Dental and Medical Problems

Dent. Med. Probl.
Index Copernicus (ICV 2018) – 113.05
MNiSW – 20
Average rejection rate – 70.86%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

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Dental and Medical Problems

2020, vol. 57, nr 2, April-June, p. 213–220

doi: 10.17219/dmp/117944

Publication type: clinical case

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Clinical aspects of pulp stones: A case report series

Aspekty kliniczne kamieni miazgi – seria przypadków

Krystyna Pietrzycka1,A,B,C,D,E,F, Halina Pawlicka1,B,D,E

1 Department of Endodontics, Medical University of Lodz, Poland

Abstract

Pulp stones (PSs) are calcified masses that can be found in the pulp cavity of any deciduous or permanent tooth. They can be observed in healthy, diseased, and even unerupted or impacted teeth. Calcifications within the pulp may lead to a poorer outcome of a root canal procedure, as they can block access to the root canals, and hinder their subsequent cleaning and shaping. The paper describes 4 clinical cases of denticles located in the coronal and radicular pulp. Therapeutic methods of PS removal with different techniques and instruments are discussed. Specialist root canal treatment (RCT) was performed in aseptic conditions with the use of long-shank rose-head burs and an endodontic ultrasonic device under the magnification of a dental operative microscope (OM). During endodontic treatment, all PSs were totally removed, which allowed the further preparation, and finally obturation of the canal system. The use of modern diagnostic and therapeutic methods – three-dimensional (3D) diagnostic radiology, endodontic techniques, such as ultrasounds used during the removal of PSs and the irrigation of the canals, and the thermoplastic methods of canal obturation – can provide good results of treatment of this pathology. The removal of PSs from the pulp cavity is a complex and difficult procedure, requiring skill, dexterity, and appropriate equipment and facilities. The clinical approach introduced in this paper allows endodontists to avoid potential complications like perforation, the unnecessary removal of hard tissues or the weakening of the tooth structure.

Key words

root canal treatment, dental operating microscope, pulp stones, denticles, ultrasonic tips

Słowa kluczowe

leczenie kanałowe, stomatologiczny mikroskop operacyjny, kamienie miazgi, zębiniaki, końcówki ultradźwiękowe

References (30)

  1. Langeland K, Rodrigues H, Dowden W. Periodontal disease, bacteria, and pulpal histopathology. Oral Surg Oral Med Oral Pathol. 1974;37(2):257–270.
  2. Kronfeld R, Boyle PE. Histopathology of the Teeth and Their Surrounding Structures. 4th ed. London, UK: Henry Kimpton; 1955.
  3. Mahajan P, Monga P, Bahunguna N, Bajaj N. Principles of management of calcified canals. Indian J Dent Sci. 2010;2(Suppl):3–5.
  4. Arys A, Philippart C, Dourov N. Microradiography and light micro­scopy of mineralization in the pulp of undemineralized human primary molars. J Oral Pathol Med. 1993;22(2):49–53.
  5. Moss-Salentijn L, Klyvert MH. Epithelially induced denticles in the pulps of recently erupted, noncarious human premolars. J Endod. 1983;9(12):554–560.
  6. Goga R, Chandler NP, Oginni AO. Pulp stones: A review. Int Endod J. 2008;41(6):457–468.
  7. Bains SK, Bhatia A, Singh HP, Biswal SS, Kanth S, Nalla S. Prevalence of coronal pulp stones and its relation with systemic disorders in northern Indian central punjabi population. ISRN Dent. 2014:2014;617590.
  8. Edds AC, Walden JE, Scheetz JP, Goldsmith LJ, Drisko CL, Eleazer PD. Pilot study of correlation of pulp stones with cardiovascular disease. J Endod. 2005;31(7):504–506.
  9. Jena D, Balakrishna K, Singh S, Naqvi ZA, Lanje A, Arora N. A retrospective analysis of pulp stones in patients following orthodontic treatment. J Contemp Dent Pract. 2018;19(9):1095–1099.
  10. Zeng J, Yang F, Zhang W, Gong Q, Du Y, Ling J. Association between dental pulp stones and calcifying nanoparticles. Int J Nanomedicine. 2011;6:109–118.
  11. Ranjitkar S, Taylor JA, Townsend GC. A radiographic assessment of the prevalence of pulp stones in Australians. Aust Dent J. 2002;47(1):36–40.
  12. Moss-Salentijn L, Hendricks-Klyvert M. Calcified structures in human dental pulps. J Endod. 1988;14(4):184–189.
  13. Aslantas EE, Buzoglu HD, Karapinar SP, et al. Age-related changes in the alkaline phosphatase activity of healthy and inflamed human dental pulp. J Endod. 2016;42(1):131–134.
  14. Kannan S, Kannepady SK, Muthu K, Jeevan MB, Thapasum A. Radiographic assessment of the prevalence of pulp stones in Malaysians. J Endod. 2015;41(3):333–337.
  15. Syryńska M, Durka-Zajac M, Janiszewska-Olszowska J. Prevalence and location of denticles on panoramic radiographs. Ann Acad Med Stetin. 2010;56(2):55–57.
  16. Gulsahi A, Cebeci AI, Ozden S. A radiographic assessment of the prevalence of pulp stones in a group of Turkish dental patients. Int Endod J. 2009;42(8):735–739.
  17. Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K. Cone beam computed tomography in endodontics – a review. Int Endod J. 2015;48(1):3–15.
  18. Rodakowska E, Ochnio A, Struniawska A. Not to be forgotten: Denticles. Case reports and review of the literature. Ann Acad Med Stetin. 2011;57(3):77–81.
  19. Udoye CI, Sede MA. Prevalence and analysis of factors related to occurrence of pulp stone in adult restorative patients. Ann Med Health Sci Res. 2011;1(1):9–14.
  20. Hsieh CY, Wu YC, Su CC, et al. The prevalence and distribution of radiopaque, calcified pulp stones: A cone-beam computed tomography study in a northern Taiwanese population. J Dent Sci. 2018;13(2):138–144.
  21. Nogueira Leal da Silva EJ, Prado MC, Queiroz PM, et al. Assessing pulp stones by cone-beam computed tomography. Clin Oral Investig. 2017;21(7):2327–2333.
  22. Patel S, Brown J, Pimentel T, Kelly RD, Abella F, Durack C. Cone beam computed tomography in endodontics – a review of the lite­rature. Int Endod J. 2019;52(8):1138–1152.
  23. Olczak K, Kabacińska K, Pawlicka H. Management of pulp canal obliterations. Czas Stomatol. 2017;70(5):597–612.
  24. Palatyńska-Ulatowska A, Pietrzycka K, Koprowicz A. Denticles of the pulp chamber – diagnostics and management. Case studies. Pomeranian J Life Sci. 2019;65(2):29–36.
  25. Freedman G, Glassman G. Buyers’ guide to endodontic equipment. An in-depth look at today’s apex locators, obturation systems, and ultrasonic systems. Dent Today. 2009;28(4):118,120,122 passim.
  26. Nanjannawar GS, Vagarali H, Nanjannawar LG, Prathasarathy B, Patil A, Bhandi S. Pulp stone – an endodontic challenge: Successful retrieval of exceptionally long pulp stones measuring 14 and 9.5 mm from the palatal roots of maxillary molars. J Contemp Dent Pract. 2012;13(5):719–722.
  27. Chen B, Szabo D, Shen Y, et al. Removal of calcifications from distal canals of mandibular molars by a non-instrumentational cleaning system: A micro-CT study. Aust Endod J. 2019 [Epub]. doi: 10.1111/aej.12376
  28. Krasner P, Rankow HJ. Anatomy of the pulp-chamber floor. J Endod. 2004;30(1):5–16.
  29. Connert T, Zehnder MS, Amato M, Weiger R, Kühl S, Krastl G. Microguided endodontics: A method to achieve minimally invasive access cavity preparation and root canal location in mandibular incisors using a novel computer-guided technique. Int Endod J. 2018;51(2):247–255.
  30. Moreira Maia L, de Carvalho Machado V, Alves da Silva NRF, et al. Case reports in maxillary posterior teeth by guided endodontic access. J Endod. 2019;45(2):214–218.