RESUMO
BACKGROUND: Pulp stones are a type of pulp calcification, the presence of which tends to hinder endodontic treatment. Thus, this retrospective study aimed to analyze the distribution of pulp stones in the population in southwest China and identify the influencing factors. MATERIALS: Cone-beam computed tomography (CBCT) scans of 5066 teeth of 200 patients (91 males and 109 females) aged 16-45 years were evaluated. Pulp stones were marked as either present or absent when distinct radiopaque masses were found in the pulp cavity, then evaluated the occurrence of pulp stones with regard to tooth type, sex, age group, and contact it with tooth status. The Pearson chi-square test and nonparametric test were used for statistical analysis. RESULTS: Pulp stones were detected in 49.0% of patients and 7.4% of teeth, respectively. The incidence in females was 1.9 times higher than in males (OR = 1.9, 95% CI = 1.1-3.3, p = 0.001). Pulp stones were most prevalent in patients 36-45 years of age. Furthermore, in the age range of 16-45 years, the likelihood of finding pulp stones increased 1.1 times per year with age (OR = 1.1, 95% CI = 1.0-1.1, p = 0.032). A higher incidence of pulp stones was observed in the maxilla and molars. Of the 5066 teeth studied, pulp stones were more common in non-intact teeth. CONCLUSION: Nearly half of the population in southwest China had pulp stones. Pulp stones were found significantly more often in females, maxilla, and non-intact teeth, and their frequency increased with age. For dentists, understanding the distribution of pulp stones is crucial for the proper design of root canal treatment (RCT). TRIAL REGISTRATION: This study was approved by the Ethics Committee of the Affiliated Hospital of Stomatology, Southwest Medical University (certificate number: 20220818001).
Assuntos
Tomografia Computadorizada de Feixe Cônico , Calcificações da Polpa Dentária , Humanos , Masculino , Feminino , Adulto , Estudos Retrospectivos , Adolescente , China/epidemiologia , Pessoa de Meia-Idade , Adulto Jovem , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/epidemiologia , Fatores Etários , Fatores SexuaisRESUMO
BACKGROUND: A pulp stone is a calcified mass that develops in the dental pulp of any tooth. Despite many studies examining the relationship between pulp stone formation and non-oral factors, the methods used in these studies have been unable to explain the exact role of these factors alone as distinct from probable effects within the oral cavity environment. Considering that totally unerupted (impacted or developing) teeth are unexposed to the oral cavity's environmental and functional conditions, they provide a more suitable material for studying the effects of these non-oral factors on pulp stone formation. This research study aimed to investigate pulp stones in unerupted teeth and the associated factors in a Saudi subpopulation. METHODS: The study included 644 cone-beam computed tomography images, with 496 (50.9%) maxillary and 479 (49.1%) mandibular teeth. Of the investigated patients, 293 (45.5%) were men, and 351 (54.5%) were women. The age range was 15-76 years. A chi-square test was used to investigate the associations between pulp stones and age, gender, and history of systemic disease and chronic medication use. RESULTS: Pulp stones in unerupted teeth were present in 24.2% of the examined dental jaws and 18.6% of the examined teeth. There was no statistically significant relationship between pulp stones and gender (p > 0.05). A significantly greater percentage of pulp stones were found with increasing age (p = 0.000). Additionally, a significantly increased number of pulp stones was observed in patients with systemic diseases and chronic medications (p < 0.05). CONCLUSIONS: The results support the idea that pulp stones can be present in any type of unerupted tooth. This study provides additional evidence of the increased incidence of pulp stones with age, systemic disease, and chronic medications.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Calcificações da Polpa Dentária , Dente não Erupcionado , Humanos , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Adulto , Masculino , Estudos Retrospectivos , Adolescente , Pessoa de Meia-Idade , Calcificações da Polpa Dentária/diagnóstico por imagem , Adulto Jovem , Idoso , Dente não Erupcionado/diagnóstico por imagem , Arábia Saudita , Fatores EtáriosRESUMO
Single tooth orange discoloration secondary to root canal calcification occurs as a consequence of dental trauma, orthodontic treatment, or for unknown rea- sons. A correct case history must be compiled and a CBCT study carried out in order to establish the diag- nosis and define the best treatment plan in each case. The aim of the present study was to offer a therapeutic protocol involving a clinical decision-making tree dia- gram based on the presence or absence of apical dis- ease and the degree of canal calcification. Dental bleaching and the use of ceramic veneers allow es- thetic restoration in such cases.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Clareamento Dental , Descoloração de Dente , Humanos , Tomografia Computadorizada de Feixe Cônico/métodos , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/etiologia , Facetas Dentárias , Clareamento Dental/métodos , Descoloração de Dente/etiologia , Descoloração de Dente/terapiaRESUMO
OBJECTIVE: To compare digital panoramic radiography (DPR) and cone beam CT (CBCT) in the detection and classification of pulp calcifications in posterior teeth in relation to tooth condition and its location. METHODS: Two hundred and fifty patients with simultaneous DPR and CBCT scans were selected from a dental image bank. For each posterior tooth, its condition was registered (healthy, restored, or decayed). The presence of calcifications was assessed and classified according to location (coronal or radicular) and type (total obliteration, partial obliteration, narrowing, and no calcification). Chi-square and McNemar tests were used to compare DPR and CBCT results, with a significance level of 5%. DPR diagnostic values were calculated using CBCT as reference. RESULTS: Decayed and restored teeth showed a significantly (P < .001) higher prevalence of pulp calcifications than healthy teeth in both imaging exams. There was a significant discrepancy between the imaging modalities in the identification of calcifications (P < .001), especially for radicular calcifications of maxillary teeth (DPR = 55.2%; CBCT = 30.9%). In the case of coronal calcifications, there was a greater discrepancy between CBCT and DPR in the mandibular teeth (10.7%) than in the maxillary teeth (7.7%). Overall, DPR presents higher sensitivity (0.855) than specificity (0.483) for pulp calcifications detection. CONCLUSION: DPR considerably overestimates pulp calcifications in posterior teeth, as compared to CBCT. A higher prevalence of pulp calcifications is related to decayed and restored teeth.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Calcificações da Polpa Dentária , Radiografia Dentária Digital , Radiografia Panorâmica , Humanos , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Masculino , Calcificações da Polpa Dentária/diagnóstico por imagem , Adulto , Pessoa de Meia-Idade , Adolescente , Idoso , Dente Molar/diagnóstico por imagemRESUMO
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.
Assuntos
Calcificações da Polpa Dentária , Feminino , Masculino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Transversais , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/epidemiologia , Cavidade Pulpar/diagnóstico por imagem , Reprodutibilidade dos TestesRESUMO
Vascular calcification, an ectopic calcification exacerbated by aging and renal dysfunction, is closely associated with cardiovascular disease. However, early detection indicators are limited. This study focused on dental pulp stones, ectopic calcifications found in oral tissues that are easily identifiable on dental radiographs. Our investigation explored the frequency and timing of these calcifications in different locations and their relationship to aortic calcification. In cadavers, we examined the association between the frequency of dental pulp stones and aortic calcification, revealing a significant association. Notably, dental pulp stones appeared prior to aortic calcification. Using a rat model of hyperphosphatemia, we confirmed that dental pulp stones formed earlier than calcification in the aortic arch. Interestingly, there were very few instances of aortic calcification without dental pulp stones. Additionally, we conducted cell culture experiments with vascular smooth muscle cells (SMCs) and dental pulp cells (DPCs) to explore the regulatory mechanism underlying high phosphate-mediated calcification. We found that DPCs produced calcification deposits more rapidly and exhibited a stronger augmentation of osteoblast differentiation markers compared with SMCs. In conclusion, the observation of dental pulp stones through X-ray examination during dental checkups could be a valuable method for early diagnosis of aortic calcification risk.
Assuntos
Calcificações da Polpa Dentária , Calcificação Vascular , Ratos , Animais , Raios X , Calcificações da Polpa Dentária/diagnóstico por imagem , Radiografia , Calcificação Vascular/diagnóstico por imagem , Diagnóstico Precoce , Polpa Dentária/diagnóstico por imagemRESUMO
PURPOSE: To evaluate the prevalence of pulp stones in a Turkish paediatric cohort from the Isparta district using panoramic radiographs. METHODS: Panoramic radiographs of 19,857 children and adolescents between the ages of 9 and 18 years were retrospectively analysed to determine the prevalence and distribution of pulp stones. Teeth with pulp stones were classified in terms of dentition, location, dental status and complete or incomplete root formation. Statistical analysis was carried out by applying Chisquare and Mann-Whitney U. Univariate logistic regression analysis was applied to determine the factors affecting pulp stone status. Differences were considered as significant when p < 0.05. RESULTS: Out of a total of 19,857 patients, pulp stones were identified in 6.5%. Among the 548,415 teeth examined, 0.96% had pulp stones. The incidence of pulp stones in girls (7.4%) was higher than in boys (5.7%) (p < 0.001). The prevalence of pulp stones increased with age and was significantly higher in molar teeth. A significant difference existed in the incidence of pulp stones according to the jaws (p < 0.001). In both jaws, no statistically significant difference was observed in terms of teeth with pulp stones being on the right and left (p = 0.834). Of molars with pulp stones, 91.8% had completed root formation. The majority of patients (37.7%) had pulp stones in four teeth. CONCLUSION: Knowing the incidence of pulp stones in paediatric patients by dentists, endodontists, and paediatric dentists will help prevent complications that may occur during applications by facilitating the determination of appropriate methods, especially during endodontic procedures.
Assuntos
Calcificações da Polpa Dentária , Masculino , Feminino , Adolescente , Humanos , Criança , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/epidemiologia , Estudos Retrospectivos , Prevalência , Radiografia Panorâmica , Arco DentalRESUMO
PURPOSE: To assess the prevalence and distribution of pulp stones in a Saudi population. METHODS: A cone beam computed tomography (CBCT) analysis of 150 upper and 150 lower dental arches was performed. The relationships between pulp stones and age, sex, tooth type, dental arch, orthodontic treatment, caries, and restoration were statistically examined (P < 0.05). RESULTS: A total of 295 dental arches (98.3%) had at least one pulp stone, and the prevalence was higher in the maxillary teeth (56.2%) than in the mandibular teeth (48.1%) (P = 0.0003). Men were more likely to have pulp stones than women (P = 0.011 for the maxilla, P < 0.0001 for the mandible). Furthermore, age and orthodontic treatment had no significant effects on the incidence of pulp stones (P > 0.05). A higher occurrence of pulp stones was observed in the first molars (>91%), and in carious and restored teeth when compared to intact teeth (P < 0.05). CONCLUSION: Pulp stones were more prevalent in the upper dental arches, first molars, and carious and restored teeth, as well as in the male population, and were not associated with age or orthodontic treatment.
Assuntos
Calcificações da Polpa Dentária , Dente , Humanos , Masculino , Feminino , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/epidemiologia , Arábia Saudita/epidemiologia , Tomografia Computadorizada de Feixe Cônico/métodos , Dente Molar , Maxila , Cavidade Pulpar , Raiz DentáriaRESUMO
Objective: This retrospective study was aimed at determining the incidence of dental pulp stone formation during fixed orthodontic treatment. Materials and Methods: A total of 100 patients who received fixed orthodontic treatment were included in this study. Pre- and posttreatment panoramic radiographs of the patients were examined to identify pulp stones. The data were analyzed using McNemar's and Pearson's chi-square tests to investigate the correlations between having a dental pulp stone and gender, age, treatment type, and duration. Results: Dental pulp stones were detected in 17% of patients on pretreatment panoramic radiographs and 35% of patients on posttreatment panoramic radiographs. The incidence of pulp stones sharply increased in the pre- and posttreatment radiographs (38%) (P < 0.001). In addition, there were associations between age, treatment duration, and the incidence of pulp stones (P < 0.05). Nevertheless, no associations were found between treatment type, gender, and the presence of pulp stones. Dental pulp stones were most frequently observed in first molars (62%), followed by second molars (36%). Conclusion: Fixed orthodontic treatment may trigger pulp irritation and calcification, resulting in the formation of pulp stones. Although pulp stones have no serious consequences, an orthodontist must consider the probability of pulp stone formation because it can cause difficulties in endodontic treatment.
Assuntos
Calcificações da Polpa Dentária , Humanos , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/epidemiologia , Estudos Retrospectivos , Prevalência , Radiografia Panorâmica , RadiografiaRESUMO
OBJECTIVES: Pulpal calcifications are discrete hard calcified masses of varying sizes in the dental pulp cavity. This study is aimed at measuring the performance of the YOLOv4 deep learning algorithm to automatically determine whether there is calcification in the pulp chambers in bite-wing radiographs. MATERIALS AND METHODS: In this study, 2000 bite-wing radiographs were collected from the faculty database. The oral radiologists labeled the pulp chambers on the radiographs as "Present" and "Absent" according to whether there was calcification. The data were randomly divided into 80% training, 10% validation, and 10% testing. The weight file for pulpal calcification was obtained by training the YOLOv4 algorithm with the transfer learning method. Using the weights obtained, pulp chambers and calcifications were automatically detected on the test radiographs that the algorithm had never seen. Two oral radiologists evaluated the test results, and performance criteria were calculated. RESULTS: The results obtained on the test data were evaluated in two stages: detection of pulp chambers and detection of pulpal calcification. The detection performance of pulp chambers was as follows: recall 86.98%, precision 98.94%, F1-score 91.60%, and accuracy 86.18%. Pulpal calcification "Absent" and "Present" detection performance was as follows: recall 86.39%, precision 85.23%, specificity 97.94%, F1-score 85.49%, and accuracy 96.54%. CONCLUSION: The YOLOv4 algorithm trained with bite-wing radiographs detected pulp chambers and calcification with high success rates. CLINICAL RELEVANCE: Automatic detection of pulpal calcifications with deep learning will be used in clinical practice as a decision support system with high accuracy rates in diagnosing dentists.
Assuntos
Aprendizado Profundo , Calcificações da Polpa Dentária , Humanos , Calcificações da Polpa Dentária/diagnóstico por imagem , Radiografia , Cavidade PulparRESUMO
En la práctica endodóntica, la etapa del acceso al canal radicular es fundamental para el éxito de las siguientes etapas del tratamiento. En casos de canales pulpares obliterados o calcificados (PCO), lograr encontrar la entrada a estos es un reto en la endodoncia convencional dado el alto riesgo de sufrir un accidente intraoperatorio. Actualmente, existen los tratamientos de endodoncia guiada o accesos guiados digitalmente, una alternativa innovadora y con múltiples beneficios para el abordaje de este tipo de dientes. El objetivo de este reporte de casos fue describir el protocolo de cuatro casos de accesos guiados estáticos para endodoncia en canales obliterados, indicando las ventajas y consideraciones del tratamiento. Se presenta un reporte de casos de cuatro pacientes atendidos entre julio 2021 y junio 2022, que requerían tratamientos endodónticos en dientes anteriores con canales pulpares obliterados. Para la realización de estos procedimientos se requirió una Tomografía Computarizada de Haz Cónico (CBCT) y el escaneo intraoral de la zona a tratar, para poder a través de la ayuda de un software, planificar virtualmente la dirección y longitud de acceso al conducto radicular. Posteriormente, se realizó la impresión en 3D de la guía estática, la cual dirige la entrada de la fresa que se utiliza para encontrar el acceso al canal radicular. En los cuatro casos clínicos en que se realizó la planificación virtual e impresión de la guía de acceso, fue posible encontrar el canal radicular en una sesión, pudiendo realizar el tratamiento endodóntico de manera exitosa y conservadora. En conclusión, la endodoncia guiada estática permite realizar los tratamientos endodónticos en PCO de manera segura, a pesar de la alta complejidad que presentaban.
SUMMARY: In endodontics, the access to the root canal is essential for the treatment success. Pulp canal obliteration (PCO) is a challenge for conventional endodontic treatments with a high risk of fracture of endodontic instruments.Currently, guided endodontic treatments, or digitally guided accesses, are novel alternatives with multiple benefits for the treatment of PCO. The objective of this case report is to describe the protocol for static guided access in PCO, indicating the advantages and considerations of the treatment. A case report of four patients treated between July 2021 and June 2022 is presented. These patients required endodontic treatments in anterior teeth with PCO. In order to virtually plan the direction and length of the access, using a software, we used a cone Beam Computed Tomography (CBCT) and an intraoral scan. Then, a 3D printing of the static guide was made, which directs the entry of the drill. With this method, it was possible to find the root canal in one session and perform the endodontic treatment successfully and conservatively. In conclusion, although static guided endodontics requires planification, it allows a safe endodontic treatment in patients with PCO.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Tratamento do Canal Radicular/métodos , Calcificações da Polpa Dentária/terapia , Calcificações da Polpa Dentária/diagnóstico por imagem , Endodontia , Tomografia Computadorizada de Feixe CônicoRESUMO
Background Pulp stones or "denticles" are a frequent finding in coronal and radicular pulp of primary and permanent dentition. These discrete calcified bodies can be seen in a healthy, diseased and sometimes even in an unerupted tooth. These calcifications are mostly present in molars as free, attached or embedded to dentine of pulp chamber or root canals. Objective To determine the occurrence of pulp stones in molars of selected adult Nepalese population using radiographs and assess the association of its occurrence gender and arch wise. Method A descriptive cross-sectional study was performed using orthopantomogram of total 380 patients (190 male and 190 females) of age group ranging from 16-30 years by convenience sampling. Data were collected through the examination of both hard and soft copies of radiographs under magnification. Pulp stones were scored as present or absent and their association with gender and dental arch were recorded. Descriptive statistics and chi square test was performed to see the prevalence and to compare the occurrence of pulp stone respectively. Result Out of 380 radiographic samples, pulp stones were present in 41.05% of the samples. The occurrence of pulp stones were found to be higher in females than in males, although the difference was not statistically significant (p=0.060).The total number of teeth with pulp stones was 238 and 61 in maxillary and mandibular arches respectively, with statistically significant difference (p<0.001). Conclusion The overall occurrence of pulp stone was found to be 41.05%. It was observed more in females (45.78%) than in males (37%) and more frequently located in maxillary molars (29.2%) than in mandibular molars (8.2%).
Assuntos
Calcificações da Polpa Dentária , Adolescente , Adulto , Estudos Transversais , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/epidemiologia , Feminino , Humanos , Masculino , Maxila , Dente Molar/diagnóstico por imagem , Centros de Atenção Terciária , Adulto JovemRESUMO
OBJECTIVE: To determine prevalence of pulp stones in molars of patients at the Institute of Dentistry Faculty of Medicine Vilnius University and to evaluate the association of pulp stones and gender, patient age, tooth condition. MATERIAL AND METHODS: Intraoral radiographs were reviewed using the Romexis program and pulp stones were assessed in molars. Teeth were distributed into intact and non-intact. Information about patients' gender and age was collected. Data were processed using SPSS IBM (Statistical Package for the Social Sciences 22.0) program. Pearson's Chi-square test (χ2) was used. Results were considered to be statistically significant when the significance level of p<0.05. RESULTS: A total of 531 patients' bitewing and periapical radiographs of molars were evaluated. 2361 molars in total were assessed. Prevalence of pulp stones was 58.8% when pulp stones were found in at least one molar. Pulp stones were detected in 832 molars (35.24%). Patients from 18 to 93 years old were assessed. The highest pulp stones' occurrence was found in the age group from 38 years and older (71.07%). Non-intact maxillary right first molars and maxillary right and left second molars demonstrated a statistically significantly more frequent occurrence of pulp stones than intact molars (p<0.05). CONCLUSION: More than half of the participants had pulp stones in molars. Higher prevalence of pulp stones was associated with older age and decayed/filled teeth. There was no statistically significant difference between genders with regards to prevalence of pulp stones.
Assuntos
Calcificações da Polpa Dentária , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/epidemiologia , Feminino , Humanos , Masculino , Maxila , Pessoa de Meia-Idade , Dente Molar/diagnóstico por imagem , Prevalência , Radiografia , Adulto JovemRESUMO
Undetected pulp stones can complicate root canal treatment. Knowledge about the prevalence of this anomaly in specific populations can improve endodontic treatment outcomes. The objective of this study was to use cone beam computed tomography (CBCT) to assess the prevalence of pulp stones in an Iranian subpopulation. In this descriptive, analytical, cross-sectional study, the CBCT scans of 150 (75 female and 75 male) patients aged 15 to 70 years were retrieved from the 2017 to 2018 archives of an Iranian university. A total of 4200 teeth were evaluated for the presence of pulp stones by a senior dental student under the supervision of an experienced oral and maxillofacial radiologist. The panoramic radiographic views were evaluated first, and then each tooth was evaluated on sagittal, coronal, axial, cross-sectional, and multiplanar views with 0.5-mm slice thickness. Data regarding the presence of pulp stones as well as the effects of age, sex, tooth type, and jaw on the presence of pulp stones were analyzed using independent t and chi-square tests. Of 4200 teeth, 571 had pulp stones, yielding prevalence rates of 13.6% in the studied teeth and 76.0% in the study population. The prevalence of pulp stones was higher in female patients, the mandible, anterior teeth, and the mandibular left quadrant. The mandibular left central incisor (tooth 24) had the highest (38.7%) and the maxillary left second premolar (tooth 13) had the lowest (1.3%) prevalence of pulp stones. The high prevalence of pulp stones in this study population suggests that dentists should consider the possible presence of pulp stones when planning endodontic treatment for Iranian patients.
Assuntos
Calcificações da Polpa Dentária , Adolescente , Adulto , Idoso , Tomografia Computadorizada de Feixe Cônico , Estudos Transversais , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/epidemiologia , Cavidade Pulpar , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Mandíbula , Pessoa de Meia-Idade , Prevalência , Raiz Dentária , Adulto JovemRESUMO
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.
Assuntos
Calcificações da Polpa Dentária , Animais , Restos Mortais , Tomografia Computadorizada de Feixe Cônico , Polpa Dentária , Calcificações da Polpa Dentária/diagnóstico por imagem , Humanos , Projetos Piloto , Microtomografia por Raio-XRESUMO
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.
Assuntos
Calcificações da Polpa Dentária , Calcificações da Polpa Dentária/diagnóstico por imagem , Humanos , Microscopia Eletrônica de Varredura , Dente Molar/diagnóstico por imagem , Análise Espectral , Raiz DentáriaRESUMO
This study evaluated the presence of pulp stones in a Seville population, correlating their presence and size with state of the crown and pulp response to cold stimuli, encompassing variables such as age, gender, location (arch and teeth group). The study included 1090 teeth corresponding to 146 patients. Each patient underwent a visual examination, periapical radiographs and sensibility tests. The SPSS 25 software (SSPS, Chicago, USA) was used to carry out the statistical analysis, doing logistic regression to compare variables and Chi-square with a significance level p < 0.001. Of 1090 teeth studied, 524 were molars and 566 premolars. Of the molars, 316 showed calcifications and of the 566 premolars only 6 showed pulp stones (p < 0.001). Due to the low prevalence of premolar pulp calcifications, our study included only molars. These calcifications were significantly more common in women than in men (71.5% vs. 28.5%) and in people over 40 years. Significant differences were identified between the state of the crown and the pulp response with the presence of pulp stones, although size did not influence this association. The set of independent variables has a statistically significant effect on the criterion variable (χ2 = 260.25, p < 0.001). There was a significant association between the state of the crown and the type of pulp response with the presence of pulp stones, but not with the size of the calcification. In conclusion, the highest probability to find pulpal calcification was observed in women over 40 years old in upper molars, and though the pulpal reaction of teeth with pulpal calcification varies, frequently there is an immediate response to a cold stimulus. There is no correlation between the size of pulp stones and the condition of the crown, just as the sensitivity of the pulp did not correlate with the size of pulp stones.
Assuntos
Calcificações da Polpa Dentária , Adulto , Dente Pré-Molar , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/epidemiologia , Feminino , Humanos , Masculino , Dente Molar/diagnóstico por imagem , Prevalência , RadiografiaRESUMO
Objetivos: Estimar la prevalencia de nódulos pulpares y agujas cálcicas en pacientes atendidos en la Cátedra de Endodoncia, Facultad de Odontología, Universidad de Buenos Aires (CEFOUBA). Se analizaron radiografías de 1866 piezas dentarias, con ápices maduros, de pacientes de ambos géneros, mayores de 15 años, tratados en CEFOUBA, en el período comprendido entre junio-noviembre de 2018. Género, edad, grupo dentario, condición del diente, presencia de patología sistémica, y ubicación anatómica, fueron las variables registradas. Se calcularon intervalos de confianza 95%, método score de Wilson. Se utilizó test z para diferencias de proporciones. El porcentaje de piezas con calcificaciones superó significativamente a piezas sin calcificaciones (z= 6,076; P<0,05). Porcentaje de piezas en mujeres fue significativamente mayor al de hombres (z=24,31; P<0,05). Porcentaje de piezas de las cuartas y quitas décadas de la vida (61%) superó significativamente a las demás décadas (39%) (z=9,88; P<0,05). El porcentaje de piezas con caries fue significativamente mayor al resto de las piezas con otras condiciones (41%) (z= 8,074; P<0,05). El porcentaje de piezas en pacientes sanos (77%) fue significativamente mayor al resto de las condiciones (23%) (z=24,310; P<0,05). El porcentaje de calcificaciones en cámara (78%) fue significativamente mayor a las del conducto (22%) (z=25,21; P<0,05). En conclusión, la presencia de este tipo de calcificaciones es frecuente en molares de pacientes femeninos y edad adulta. Es importante detectarlos radiográficamente porque complican la realización del tratamiento endodóntico, especialmente si están adheridos y obliteran la entrada de los conductos (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Calcificações da Polpa Dentária/epidemiologia , Calcificações da Polpa Dentária/diagnóstico por imagem , Argentina , Faculdades de Odontologia , Radiografia Dentária/estatística & dados numéricos , Estudos TransversaisRESUMO
The detection of pulp stone in a patient suffering from undiagnosed systemic diseases can be an early diagnostic indicator. Thus, the aim of the study was to assess the prevalence of pulp stones in the Saudi Arabian population with cardiovascular diseases and diabetes mellitus. In a retrospective study, we included cone-beam computed tomography (CBCT) scans of 73 patients with cardiovascular disease and 76 patients with diabetes mellitus as group I and II, respectively. Group III comprised of CBCT scan of 80 healthy controls. From a total of 229 scans, 4807 teeth were screened for pulp stones throughout the arches. A chi-square test was used for comparing the prevalence of pulp stones among the groups. Univariable and multivariable analysis was done to evaluate the independent risk indicators for pulp stones. The tooth-wise prevalence of pulp stones in group I, II, and III was found to be 16.65%, 9.01%, and 3.86%, respectively. Patient-wise (p < 0.01) and tooth-wise (p < 0.01) prevalence was recorded significantly highest in the cardiovascular group followed by the diabetic group. The control group had the least prevalence. Significantly (p < 0.01) higher number of pulp stones were found in cardiovascular patients with age > 50 years compared to other groups. Similarly, a significantly increased number of pulp stones were seen in the 1st molar (p < 0.05) and the maxillary jaw (p < 0.05) of patients with cardiovascular diseases. Subjects with cardiovascular disease and diabetes were found to have 2.94 times (p < 0.001; CI 1.54-3.10) and 1.81 times (p < 0.01; CI 0.48-2.06) higher risk of having pulp stones in comparison to healthy subjects. The first molar has 2.20 times (p < 0.001; CI 0.84-2.45) increased the risk of having pulp stones compared to other tooth types. Systemic disease such as cardiovascular disease and diabetes mellitus poses a higher risk for the development of pulp stones. Among the systemic disease group, patients in the cardiovascular group showed a higher risk for pulp stones and also reported the maximum number of pulp stones compared to the diabetic and healthy subjects.
Assuntos
Doenças Cardiovasculares , Calcificações da Polpa Dentária/epidemiologia , Diabetes Mellitus , Tomografia Computadorizada de Feixe Cônico Espiral , Adulto , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Calcificações da Polpa Dentária/diagnóstico por imagem , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Adulto JovemRESUMO
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.