The Pulp Stones: Morphological Analysis in Scanning Electron Microscopy and Spectroscopic Chemical Quantification

Background and objectives: Pulp stones are hard tissue structures formed in the pulp of permanent and deciduous teeth. Few studies have evaluated their morphology and chemical composition. However, their formation, composition, configuration and role played in overall health status are still unclear. Clinically, they may be symptomatic; technically, they impede access during endodontic therapy, increasing the risk of treatment errors. Thus, this study aimed to morphologically analyze pulp stones and present their chemical quantification, identifying their main chemical elements. It also correlates the results with their possible induction mechanisms. Materials and Methods: Seven pulp nodules were collected from molar teeth needing endodontic treatment. The morphology of the stones was analyzed by scanning electron microscopy (SEM), and their chemical composition was determined by X-ray dispersive energy spectroscopy (EDX). Results: These structures varied considerably in shape, size and topography. The site of the stones in the pulp cavity was the factor that most affected the morphology. The majority of the stones found in the pulp chambers presented nodular morphology, while those in the root canals presented a diffuse shape, resembling root canal anatomy. The topography of the nodules showed heterogeneous relief, revealing smooth and compact areas contrasting with the rugged and porous ones. The chemical composition varied depending on the location of the nodule in the pulp cavity and the relief of the analyzed area. Radicular stones presented considerably lower calcium and phosphorus content than coronary nodules. Conclusions: The high cellularity rate of the coronal pulp predisposes this region to nodular mineralizations around injured cells. The presence of larger caliber vascular bundles and higher collagen fiber content in radicular pulp determines a diffuse morphological pattern in this region. Understanding the morphology and chemical composition of the pulp stones allows future translational pathways towards the prevention or treatment of such conditions.

Comparison of Abundance of Premolar and Molar Pulp Stones Before and After Orthodontic Treatment Using Panoramic Radiography

Objectives: Pulp stone is a focal calcification in dental pulp, which is often detected on conventional dental radiographs. Pulp stones can complicate easy access to the root canal and pulp chamber in root canal treatment. Orthodontic treatment may be associated with the formation of pulp stones. Therefore, this study examined the number of pulp stones pre- and post-orthodontic treatment. Materials and Methods: In this retrospective cross-sectional comparative study, 222 digital panoramic radiographs collected from private orthodontic offices in Rasht, were divided into two groups: radiographs of patients undergoing orthodontic and non-orthodontic treatment according to the inclusion criteria. The obtained data were analyzed by SPSS via the Wilcoxon and Mann-Whitney tests (P<0.05). Results: The difference in the number of pulp stones pre- and post-orthodontic treatment was significant (P<0.0001). The maximum number of pulp stones after orthodontic treatment was observed in second molars (P=0.016). The change in the number of pulp stones in the mandible (P=0.001) was significantly higher than that in the maxilla (P=0.002). This change was also greater in the left side (P<0.0001) than in the right side (P=0.002). The changes in the number of pulp stones was significant in females (P=0.02). Age had an insignificant effect on pulp stone formation (P>0.05). Conclusion: This study showed the effect of orthodontic treatment on the number of pulp stones. Further studies are required to clarify the underlying mechanisms for this increase and come up with strategies to prevent it.

CLINICAL CASE OF DENTINE DYSPLASIA TYPE I

Developmental dental hard tissues disorders are rarely diagnosed both in children and adults, and their treatment is a problem for dentist. Despite the fact that molecular genetics studies allow to discriminate some dentine disorders, pathogenesis of radicular dentin dysplasia is still obscure. Type I dentin dysplasia is characterized by normal or slightly coloured crowns with no roots or only rudimentary roots, reduced pulp space in permanent teeth and incomplete or total obliteration of the pulp chambers, and periapical radiolucent areas or cysts which might result in premature loss of tooth. Fortunately, teeth demonstrate higher resistance to caries than normal teeth do. Dentin dysplasia type II is characterized by yellow, brown, grey, translucent primary teeth with complete pulpal obliteration. Permanent teeth are normal or might be slightly coloured. Roots are normal in size, but pulp chamber has pulp stones. A third type of dentine dysplasia or focal odontoblastic dysplasia has radiographic aspects of the other two types of disease. Also dentine dysplasia type I has subtypes Ia, Ib, Ic and Id. Dentine dysplasia Ia is characterized by complete obliteration of the pulp, disorder of root development, and many periapical radiolucent areas. A single small horizontally oriented and half-moon shaped pulp is presented in case of dentine dysplasia Ib, roots have a few millimetres length and frequent periapical radiolucencies. Dentine dysplasia Ic is characterized by the presence of two horizontal or vertical semicircle-shaped pulpal remnants which surround dentine in pulp chamber. Also teeth have shortened roots and variable periapical radiolucencies. Dentine dysplasia Id is characterized by the distinct pulp chambers with pulp stones in the coronal third of the root canal; periapical radiolucencies are possible as well. Aim of this study was to analyse clinical case of dentine dysplasia in 8,5-year-old boy. A 8,5-year old boy patient with parents came to a dental office due to caries cavity in tooth 62. Shape of tooth crowns was not changed and teeth with no signs of mobility; white lines and spots on teeth are were detected. Based on age, the decision of orthopantomogram was made to evaluate status of primary and permanent teeth. The image showed almost obliterated pulp chamber in both erupted and developing teeth and considerably shortened, blunted and malformed roots without a visible lumen of root canals in primary teeth. Periapical lesions were found about roots of primary molars and follicles of teeth 12 and 14 without caries lesions. Patient's medical history revealed no disturbance in general health. Clinical examination of the patient's mother did not show dental hard tissues disorders, but radiograph examination revealed such disorder in the orthopantomogram. Thus, history, clinical and radiographic findings revealed this case as dentine dysplasia type I subtype 1c inherited from mother. Oral rehabilitation of patients with dentine dysplasia type I require effective prevention and a complex approach. Thus, meticulous oral hygiene measures and dietary instructions, regular check-ups twice a year were established for this patient; orthodontic consultation was recommended. Varnish «Ftoplen-LC» was applied on the permanent teeth 3 times. To prevent early exfoliation, plan of preventive measures was developed included application of fluoride varnish twice a year and fissure sealing in the premolars in 9-10 years and in the second premolars in 12-13 years. Treatment of dentine dysplasia I type that depends on patient age and severity of disease may include also filling of carious teeth, orthodontic, surgical and orthodontic treatment. In this regard, dentist has to know developmental dental hard tissues disorders and select measures to prolong the retention of affected teeth maintaining them as long as possible.

Pulp Stones: Diagnostic Significance in Early Diagnosis and Radiographic Correlation with Ischemic Heart Diseases

Context and Aim Sufficient evidence exists in the literature which indicates that patients with ischemic heart diseases (IHDs) show higher degree of pulp calcifications. The present study was, therefore, planned to estimate the prevalence of pulp stones in patients diagnosed with/or undergoing treatment for IHDs. Materials and Methods The present study, which consisted of 300 subjects within the age range of 25 to 65 years, was divided into two groups: study group comprising 150 patients (113 males and 37 females) and 150 age- and sex-matched healthy controls. Pulp stones were imaged using bitewing radiographs and paralleling technique under standard conditions. Statistical Analysis Used Statistical analysis was done using IBM SPSS Statistics for Windows version 21 (IBM Corp, Armonk, USA), while independent t-test and Chi-square test were done to check the prevalence of pulp stones in the study and control groups, based on gender-, arch-, region- and side-wise distribution. p < 0.05 was considered statistically significant. Results The patients with IHDs exhibited 100% prevalence of pulp stones and the difference was found to be statistically significant, although there was a significant difference in the mean number of pulp stones observed in the study and control groups, with the study group revealing 2217 pulp stones as against 639 pulp stones observed in the control group (p < 0.001). Furthermore, maxillary arch and posterior teeth were predominantly affected in both the groups, although the difference was not found to be statistically significant. Conclusions The findings of the present study suggested a positive correlation between pulp stones and IHDs, highlighting the significance of dental radiographic examination, which may have a possibility for an early detection of IHDs.

PULP STONES: A REVIEW

Pulp stones are seen to be a fairly common nding in most routine radiographs but they have been given relatively less attention in research as well as textbooks. New investigations have been done in abundance when it comes to their prevalence as well as etiological factors. Despite numerous studies, their formation still remains a riddle for endodontists and researchers alike. Historical perspective of pulp stones being an age dependent process are now being questioned as more studies report their prevalence in young population. This review article evaluates the recent studies pertaining to pulpal calcications where newer etiological factors as well as molecular factors have been highlighted in their formation. Their signicance has been largely studied correlating their occurrence with various other systemic calcications.

Incidence and distribution of pulp stones among Southern Saudi Arabian sub-population

Purpose: To assess the incidence of pulp stones in molar and premolar teeth of Southern Saudi Arabian adult sub-population. Materials and Methods: Six hundred patient files were randomly selected from the database (records) of the College of Dentistry outpatient department screened by Oral Medicine and Radiology division. Orthopantomogram and bitewing radiographs using radiovisiographs of first and second maxillary and mandibular molars and premolars were interpreted by three examiners. Pulp stones were identified as definite radiopaque masses and scored as present or absent. Data were subjected to statistical analysis using SPSS version 19. Results: Out of total 600 patients, pulp stones were found in 88 (14.7%) patients. Females showed statistically significant higher presence of pulp stones in mandibular molars than males. The patients belonging to middle age group (31–40 years) showed statistically significant higher presence of pulp stones than the other two groups in all first and second molar teeth in both arches. The presence of pulp stones was observed to be higher in maxillary arch than mandibular arch with left side having more frequency than the right side of the arch. Conclusion: The prevalence of pulp stones in the study population was found to be 14.7%, and it was higher in molars than premolars. It is quite significant to know the frequency distribution of pulp stones especially for an endodontist or a dentist to plan the root canal treatment of such teeth accordingly.