

26. Causes of external resorption 26

27. Periapical inflammation Caries/ trauma Increases inflammatory response Protective layer is damaged ,osteoclasts acts on the damaged area. resorption. 27

28. Reimplantation of teeth Extensive resorption Tooth outside socket – PDL cells undergo necrosis No PDL cells – bone view tooth as foreign body thus resorption occurs 28

29. Tumours and Cysts 29 Pressure phenomenon

30. Excessive mechanical or occlusal forces 30 Resorption from orthodontic treatment Maxillary incisor region

31. Impaction of teeth 31

32. Idiopathic resorption Root resorption without any etiological factor When multiple teeth involved – multiple idiopathic root resorption 32

33. Radiographic feature Moth – eaten appearance Borders irregular & ill defined Outline of root canal is normal Root canal is seen running through the defect Almost always accompanied by resorption of bone Radiolucency appear in root and adjacent bone Lesion moves away from canal as angulation changes 33

34. Treatment Removal of tooth Identification and elimination of accelerating factor 34

35. Internal root resorption Other synonyms Chronic perforating hyperplasia of pulp Internal granuloma Odontoclastoma Pink tooth of Mummery The progressive destruction of intraradicular dentin and dentinal tubules along the middle and apical thirds of the canal walls as a result of clastic activities . Resorption begins centrally within tooth (dental pulp) Cause unknown – but may be associated with carious exposure and pulpal infection 35

36. Clinical features No early clinical symptoms First evidence of lesion – appearance of pink – hued area on crown of tissue filling resorbed area Incisors, cuspids, bicuspids and molars – resorption reported one time or another 36

37. Types of internal resorption 37

38. Radiographic features 38 Margins are smooth & clearly defined Root canal walls appear to balloon out Outline of root canal distorted Root canal & resorptive defect appear continuous Radiolucency confined to root (does not involve bone) Bone lesion seen only if resorption perforate tooth Lesion appear close to root canal in different angulations

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40. Histopathology An internal resorption lesion mainly consists of granulation tissue. The pulpal connective tissue is highly vascularized with varying degrees of inflammation, infiltrated by lymphocytes, macrophages, neutrophilic leukocytes, and plasma cells. Neutrophils and macrophages are attached to the mineralized dentin surface. “Resorptive bays” with numerous odontoclasts are also seen 40

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42. Treatment Early identification – endodontic treatment Later removal of teeth 42