Calcified structures in human dental pulps

Evaluation of Morphological and Chemical Composition of Dental Pulp Stones: A Combined Microanalytical Approach

INTRODUCTION

Pulp stones (PSs) are mineralized ectopic structures within the dental pulp that vary in morphology, composition, and location. Their etiology remains uncertain and poses clinical challenges in endodontics. This study hypothesized that combined analytical techniques would enhance understanding of PS morphology and composition, facilitating clinical management of complex cases.

METHODS

Fifteen permanent molars with radiographic evidence of PSs were analyzed using microcomputed tomography (μ-CT), light microscopy, and scanning electron microscopy associated with energy-dispersive spectroscopy (SEM-EDS). The samples underwent qualitative and quantitative assessments to explore their morphology, distribution, and chemical composition. Statistical analysis was conducted using one-way analysis of variance to evaluate differences in Ca/P ratios between PS and dentin, with significance set at P < .05.

RESULTS

μ-CT and histological evaluations revealed distinct morphological differences between coronal and radicular PS. Coronal PS exhibited regular nodular or mold shapes, whereas radicular PS showed irregular and diffuse patterns. Histological findings highlighted the nature of PS as mineralized ectopic connective tissue in coronal regions. On the other hand, radicular PSs displayed linear arrangement of collagen fibers intertwined with vascular bundles. SEM-EDS demonstrated no significant differences in mineralization between PS and dentin, with comparable Ca/P ratios.

CONCLUSIONS

PSs exhibit distinct morphological and structural characteristics depending on their location. Despite these differences, PSs and dentin share similar chemical compositions, as demonstrated by similar Ca/P ratios. The combined microanalytical approach employed provides novel insights into PS morphology and composition, offering a foundation for translational advancements in diagnostic and therapeutic strategies.

Radiographic evaluation of teeth with pulp stones and pulp canal obliteration: characteristics, and associations with dental parameters

The study aimed to radiographically assess the characteristics of pulp stones (PS) and pulp canal obliteration (PCO) in teeth and examined their associations with various dental parameters such as caries, restorations, periodontal status, and age. This cross-sectional observational study was conducted at the Faculty of Dentistry, King Abdulaziz University between September 2022, and May 2023, involved 101 patients exhibiting 402 teeth with PS or PCO. Data were collected from periapical and bitewing radiographs, and analyzed by two calibrated dentists. Multiple dental parameters were assessed, including caries level, presence and level of restorations, periodontal condition, and age of the patient. The study population consisted of 62 females and 39 males, with an age range of 18-65 years. Inter- and intra-examiner reliability were high (Kappa = 0.88 and 0.98 respectively). PS were more commonly found in molars (81.2%), while PCO were presented in only 115 teeth (23%). Age significantly affected the type of calcification (p < 0.001), with PS more common in the 20-30 age group and PCO more common in individuals over 40. Presence of caries was significantly associated with the type of calcification (p = 0.013), but restoration was not. The majority of teeth with PS (76%) or PCO (93%) had healthy periodontium. Around 40% of teeth with PCO showed signs of periapical changes, a finding significantly different from those with PS (p < 0.001). Pulp calcifications were significantly associated with various dental parameters, including caries presence, age, and periodontal status. The findings provide crucial insights into the epidemiology and aetiology of pulp calcifications.

Patterns of Pulpal Mineralization in Mandibular Anteriors: A Micro-computed Tomography Analysis

INTRODUCTION

Current understanding of the morphology of pulpal mineralizations is limited. Understanding the specific location and type of such mineralizations will aid clinicians in diagnosis, case complexity assessment, and treatment planning. Therefore, this study correlated the appearance of a reduced canal volume (CV) in conventional radiographs with the presence of pulp mineralizations (PMs) utilizing micro-computed tomography (CT) analysis. The morphology of PMs utilizing micro-CT technology was also analyzed.

METHODS

One hundred and twenty-one extracted permanent mandibular incisors were collected. Periapical radiographs were taken of the teeth to determine if a reduced canal space was present, in which case the sample was included for micro-CT assessment. Various descriptors for PM were then determined and these labels were then applied to the entire sample to demonstrate PM. Numerical analysis was undertaken for all teeth scanned; the following data was extracted: the presence or absence of PMs, types of PM, and their morphological structures; CVs were determined. Cohen's kappa test was used to assess intraexaminer agreement.

RESULTS

Based on radiographic appearance, forty-two teeth were included for micro-CT analysis. PMs were demonstrable in 57% and absent 43% of teeth. When PMs were absent, the CV was significantly smaller compared to when they were present (P < .05). Discrete mineralizations were more frequently located in the coronal and middle thirds compared to diffuse mineralization (P < .01). No differences in the prevalence of the individual features of discrete or diffuse mineralizations were detected (P > .05).

CONCLUSIONS

Two detectable forms of PMs were found in micro-CT analysis at all levels of the canal: discrete and diffuse mineralizations. A reduced CV on a PA was reflective of mineralized changes within the pulp but the type of PM could not be determined. PMs occurred at any level of the root canal; clinicians need to be aware of this when performing root canal treatment.

Multiple pulp stones emerge across all teeth during mixed dentition: A case report

BACKGROUND

This paper reports a rare presentation of multiple pulp stones (PSs) emerging in all teeth during mixed dentition. It offers valuable insights into the clinical diagnosis, treatment, and prognosis of multiple PSs, shedding light on their occurrence during the mixed dentition period.

CASE SUMMARY

A 10-year-old girl presented with repeated pain in the mandibular right posterior teeth. Intraoral examination revealed carious lesions, abnormal tooth shapes, and anomalies in tooth number. Radiographic examinations showed multiple PSs with diverse shapes, sizes, and quantities in all teeth, alongside anomalies in tooth shape and number. Root canal therapy was initiated, but the patient initially lacked timely follow-up. Upon return for treatment completion, an extracted tooth revealed irregular calculus within the pulp cavity.

CONCLUSION

This case underscores the importance of considering multiple PSs in mixed dentition, necessitating comprehensive evaluation and management strategies.

Cone-Beam Computed Tomography-Based Investigation of the Prevalence and Distribution of Pulp Stones and Their Relation to Local and Systemic Factors in the Makkah Population: A Cross-Sectional Study

Objectives This study aimed to assess the prevalence and distribution of dental pulp stones and evaluated their possible associations with local and systemic factors in the Makkah population in Saudi Arabia. Materials and methods Archived cone-beam computed tomography (CBCT) images for 390 patients, from the electronic health records (EHR) in the Dental Teaching Hospital, Umm Al-Qura University, were used. Images were examined in all planes (coronal, sagittal, and axial) for a discrete radiopaque mass in the pulp of all teeth, in both arches. The teeth conditions (the presence of caries, restoration, the periodontal condition, and the presence of pulp stones) were recorded. Additional patient information, including age, gender, and medical condition, was obtained from the patients' archived files. The collected data were statistically analyzed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY) software; a p-value of ≤ 0.05 is considered statistically significant. Results Pulp stone prevalence was 78.97% of the subjects (308 out of 390) and 15.92% of the examined teeth (1644 out of 10326). There were statistically significant differences regarding nationality (p=0.043) and age (p=0.023) but no significant difference between males and females (p=0.876), maxillary and mandibular teeth (p=0.392), and right and left sides (p=0.222) in pulp stone prevalence. Significant differences were found between pulp stone prevalence of sound versus and carious and restored teeth and between periodontally affected teeth and periodontally healthy teeth (p=0.031). Conclusion The prevalence of pulp stones in the Makkah population is high. A positive association was found between nationality, age, tooth restorations, caries, periodontal diseases, and pulp stone prevalence, but no correlation was found with patients' health or gender. The molars were the most affected teeth, while the incisors were the least.

Morphology of pulpal mineralizations: A scoping review

OBJECTIVE

The aim of this scoping review was to summarize and discuss the morphological features and associated factors of pulpal mineralizations (PMs) as described within the literature.

DATA

The study protocol was registered on the Open Science Framework platform and is available at the following link: https://osf.io/hfqwe. This scoping review was developed according to the PRISMA-ScR guidelines.

SOURCES

A literature search of four electronic databases was performed in SCOPUS, MEDLINE (PubMed), EMBASE and Word of Science, with the last search on May 29, 2023. Study selection was completed by two reviewers independently. Data was extracted regarding study characteristics, types, and features of PM and associated factors.

STUDY SELECTION

Of 1016 studies initially identified ten which qualified were included in this scoping review. Systemic and local factors that result in pulpal insult can contribute to the development of PMs. Three forms of PM have been reported, pulp stones, diffuse mineralizations, and mineralized ectopic connective tissue, with discrete and diffuse mineralization being the two clinically relevant forms. The different forms of PMs exhibit dissimilar morphological features.

CONCLUSION

Pulpal mineralizations exist in two clinically relevant forms: diffuse and discrete mineralizations and are likely associated with a pulpal insult.

CLINICAL SIGNIFICANCE

Understanding the morphology of dental pulp mineralization is the first step to expanding the knowledge of pulp mineralization and could result in improved diagnosis of endodontic pathosis.

A systematic review assessing the dental pulp stone prevalence in the Saudi Arabian population

This Systematic Review (SR) was to report on the prevalence of pulp stones in the Saudi Arabian (KSA) population. The electronic databases were searched for scientific research articles during May 2021. The data search was performed in electronic search engines like PubMed, Scopus, Web of science, and Saudi Digital Library, and 6 original research articles which fulfilled the eligibility criteria were assessed for qualitative data. The prevalence of pulp stones among the KSA population ranged from 4.6% to 50.93% among the study participants and it ranged between 10.2%-13.34% in the teeth assessed. The pulp stones were more frequently reported in decayed teeth, periodontal diseases, attrition, teeth with dental restorations, and higher in the molar teeth in comparison with the premolar teeth. The data on the prevalence of pulp stones among the Saudi population will be helpful for clinicians in planning endodontic procedures.

Mechanisms underlying the adaptive pulp and jaw bone trabecular changes in sickle cell anemia

OBJECTIVE

Mechanisms underlying the oral outcomes in sickle cell anemia (HbSS) have been less explored. This study aimed to investigate the association of morbimortality indicators and hydroxyurea use with adaptive pulp and jaw bone trabecular changes in HbSS.

METHODS

This cross-sectional study included 123 individuals with HbSS. The exposures were the morbimortality indicators of HbSS (number of vaso-occlusive crises, organ damage, hemoglobin level, and leukocyte count) and the use of hydroxyurea for HbSS treatment. The outcomes were adaptive pulp and jaw bone trabecular changes confirmed by radiographic examination. Associations were estimated by Poisson regression in crude and adjusted analyses for sex, skin color, socioeconomic class, and age.

RESULTS

The vaso-occlusive crises (mean ratio (MR) = 3.5, p = 0.045), lower hemoglobin (MR = 2.4, p = 0.037), and higher leukocyte count (MR = 2.17, p = 0.036) were risk factors, while the use of hydroxyurea was inversely associated with adaptive pulp changes (MR = 0.23, p = 0.024). The vaso-occlusive crises were associated with jaw bone trabecular changes (MR = 1.33, p = 0.02).

CONCLUSION

Adaptive pulp changes may be a potential clinical marker of chronic vasculopathy in HbSS. The use of hydroxyurea may reduce the frequency of adaptive pulp changes.

Cone beam computed tomography assessment of the prevalence and association of pulp calcification with periodontitis

Periodontitis has a known association with pathological calcification in the cardiovascular system. Considering the close anatomic and circulatory association between dental pulp and the periodontium, this study aimed to evaluate the prevalence of pulp calcification (PC) under different periodontal conditions, as well as the associations of PC with the degree of periodontal damage, via cone beam computed tomography (CBCT) examination. In this study, 55 patients were categorized into three groups according to periodontal condition: group 1 (healthy controls), group 2 (periodontitis stage I-II), and group 3 (periodontitis stage III-IV). PC and radiographic bone loss (RBL) was assessed by CBCT in sagittal, axial, and coronal views, and statistical analyses were conducted. PC was identified in 378 of 1170 teeth (32.3%). The prevalence significantly differed among the three groups (P < 0.001). Group 2 had a 2.43-fold (P < 0.001, 95% confidence interval [CI] 1.64-3.61) higher risk of PC than group 1; and the risk of PC was 3.04-fold (P < 0.001, 95% CI 2.06-4.48) higher in group 3 than group 1. Teeth with more severe RBL exhibited a higher prevalence of PC (P < 0.001). Molar teeth had a higher risk of PC than incisors and premolars. In conclusion, the occurrence of PC is related to the periodontal state, and the prevalence of PC is higher in teeth with periodontitis; tooth type and periodontitis status are important risk factors for PC.

Intra-pulpal connective tissue formation and the advanced carious lesion: Is chondrogenesis and heterotopic ossification a response to pulpal inflammation?

AIMS

(a) The aim of this study was to investigate both the formation of dense connective tissue within the dental pulp, and its association with pulpal inflammation in teeth with advanced carious lesions; and (b) to investigate in vitro whether inflammation affects the expression of markers related to chondrogenesis/osteogenesis in pulp cells.

MATERIALS AND METHODS

Radiology and Histology: Forty-six teeth with advanced carious lesions were radiographically investigated for intra-pulpal radiodense structures. Specimens were processed for histology and stained with haematoxylin/eosin and proteoglycan-specific stains. The intra-pulpal connective tissue was scored as pulp stones or ectopic connective tissue. Cell culture: pulpal cells from human third molars (n = 5) were cultured in chondrogenic medium +/- TLR2/4 agonists. Expression of the genes IL6, TLR2/4, SOX9, COL1A1, COL2A1, TGFB1, RUNX2 and ALPL was assessed by qPCR. Proteoglycan content within cultures was assessed spectrophotometrically.

RESULTS

Radiodense structures were discovered in about half of all pulps. They were associated with ectopic connective tissue (χ²  = 8.932, p = .004, OR = 6.80, 95% CI: [1.84, 25.19]) and with pulp stones (χ²  = 12.274, df = 1, p < .001, OR = 22.167, 95% CI: [2.57, 200.00]). The morphology of the ectopic tissue resembled cartilage and was associated with inflammatory infiltration of the pulp (χ²  = 10.148, p = .002, OR = 17.77, 95% CI: [2.05, 154.21]). After continuous stimulation of cultured cells with TLR2/4 agonists, the expression of two inflammatory markers increased: IL6 at Days 7 (p = .020) and 14 (p = .008); TLR2 at Days 7 (p = .023) and 14 (p = .009). Similarly, expression of chondrogenic markers decreased: SOX9 at Day 14 (p = .035) and TGFB1 at Day 7 (p = .004), and the osteogenic marker COL1A1 at Day 7 (p = .007). Proteoglycan content did not differ between unstimulated and stimulated cells.

CONCLUSIONS

Ectopic connective tissue resembling cartilage can form in teeth affected by advanced carious lesions. This tissue type is radiographically visible and is associated with inflammatory infiltration of the pulp. Although TLR2/4 agonists led to an inflammatory response in cell culture of pulp cells, the effect on the expression of osteogenic/chondrogenic markers was limited, suggesting that immune cells are needed for connective tissue formation in vivo.

Association between Periodontitis and Pulp Calcifications: Radiological Study

Objective

The presence of intrapulpal calcifications is one of the effects reported as a consequence of periodontal pathology. Although the impact of the pulp pathology on the periodontium is obvious, the contrary remains unclear and controversial. This study was conducted in order to better understand this fact and establish a potential association between periodontitis and intrapulpal calcifications and then to determine the factors associated with their occurrence.

Materials and Methods

To investigate the issue, a retrospective radiological study using periapical preoperative radiographics assessed 332 teeth taken from the records of 79 patients who received treatment for periodontitis. In the second part of the study, 81 of the sample with intact dental crowns presenting an attachment loss were compared to their contralateral with intact dental crowns without any attachment loss. The study of the association between periodontitis and intrapulpal calcifications and the factors associated with their occurrence was performed by the Chi squared and Fisher's exact tests. The significance level was set at 0.05.

Results

The results indicated that 251 (75.6%) teeth had an attachment loss while 102 (30.7%) had intrapulpal calcification. Among the 206 (62%) teeth with intact crown, only 6 (1.8%) showed calcification in the pulp cavity and 20 (6%) showed calcification in the root canals, with a statistically significant difference (p < 0.005) compared to teeth with restorations and caries. For the 32 (19.7%) teeth with coronary calcification, 18 (22.2%) presented an attachment loss versus 14 (17.2%) without attachment loss; the difference was not statistically significant (p=0.6). Similarly, only 13 (16%) of a total of 22 (13.5%) teeth with root canal calcification had attachment loss versus 9 (11.1%) without attachment loss. This difference was not statistically significant (p=0.5).

Conclusion

This radiographic study revealed no association between the presence of periodontitis and the occurrence of intrapulpal calcifications. Although intrapulpal calcifications were present in some teeth with loss of attachment, they were not necessarily the consequence of periodontal disease.

A comparison of dietary isotopes in pulp stones and incremental dentine from Early Neolithic individuals of the Whitwell Long Cairn, England

Objectives

This study investigates if palaeodietary information can be obtained from pulp stones through stable isotope analysis, presents a method for their extraction from tooth samples, and assesses their utility as a source of paleodietary information when coupled with the incremental dentine method.

Materials and Methods

Six tooth samples (2 per individual), four of which contained pulp stones, were selected from three Early Neolithic (3720–3650 cal BC) individuals from the Whitwell Long Cairn in Derbyshire, England. After demineralization, each tooth was divided into 1 mm increments. Stable isotope analysis of collagen was conducted on each dentine increment and a portion of each pulp stone.

Results

All samples met the quality control criteria for well‐preserved collagen. Excluding the pulp stones, the mean δ¹³C value of the teeth sampled was −21.5 ± 0.2‰ and the mean δ¹⁵N value was 9.9 ± 0.5‰, suggesting these individuals had a terrestrial‐based diet. The pulp stones produced similar δ¹³C values between −21.6 and −21.4‰ and δ¹⁵N values between 9.1 and 9.8‰.

Discussion

The results demonstrate that paleodietary information can be obtained from pulp stones through stable isotope analysis. There are, however, significant challenges in interpreting this data, particularly as to inferring the timing and duration of their formation. The pulp stone results were compared with the incremental dentine profiles for each person to further investigate when they might have formed. For two individuals, the pulp stones appear to reflect diet from a time period after childhood and adolescence. For the third individual, it could not be determined if the pulp stones reflect a contemporary or later time period than the incremental dentine series. All teeth with pulp stones have moderate to severe wear on the occlusal surface, which could have been a contributing factor to their development.

Detecting calcified pulp stones in patients with periodontal diseases using digital panoramic and periapical radiographies

Background/purpose

Pulp stones are discrete calcified masses appearing in the dental pulp of healthy, disease and unerupted teeth. They are presented freely within the pulp tissue or attached and embedded in any part of coronal and radicular dentin. Here, the purposes of this study were to identify the presence of pulp stones in periodontal patients using digital panoramic and periapical radiographies, and to determine the association with gender, age, tooth type and dental arch.

Materials and methods

This is a retrospective study on selected records of 465 dental samples obtained between January and December, 2020. Data were collected from patients diagnosed with generalized chronic periodontitis and accepted the full periodontal treatment covered by the Government's Periodontal Health Care Program. Their digital panoramic (DPR) examination and full mouth periapical radiographic (DPA) examination (including 12 periapical and 4 bitewing images) were performed at the Outpatient Clinics of the Department of Stomatology, Taichung Veterans General Hospital. Patients were segregated into various groups according to their age, gender and tooth locations. All radiographic images were examined by a dental radiologist and two dentists to identify the presence of pulp stone calcifications and their associated factors using the Sirona applications software. Records were analyzed using SPSS version 22.0 based on tests of Pearson Chi-square and McNemar correlation.

Results

From 271 males and 194 females, a total of 465 DPR and 7440 DPA radiographs were studied. Pulp stone calcifications were identified in 270 (58.0%) subjects in DPR images and 348 (74.8%) subjects in DPA images (for 1 or more teeth per subject). We detected calcified opacities in 1031 teeth with DPR images and in 1326 teeth with DPA images from a total of 12,407 teeth. The incidence of pulp stones was similar across genders, but different in tooth locations and dental arch sextant. Moreover, pulp stones were detected more often on maxillary molars and subjects of old ages (>40 years). Digital panoramic and periapical radiography showed significant differences in the detection of pulp stone calcifications (P < 0.05), and detected better with digital periapical radiography examination.

Conclusion

We found 58.0% (n = 645) of our patients with pulp stones using digital panoramic radiography, and 74.8% using digital periapical radiography. Regarding individual teeth, only 8.5% of pulp stones were observed in digital panoramic radiography and 10.6% in digital periapical radiography. Pulp stones were more often seen in maxillary molar teeth and old patients of ages >40 years old using periapical radiography examination especially in those patients with periodontally condition. As a two-dimensional imaging system, digital periapical radiography is recommended for a definitive and routine assessment in patients suspected of hard tissue abnormality and pulp calcification formation.

Evaluation of the relation between the pulp stones and direct restorations using cone beam computed tomography in a Turkish subpopulation

Objectives

This study aimed to assess the presence of pulp stones through an examination of cone beam computed tomography images and correlate their prevalence with age, sex, dental arch and side, tooth type, and restoration type and depth.

Materials and Methods

Cone beam computed tomography images obtained from 673 patients and archival data on 11,494 teeth were evaluated. The associations of pulp stones with age, sex, dental arch and side, tooth type, and restoration type and depth were noted. All the measurements were subjected to a χ² test and one sample χ² test (p < 0.05).

Results

In the study group, 163 (24.2%) patients and 379 (3.3%) teeth had at least one pulp stone. The pulp stone frequency in those aged 30–39 years was significantly greater than in those aged 18–29 and ≥ 60 years, and the frequency was higher in females than in males (p < 0.05). The highest prevalence of pulp stones was found in maxillary dental arches and molar teeth (p < 0.05). Pulp stones were significantly more common in medium-depth restorations (p < 0.05).

Conclusions

Maxillary molar teeth, medium-depth restorations, individuals aged 30–39 years and females had a greater percentage of pulp stones.

The colocalizations of pulp neural stem cells markers with dentin matrix protein-1, dentin sialoprotein and dentin phosphoprotein in human denticle (pulp stone) lining cells

BACKGROUND

The primary dentin, secondary dentin, and reactive tertiary dentin are formed by terminal differentiated odontoblasts, whereas atubular reparative tertiary dentin is formed by odontoblast-like cells. Odontoblast-like cells differentiate from pulpal stem cells, which express the neural stem cell markers nestin, S100β, Sox10, and P0. The denticle (pulp stone) is an unique mineralized extracellular matrix that frequently occurs in association with the neurovascular structures in the dental pulp. However, to date, the cellular origin of denticles in human dental pulp is unclear. In addition, the non-collagenous extracellular dentin matrix proteins dentin matrix protein 1 (DMP1), dentin sialoprotein (DSP), and dentin phosphoprotein (DPP) have been well characterized in the dentin matrix, whereas their role in the formation and mineralization of the denticle matrix remains to be clarified.

METHODS

To characterize the formation of denticle, healthy human third molars (n = 59) were completely sectioned and evaluated by HE staining in different layers at 720 µm intervals. From these samples, molars with (n = 5) and without denticles (n = 8) were selected. Using consecutive cryo-sections from a layer containing denticles of different sizes, we examined DMP1, DSP, and DPP in denticle lining cells and tested their co-localizations with the glial stem cell markers nestin, S100β, Sox10, and P0 by quantitative and double staining methods.

RESULTS

DMP1, DSP and DPP were found in odontoblasts, whereas denticle lining cells were positive only for DMP1 and DSP but not for DPP. Nestin was detected in both odontoblasts and denticle lining cells. S100β, Sox10, and P0 were co-localized with DMP1 and DSP in different subpopulations of denticle lining cells.

CONCLUSIONS

The co-localization of S100β, Sox10, and P0 with DMP1 and DSP in denticle lining cells suggest that denticle lining cells are originated from glial and/or endoneurial mesenchymal stem cells which are involved in biomineralization of denticle matrix by secretion of DMP1 and DSP. Since denticles are atubular compared to primary, secondary, reactionary tertiary dentin and denticle formed by odontoblasts, our results suggest that DPP could be one of the proteins involved in the complex regulation of dentinal tubule formation.

Dental pulp calcifications in prehistoric and historical skeletal remains

BACKGROUND

The prevalence of hard tissue formations in the dental pulp varies considerably. Beside ageing processes and irritations of the dental pulp, etiological associations with cardiovascular disease and dietary habits have been discussed, which are of particular research interest. The aim of this pilot study is to provide new insights on structural and etiological factors involved in the development of pulp calcifications by investigating skeletal remains from different (pre)historic periods.

METHODS

The jaws of 46 skeletons excavated in central Germany, were examined for the presence of pulp stones using digital volume tomography (DVT). A total of 1122 teeth were examined with all tooth types considered. To obtain information about the three-dimensional structure of pulp calcifications, micro-CT images were taken. Thin sections of three molars were histologically analysed. Potential dietary effects were studied by analysing stable isotope ratios of nitrogen (δ¹⁵N) in bone samples collected from each individual.

RESULTS

The analysis indicates that pulp stones affect molars in particular and increase slightly with age and dental wear. The micro-CT scans and the histological analysis show that the structures are much more complex than presumed on the basis of DVT imaging. Individuals with lower δ¹⁵N-isotope values and thus with a potentially lower proportion of animal protein in their diet appear to be less affected by pulp stones.

CONCLUSION

When comparing between archaeological and recent data, DVT analysis provides qualitatively comparable results. Micro-CT and histological images illustrate the excellent preservation of pulp calcifications and their complex structure. Differences in prevalence rates and δ¹⁵N-isotope values of Neolithic and historical individuals support the assumption that dietary habits and living conditions could have an influence on the development of pulp calcifications. Due to the small sample size these results require further validation.

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.

The Relationship between carotid artery calcification and pulp stone among hemodialysis patients: A retrospective study

The aim of this study was to determine the relationship between the presence of carotid artery calcification (CAC) and pulp stone (PS). A total of 60 chronic hemodialysis (HD) patients (30 CAC positive, 30 CAC negative) participated in this study. The mean age of patients was 54.7 ± 16.4 years, and 32 (53%) of them were male. CAC was defined as the presence of heterogeneous nodular opacities in the soft tissue in C3-C4 intervertebral area. Panoramic radiographs of the patients were evaluated for CAC and PS by two oral and maxillofacial radiologists. PS was evaluated in all healthy, decayed, and restored teeth except the third molar teeth, in the coronal, sagittal, and axial planes. The Statistical Package for the Social Sciences (version 20.0; SPSS, Inc., an IBM Company, Chicago, IL, USA) was used. A probability P <0.05 was considered statistically significant. The prevalence of PS in this study was 30% (18 patients) all group. A total of 1324 teeth were analyzed and PS was detected in 237 teeth (17.9%). The occurrence of PS in teeth in CAC-positive group (10 patients, 17.2% of 654 teeth) was similar to that in CAC-negative group (8 patient, 18.3% of 670 teeth). There was no statistical correlation between CAC and PS in chronic HD patients (P = 0.08). In the subgroup analysis, the presence of diabetes (P = 0.003), parathormone level (P = 0.02), calcium × phosphorus product (P = 0.04), and C-reactive protein levels (P = 0.002) were higher, and duration of HD (P = 0.03) was significantly longer in patients with CAC-positive and PS. In chronic HD patients, the presence of PS was not a strong predictor for the presence of CAC.

Morphologic, Structural, and Chemical Properties of Pulp Stones in Extracted Human Teeth

INTRODUCTION

Pulp stones are mineral structures that develop in the pulp tissue triggered by several clinical conditions. The exact biochemical process behind the occurrence of pulp stones is uncertain. This study aimed to perform a structural and crystallographic characterization of pulp stones and dentin from extracted human teeth.

METHODS

The sample consisted of 13 erupted and unerupted permanent human teeth diagnosed with pulp stones. The teeth were analyzed with scanning electron microscopy with secondary and backscattered electrons, energy-dispersive spectroscopy, micro-Raman spectroscopy, micro-X-ray diffraction, and inductively coupled plasma atomic emission spectroscopy.

RESULTS

The pulp stones revealed a heterogeneous morphology and structure compared with each other. Compared with the adjacent dentin, the pulp stones had a similar structure. From a chemical point of view, oxygen, calcium, carbon, and phosphorus were the most prevalent chemical elements in the inner part of the stones, whereas on the surface carbon, nitrogen, sulfur, chlorine, aluminum, potassium, zinc, copper, and lead were the most prevalent. Copper, iron, and zinc were higher in the stones than the dentin (P < .05). Statistically significant differences between the chemical structure of stones from erupted and unerupted teeth were not detected (P > .05).

CONCLUSIONS

Pulp stones have structural and chemical properties that are similar to dentin. Variations in morphology are common.

Dental anomalies and orthodontic characteristics in patients with pseudohypoparathyroidism

Background

Pseudohypoparathyroidism (PHP) is a rare and inherited disease caused by mutations in the GNAS-gene or upstream of the GNAS complex locus. It is characterized by end-organ resistance to PTH, resulting in hypocalcemia and hyperphosphatemia. We aimed to investigate the dental anomalies according to tooth types and the orthodontic characteristics of patients with PHP.

Methods

Using a cross-sectional design, 29 patients (23 females) with PHP, living in Denmark, were included, and their clinical intraoral photos and radiographs were examined.

Results

Pulp calcification was found in 76% of the patients. Blunting of root apex was present in 55% and shortening of root in 48% of the examined patients. Blunting and shortening of roots were seen more often in premolars than in other tooth types (p_both < 0.01). Crowding of lower anterior teeth was frequently observed (36%) as well as diastema in the upper arch (25%), midline diastema (18%), and Class III malocclusion (11%).

Conclusion

In the present study population, the teeth were frequently affected by pulp calcification and/or deviation of the root morphology. Blunting and shortening of root(s) were more often seen in premolars than in other tooth types. Class III malocclusion was relatively prevalent. It is important to pay attention to dental anomalies and occlusion in order to provide adequate care for patients with PHP.

Prevalence of pulp stones: A systematic review and meta-analysis

OBJECTIVE

During the last years, different prevalences of dental pulps had been reported from different parts of the world. Combining these original estimates will provide useful information for policymaking in the field of health, treatment and research. This study aims to estimate the global prevalence of pulp stones.

METHODS

Electronic databanks such as PubMed, Scopus, Science direct, Cochrane, and also Google scholar motor engine were searched by 2 researchers using related keywords. The heterogeneity between the results was assessed using Cochrane and I² indices. The initial estimates were represented by forest plot and were combined according to random effects models. Factors responsible for heterogeneity were investigated using meta-regression models, and studies responsible for heterogeneity were assessed following sensitivity analysis.

RESULTS

Prevalence of pulp stones had been reported in 16 studies including 14 093 subjects. The pooled prevalence (95% confidence interval) of pulp stones among the total population, men and women were estimated as of 36.53% (27.17-45.88), 32.58% (24-41.15), and 39.23% (28.73-49.73), respectively. In addition, of 193 687 teeth investigated during the primary studies, 9.57% (95% confidence interval: 7.05-12.08) were affected by pulp stones.

CONCLUSION

Our meta-analysis shows a considerable prevalence of pulp stones, especially among women.

A comparative study of cone-beam computed tomography and digital panoramic radiography for detecting pulp stones

PURPOSE

The aim of this study was to compare cone-beam computed tomography (CBCT) and digital panoramic radiography (DPR) for the detection of pulp stones.

MATERIALS AND METHODS

DPR and CBCT images of 202 patients were randomly selected from the database of our department. All teeth were evaluated in sagittal, axial, and coronal sections in CBCT images. The systemic condition of patients, the presence of pulp stones, the location of the tooth, the group of teeth, and the presence and depth of caries and restorations were recorded. The presence of pulp stones in molar teeth was compared between DPR and CBCT images.

RESULTS

Pulp stones were identified in 105 (52.0%) of the 202 subjects and in 434 (7.7%) of the 5,656 teeth examined. The prevalence of pulp stones was similar between the sexes and across various tooth locations and groups of teeth (P>.05). A positive correlation was observed between age and the number of pulp stones (ρ=0.277, P<.01). Pulp stones were found significantly more often in restored or carious teeth (P<.001). CBCT and DPR showed a significant difference in the detection of pulp stones (P<.001), which were seen more often on DPR than on CBCT.

CONCLUSION

DPR, as a 2D imaging system, has inherent limitations leading to the misinterpretation of pulp stones. Restored and carious teeth should be carefully examined for the presence of pulp stones. CBCT imaging is recommended for a definitive assessment in cases where there is a suspicion of a pulp stone on DPR.

Unusual Dental Morphology in a Chimpanzee: A Case Report Utilizing Cone-Beam Computed Tomography

This case report illustrates the teeth morphology of a chimpanzee and its anatomical variations. A well-preserved skull of a male Pan troglodytes troglodyte chimpanzee was scanned using a cone-beam computed tomography machine. Measurements included tooth and crown height, root length, root canal length and width (posterior teeth), and pulp cavity length (anterior teeth). Nonmetrical parameters included number of canals and foramina per root of every root. Interestingly, the mandibular central incisor was longer than the lateral incisor, and all the mandibular anterior teeth presented with a solitary flame-shaped or conical-calcified structure in their pulp cavity. The premolars are usually dual rooted except for the first maxillary premolar that displayed 3 roots. Other unusual discoveries were the presence of bilateral radicular dens invaginatus in the mandibular first premolars and the possibility of having 2 canals and 2 foramina in the roots of the posterior teeth. The presence of conical stone mineralizations at the pulp cavity and the presence of dens invaginatus were of particular interest.

The prevalence and distribution of radiopaque, calcified pulp stones: A cone-beam computed tomography study in a northern Taiwanese population

Background/purpose

Presence of pulp stones increase the difficulty of locating canal orifice during endodontic treatment. This study aims to determine the prevalence of pulp stones in a northern Taiwanese population through analysis of cone beam computed tomography (CBCT).

Materials and methods

A total of 144 patients and 2554 teeth were used in the present study which were collected from a CBCT image archive. To determine the presence of pulp stones, images of pulp chamber and root canals were analyzed in the sagittal, axial and coronal planes and from the occlusal to apical direction. Correlations between pulp stones and gender, age, tooth type, dental arch or side were also examined.

Results

Of the 144 patients, 120 patients (83.3%) and 800 (31.3%) teeth were found to have one or more pulp stones through CBCT examination. Prevalence of pulp stones between dental arches and tooth types were significantly different (P < 0.001). Pulp stones were found to be the most prevalent in first molars (50.0%) and most scarce in first premolars (18.8%). There was no significant correlation between pulp stones and gender, increasing age, or dental sides.

Conclusion

Pulp stones are more frequent in maxillary teeth compared to mandibular teeth. Pulp stones in molar teeth were significantly more common than premolars and incisors. CBCT could be a sensitive tool to detect pulp stones, especially simplifying identification of pulp stones in radicular pulp. Knowledge of pulp stones distribution can aid dentists in clinical endodontic treatment.

Radiographic Assessment of the Prevalence of Pulp Stones in a Yemeni Population Sample

Objective:

To determine the prevalence and distribution of pulp stones in the posterior teeth of a sample of adult Yemeni dental patients using digital panoramic radiographs.

Methods:

In total, 913 panoramic radiographs from patients attending the hospital dental clinics of at University of Sciences and Technology, Sana’a, Yemen, from January 2013 to December 2014 were examined. The occurrence of pulp stones in the posterior teeth of adult subjects was recorded. Associations between pulp stones and gender, age, arch, side and tooth type were studied.

Results:

The overall prevalence of pulp stones was 18.6% for individuals (170 out of 913 subjects) and 3.99% for examined teeth (351 out of 8802 teeth). The pulp stone occurrence was significantly higher in the maxilla than in the mandible for each tooth type and location (P<0.001). Pulp stones occurred more often on the right side (P<0.001). First molars represented 71% of the affected teeth with the maxillary right first molar showing the highest occurrence. Fifty-six percent of the affected subjects had pulp stones in more than one tooth. No significant difference in the occurrence of pulp stones was detected between genders or among age groups (P>0.05).

Conclusion:

The prevalence of pulp stones is different among populations. Pulp stones were found in approximately one-fifth of subjects in the Yemeni population, where up to 90% of the population have a Qat-chewing habit. This habit usually causes mechanical and chemical irritation and results in pulp calcification.

Assessing pulp stones by cone-beam computed tomography

OBJECTIVES

The aim of this study was to evaluate the occurrence of pulp stones by cone-beam computed tomography (CBCT) and to correlate their prevalence with patient's gender, location of tooth (right or left of maxillary or mandibular arch), group of teeth, and restorations.

MATERIALS AND METHODS

CBCT images of 382 patients randomly selected from the database of the University Oral Radiology Department were retrospectively examined. A total of 2833 tooth images obtained using the i-CAT 3D Imaging System were evaluated. Image analysis was performed with the i-CAT software, and all teeth were evaluated in sagittal, axial, and coronal views. All the measurements were subjected to chi square test, odds ratio, and Fisher's exact tests (p < 0.05).

RESULTS

The prevalence of pulp stones was similar between patient's genders and tooth locations. Pulp stones were detected in 31.9% of patients and 9.5% of teeth. Maxillary and mandibular molars were the groups of teeth with the highest frequency of pulp stones. The presence of restorations increased the chance of occurrence of pulp stones by 2.1 times in all teeth examined (p < 0.0001) and by 4.7 times in maxillary teeth (p < 0.0001).

CONCLUSIONS

Pulp stones had a high prevalence with molar teeth showing the highest prevalence. The presence of restorations increased the chance of occurrence of these calcifications, specifically in maxillary teeth.

CLINICAL RELEVANCE

CBCT provides accurate anatomical details in three dimensions, offering the possibility to view an individual tooth in axial, sagittal, and coronal views. This study performed an investigation of the occurrence of pulp stones by CBCT.

A histological and radiographic study of pulpal calcification in periodontally involved teeth in a Taiwanese population

BACKGROUND/PURPOSE

The prevalence of pulpal calcifications was widely studied in the past. The purposes of this study were to investigate the incidence of pulpal calcifications of periodontally involved teeth in a Taiwan Chinese population using radiographic and histological examinations, and to find out any association of pulpal calcification with systemic disease and dental conditions.

MATERIALS AND METHODS

A total of 197 teeth freshly extracted because of severe periodontal destruction were collected and prepared for histological and radiographic studies of the incidence of pulpal tissue calcifications. The occurrences of calcifications were recorded based on the different types of classifications proposed by Seltzer (1972). The number of examined teeth with pulpal calcifications was calculated, and they were statistically analyzed with the Chi-square test.

RESULTS

The patient population ranged in age from 16 years to 85 years. Of them, 165 (84%) were male and 32 (17%) were female. The results show that the incidence of pulpal calcifications of periodontally involved teeth was 62% in histological and 30% in radiographic examinations. The occurrences were slightly higher than that reported in some previous studies and significantly different between the two examined methods. No significant association of pulpal calcification with age and systemic disease was found. Moreover, molars were observed to have more pulpal calcifications than bicuspids and incisors statistically (P < 0.001).

CONCLUSION

The true incidence of pulpal calcifications of periodontally involved teeth is likely to be higher in histological examination because pulpal calcifications with a small diameter may not be seen on radiographs. The prevalence of pulpal calcifications was found to increase significantly in molar teeth, and the results indicated that localized calcifications occur mostly in the radicular area of the pulp tissue.

Comparative Physicochemical Analysis of Pulp Stone and Dentin

INTRODUCTION

Odontoblasts are responsible for the synthesis of dentin throughout the life of the tooth. Tooth pulp tissue may undergo a pathologic process of mineralization, resulting in formation of pulp stones. Although the prevalence of pulp stones in dental caries is significant, their development and histopathology are poorly understood, and their precise composition has never been established. The aim of the present study was to investigate the physicochemical properties of the mineralized tissues of teeth to elucidate the pathologic origin of pulp stones.

METHODS

Areas of carious and healthy dentin of 8 decayed teeth intended for extraction were analyzed and compared. In addition, 6 pulp stones were recovered from 5 teeth requiring root canal treatment. The samples were embedded in resin, sectioned, and observed by scanning electron microscopy and energy-dispersive spectroscopy. X-ray diffraction was performed to identify phases and crystallinity. X-ray fluorescence provided information on the elemental composition of the samples.

RESULTS

Pulp stones showed heterogeneous structure and chemical composition. X-ray diffraction revealed partially carbonated apatite. X-ray fluorescence identified P, Ca, Cu, Zn, and Sr within dentin and pulp stones. Zn and Cu concentrations were higher in pulp stones and carious dentin compared with healthy dentin.

CONCLUSIONS

Pulpal cells produce unstructured apatitic mineralizations containing abnormally high Zn and Cu levels.

Radiographic assessment of the prevalence of pulp stones in Malaysians

INTRODUCTION

The aim of this study was to determine the prevalence of pulp stones in the Malaysian population using radiographs, and to assess the association of pulp stones with gender, age, tooth type, dental arch and tooth status. Occurrence of pulp stones among the three races in Malaysia (Malay, Chinese and Indians) was also studied.

METHODS

A retrospective study was performed from a random sample of 361 dental records in AIMST Dental Centre, Faculty of Dentistry, AIMST University, Kedah, Malaysia. Data were collected from patient files and 507 intraoral periapical radiographs. All radiographs were examined by an oral radiologist to identify pulp stones and associated factors. Statistical analysis was performed using the Pearson chi-square test.

RESULTS

Of the 361 patients, 205 were female and 156 were male. Pulp stones were identified in 162 (44.9%) subjects in 1 or more teeth and in 280 (15.7%) teeth of the total 1779 teeth examined. Pulp stones were found significantly more in molars and teeth that were not intact (carious/restored/both carious and restored). There was no significant correlation with sex, increasing age, dental arches, and ethnic races.

CONCLUSIONS

The prevalence of pulp stones in the Malaysian population studied was 44.9%. Pulp stones were more often seen in teeth that were restored or affected with caries. These findings require further investigation.

A Radiographic Correlation between Renal and Pulp Stones

AIM

The purpose of this study was to determine the correlation between pulp stones and renal stones. This study also aims to report associations between the presence of pulp stone and gender, age, tooth type, dental arches and sides.

PATIENTS AND METHODS

Data were collected through radiographic examination of bitewing radiographs of 116 kidney stone patients and a similar number of age-matched controls, referred to the Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University. Two oral radiologists examined the radiographs to identify pulp stones. The Chi-squared and Mann Whitney U tests were used to investigate the correlations between the presence of pulp chamber calcification and age, gender, dental status and kidney stone.

RESULTS

Pulp chamber opacities were detected in 199 (19.3%) out of the 1031 examined teeth, and in 84 (72.4%) out of the 116 kidney stone patients. There was no statistically significant difference between the study and control group (p = 0.882). The occurrence of pulp stones was significantly higher in molars than premolars and similar prevalences were found between dental arches and sides.

CONCLUSION

In this study, no correlation was found between the presence of pulp stones and kidney stones in the investigated group. Therefore, the presence of pulp stones does not seem to be correlated with that of kidney stones.

A study on pulp stones in a group of the population in Andhra Pradesh, India: An institutional study

Aim:

The aim of this study was to determine the occurrence of pulp stones in a group of the population of Andhra Pradesh. This study also aims to determine the association of pulp stones in different sexes, tooth type, dental arches and sides and with systemic diseases.

Materials and Methods:

A total of 4449 teeth of 2000 patients were examined, comprising of patients with C.V.S. disorders; Type II diabetes mellitus and gastritis were examined. Patients were selected from the radiology department who came for diagnostic radiograph of posterior teeth. The presence or absences of pulp stones were recorded.

Statistical Analysis Used:

Statistical analysis of the data was done using the statistical package for the social sciences (SPSS 15.0-SPSS Inc., 233 South Waker Drive, 11^th floor, Chicago, IL 60606-6412.) using Chi-square analysis. Differences were considered as significant when P ≤ 0.05.

Results:

Pulp stones were found in 799 (17.9%) of 4449 teeth detected. Significantly, higher numbers of pulp stones were recorded in patients with systemic diseases. The occurrences of pulp stones were significantly higher in maxillary first and second molars. No significant difference was found between sexes and sides.

Conclusions:

Positive correlation was found between systemic disorder and occurrence of pulp stones.

Successful removal of a 16 mm long pulp stone using ultrasonic tips from maxillary left first molar and its endodontic management

To present a case report describing successful removal of a 16 mm long pulp stone in a single mass from a maxillary left first molar and its endodontic management. In the presented case, the conventional approach of dissecting the pulp stone was not considered, as radiographically the calcification was extending up to the apex of the palatal root canal and the separation of the coronal and radicular pulp stone would have risked the obliteration of its orifice. A new set of ultrasonic endodontic tips were used for the removal of significantly large pulp stone in single mass.

Incidence and distribution of pulp stones found in radiographic dental examination of adult Turkish dental patients

Background:

Pulp stones (PS) are discrete calcified masses found in the dental pulp, in the pulp tissue or become attached to or embedded into the dentine. The formation of pulp stones is still something of an enigma, leading to existence of some epidemiological gaps.

Aim:

To determine the prevalence and distribution of pulp stones in posterior tooth group by using panoramic radiograph.

Materials and Methods:

Panoramic radiographs from 6912 patients attending Kirikkale University Dental Faculty Hospital, Kirikkale, Turkey during the period from July 2009 to August 2011 were reviewed for the presence of pulp stones. The overall incidence of pulp stones in the patients and their correlations between female and male patients and between the right-side and left-side occurrences were analyzed by computer program, SPSS 15. (SPSS Inc. Chicago, USA) with using the χ² test. Differences were considered as significant when P < 0.05.

Results:

Pulp stones were detected in 879 out of 6912 patients (person prevalence 12.7%). Pulp stones were detected in 2009 teeth out of a total of 96240 teeth to give a tooth prevalence of 2.1%. Their occurrence was higher in the maxilla than in the mandible for each tooth type. Pulp stones were found to involve the right side more (1224/2009) (61%) than the left side (785/2009)(39%) and they were significantly more common in females than males (P < 0.001).

Conclusions:

Attention should be paid to the presence of pulp stones and the treatment problems associated with them.

The effect of light-curing access and different resin cements on apical bond strength of fiber posts

PURPOSE

This study evaluated the effect of light-curing access on the bond strength of fiber glass posts to the apical area of bovine roots using self-adhesive cement or dual-cured cement with an etch-and-rinse adhesive system.

MATERIALS AND METHODS

The root canals of 60 bovine teeth were endodontically treated and filled. A 15-mm-length post space was prepared and roots were randomly divided into three groups, simulating the levels of light-curing access: coronal (C), with 15-mm post space; middle (M), in which the coronal thirds of roots were cut out, leaving a 10-mm post space; and apical (A), in which the coronal and middle thirds of roots were cut out, leaving a 5-mm post space. Fiber glass posts (Reforpost # 3, Angelus) were cemented with RelyX U100 (3M ESPE) or RelyX ARC/Scotchbond Multi Purpose Plus (SBMP) (3M ESPE) (n=10) and light-cured. After 24 hours, the apical thirds of roots were sectioned perpendicularly to the long axis and submitted to a push-out test (0.5 mm/min, 200 N). The Kruskal-Wallis test compared the three levels of light-curing access, and the Mann-Whitney test compared the cements.

RESULTS

The bond strength was significantly higher in the groups C (p=0.028) and M (p=0.016) when U100 was used, whereas it was similar for both cements in group A. The bond strengths of posts cemented with ARC/SBMP were significantly higher in group A compared to group C (p=0.031).

CONCLUSIONS

The type of cement used and the light-curing access level influenced the bond strength between glass fiber posts and root canals. The bond strength of the RelyX ARC/SBMP cement proved to be more dependent on photoactivation than was the RelyX U100 cement. The light-curing access level did not influence the apical bond strength of RelyX U100.

Assessment of the prevalence of pulp stones in a sample of Turkish Central Anatolian population

Objective. The aim of this study was to determine the prevalence of pulp stones (PS) in a Turkish dental patient population with respect to sexes and dental localization in relation between sex and this anomaly. Materials Methods. A retrospective study was performed using bitewing radiographs of 814 patients ranging in age from 15 to 65. All data (age, sex, and location) was obtained from the files. These patients were analyzed for pulp stones. Descriptive characteristics of sexes, jaws, and dental localization were recorded. The Pearson chi-squared test was used. Results. Of the patients, 462 (56.8%) were female and 352 (43.2%) were male. Sixty (12%) had one or more teeth that contained pulp stones. Pulp stones were identified in 518 (63.6%) of the subjects and in 2391 (27.8%) of the teeth examined. Pulp stone occurrence was significantly more common in the females than in males. With the increasing of age, the prevalence of pulp stones increased. Molars had statistically more pulp stones than premolars. Pulp stones were significantly more common in the maxilla compared with mandible. Conclusion. Prevalence of pulp stones in Turkish population was 27.8% but further larger-scale studies are required to assess its prevalence in the general population to compare it with other ethnic groups.

The prevalence of pulp stones in a Turkish population. A radiographic survey

Objectives: The goal of this retrospective study was to determine the prevalence of pulp stones in a Turkish population. Any possible associations between pulp stones and gender, tooth type and dental arch were also evaluated. Study Design: Four hundred and sixty nine patients’ bitewing radiographs which were reached through the patient database of Erciyes University Dentistry School, Department of Oral Diagnosis and Radiology were examined. Of these 469 subjects whose mean age was 24( ± 10.7), 302 were females and 167 were males. A total of 6,926 teeth were examined during this study. Pulp stones were recorded as present or absent and any relations with gender, tooth type and dental arch were noted. Results: Pulp stones were identified in 270 (57.6 %) of the subjects and in 1,038 (15 %) of the teeth examined. Their presence were seldom found in the premolars (9.07%) but was much higher in the molars (90.92 %). Pulp stone occurrence was significantly more common in the first molars than in the second molars, and in the first premolars than in the second premolars in each dental arch. Their occurrence was higher in the maxilla than in the mandible for each tooth type. No difference between the two genders could be identified. Conclusion: Pulp stones are not only incidental radiographic findings of the pulp tissue but may also be an indicator of some serious underlying disease. On the other hand, they may provide useful information to predict about the susceptibility of patients for other dystrophic soft tissue calcifications such as urinary calculi and calcified atheromas. However, further study on this issue is needed.

Key words: Prevalence, pulp stone, Turkish population.

Pulp calcification in traumatized primary teeth: prevalence and associated factors

AIM

To establish the prevalence of pulp calcifications in 946 patients at the Research and Clinical Center of Dental Trauma in Primary Teeth.

STUDY DESIGN

The clinical and radiographic records of l675 traumatized primary teeth were evaluated. Statistical analysis was performed using chi-square and univariate logistic regression.

RESULTS

197 (20.8%) patients showed pulp calcification (PC). A total of 250 (14.9%) calcified teeth were observed In most teeth, PC appeared within the first 12 months following trauma. PC prevalence was higher in cases of repeated trauma (29.6%) than in single trauma (16.4%), p < 0.05, with a 2.14 chance of showing pulp calcification when a child suffered recurrent trauma. Most teeth showing calcified pulp, suffered trauma to the supportive tissue (67.4%), being statistically significant in relation to the trauma to dental tissue (p < 0.05).

CONCLUSION

PC is a sequelae in cases of trauma to the primary dentition; teeth that suffered recurrent traumatic injuries show higher risk of presenting.

Generalized pulp stones: report of a case with 6-year follow-up

AIM

To present a mildly mentally retarded patient with generalized pulp stone formation and the six-year follow-up and to discuss the differential diagnosis of the case.

SUMMARY

Pulp stones were radiographically detected in the pulp chamber of all permanent teeth in a 25-year-old woman with mild mental retardation who presented for endodontic treatment on tooth no 11 (FDI). The patient's medical, dental and family history was noncontributory. The pulp stone in the pulp chamber of tooth no 11 was removed during canal filing, and root canal treatment completed uneventfully. Six years later, the patient was re-evaluated and the pulp stones were unchanged radiographically. The patient's family history, facial phenotype and karyotype as well as the radiographic, laboratory and physical examination were not consistent with any of the known genetic syndromes associated with generalized pulp stones. Molecular analysis for the DSPP gene proved negative. The aetiology of this case remains unknown.

KEY POINTS

Generalized pulp stones occur rarely; Such patients should be referred for genetic evaluation because pulp stones are mostly associated with genetic dentine defects; Pulp stones may hinder root canal treatment; Pulp stones may remain unchanged overtime.

A clinical and histological study of dental defects in a 10-year-old girl with pseudoxanthoma elasticum and amelogenesis imperfecta

BACKGROUND

The prominent dental feature of a 10-year-old girl was severely hypoplastic enamel in permanent teeth.

CASE REPORT

Severe dental defects were detected in a 10-year-old female patient affected by pseudoxanthoma elasticum and amelogenesis imperfecta. An orthopantomographic examination revealed a reduction of enamel thickness on the crown of all erupted and unerupted teeth, agenesis of the maxillary right second premolar, delayed eruption of mandibular first premolars, and the presence of large calcifications in all tooth pulp chambers. A detailed histological analysis of permanent mandibular first molars showed that pulp calcifications presented a concentric laminate organization and merged to almost completely obliterate the pulp chamber. Osteodentine was visible all along the pulpal surface of the radicular dentine. Broad resorption areas were present in the outermost dentine at both coronal and radicular levels. Radicular resorption areas presented a typical rectangular form and were filled with acellular cementum. Cementum thickness was highly increased on the root surface. Apposition of cellular cementum-like tissue was also observed on the coronal dentine surface.

CONCLUSION

Before treating patients affected by amelogenesis imperfecta and/or pseudoxanthoma elasticum, paediatric dentists should be aware of the presence of pulp calcifications that add to the complexity of endodontic procedures.

Pulp stones: a review

Pulp stones are a frequent finding on bitewing and periapical radiographs but receive relatively little attention in textbooks. A review of the literature was therefore performed, initially using the PubMed database and beginning the search with 'pulp calcifications' and 'pulp stones'. Each term provided more than 400 references, many of which related to pulp calcification in general rather than pulp stones, and focussed largely on the problems these changes presented to clinicians. A manual search using references from this source was carried out. Contemporary textbooks in endodontology were also consulted, and an historic perspective gained from a number of older books and references. The factors involved in the development of the pulp stones are largely unknown. Further research may determine the reasons for their formation, but with current endodontic instruments and techniques this is unlikely to alter their relevance to clinicians.

Multiple pulp stones and shortened roots of unknown etiology

An unusual case of generalised pulpal calcifications (pulp stones) with normal clinical crowns is reported in a 13-year-old boy. Radiographic examination revealed pulp stones in the single rooted and premolar teeth, situated at the midroot level, with the roots bulging around them. The apical portion of the roots, periodontal ligament space, and surrounding bone had a normal radiographic appearance, apart from the upper premolars, and no periapical pathology was discernible. The upper premolars exhibited considerably shortened roots. No medical, dental, or family history was found to be contributory. Reviewing the literature revealed similar cases, but with differing diagnoses including dentine dysplasia (DD) or idiopathic cases. This report suggests either a variation of DD or possibly a new nonsyndromic dentine defect, and highlights the difficulties in establishing a definitive diagnosis by traditional methods. The recent discovery that mutation of the bicistronic dentine sialophosphoprotein gene (DSPP) is involved in DD may provide solutions to this problem.

Immunohistochemical localization of components of the insulin-like growth factor system in human permanent teeth

There is growing evidence that the insulin-like growth factor (IGF) system plays an important role in the biology of oro-dento-facial tissues and organs, including the development, homeostasis and regeneration of the periodontium. To obtain basic data on the occurrence and distribution of IGF components in human permanent teeth we immunohistochemically investigated 25 extracted, decalcified and paraffin-embedded teeth using mono and polyclonal antibodies against the ligands IGF-I and -II, the IGF1 receptor (IGF1R) and all six IGF binding proteins (IGFBP-1 to -6). In the extracellular matrix (ECM) of the adhering periodontal ligament (PDL), immunoreactivity for IGF-I, -II and IGFBP-1 and -6 was observed. PDL fibroblasts showed immunostaining for the IGF1R. For the cementum, in the acellular cementum only IGF-II could be detected, while outer cementum layers with inserting Sharpey's fibers reacted with all antibodies applied except for IGFBP-4 and -6. In the pulp, mainly fibrotic areas and areas around denticles were immunoreactive for IGF-I, IGFBP-1, -3, -5 and -6. Predentin and odontoblastic processes were stained for IGF-I and IGFBP-3. The spatially oriented occurrence of components of the IGF system in human permanent teeth indicates that specific functions of the IGFs may be localized in particular tissue compartments. In the cementum, several IGF components were found indicating roles in tissue homeostasis or attachment. The PDL may function as a reservoir for IGFs probably bound to ECM components. PDL fibroblasts could then respond in a paracrine manner. In the pulp, the IGF system may be involved in odontoblast biology, fibrosis and denticle formation.