Management of compound odontoma with 70 denticles and impacted lateral incisor over an 8-year follow-up.

Odontomas are benign developmental tumors formed by the improper growth of completely differentiated epithelial and mesenchymal cells of odontogenic origin. The etiology of odontoma is unknown and it is detected during routine radiographic examination. The ideal management is early detection and surgical enucleation. The commonly associated clinical problems of odontomas are delayed exfoliation of primary teeth, delayed eruption or impaction of permanent teeth, displacement of teeth, root resorption, congenital missing, and widening of follicular space. Here, we describe a unique case of compound odontoma with a high number of denticles managed based on a definite decision support system over 8 years. An 8-year-old boy with 70 denticles in the left maxillary region underwent enucleation. On periodic follow-up, the associated impacted lateral incisor was extruded orthodontically.

The Association of Dental Pulp Stones to Cardiovascular and Renal Diseases: A Systematic Review and Meta-Analysis.

BACKGROUND: Pulp stone (PS) is a dystrophic calcification in the tooth's pulp chamber and was suggested in the literature to be associated with other calcifications in the body. This study aimed to investigate the association of PS to cardiovascular diseases (CVD) and renal stones (RS). METHODS: Three databases were searched until June 2021 in addition to manual searching of Google Scholar and grey literature. Original studies were only included and critically appraised using an adapted version of the Newcastle-Ottawa scale. The odds ratio (OR) effect measure was calculated using the Mantel-Haenszel statistical test (95% confidence interval [CI]) to investigate the association of PS with CVD and or RS (P value ˂ .05). RESULTS: The database search identified 4933 studies, and 19 studies were finally included. The risk of bias was low in 13 studies, moderate in 4 studies, and high in 2 studies. The meta-analysis of the moderate and low risk of bias studies revealed a significant association between PS and CVD (OR, 3.35; 95% CI, 1.91-5.89; P < .001, I2 = 65%), but no association was found between PS and RS. The results also revealed an association between PS and CVD in patients older than 40 (OR, 8.78; 95% CI, 3.64-21.17; P < .001, I2 = 0%). CONCLUSIONS: The current study results showed an association between PS and CVD, but no association was found between PS and RS. PS in patients older than 40 years, compared with younger patients (<40 years), was associated with CVD.

Distal renal tubular acidosis, autoimmune thyroiditis, enamel hypomaturation, and tooth agenesis caused by homozygosity of a novel double-nucleotide substitution in SLC4A4.

BACKGROUND: Mutations in SLC4A4 have been reported to be associated with proximal renal tubular acidosis (RTA), short stature, band keratopathy, cataract, glaucoma, and hypoplastic-type amelogenesis imperfecta. In this study, the authors describe the clinical manifestations, and investigate the molecular etiology, in a patient with RTA. CASE DESCRIPTION: The authors report on a girl with distal RTA who carried a novel homozygous base substitution of 2 consecutive base pair variants (NM_001098484.3:c.808-2A>C and NM_001098484.3:c.808-1G>C) in the SLC4A4 gene. The patient had clinical manifestations of autoimmune thyroiditis and distal RTA, including hypercalciuria, nephrocalcinosis, and nephrolithiasis. In addition to the presence of hypoplastic-type amelogenesis imperfecta, generalized enamel hypomaturation, a feature seen in mice lacking Slc4a4, was also observed in the patient. The basic defect in this patient appeared to be impaired hydrogen ion secretion, leading to an inability to acidify the urine, resulting in alkaline urine (despite a normal serum anion gap), hypokalemic, and hyperchloremic metabolic acidosis. The pulp stones found in the patient may likely be the consequences of a disrupted acid-base homeostatic environment that precipitated mineral deposits. Even with proper treatments for distal RTA, the patient has had frequent recurrences of band keratopathy, pupillary membrane, and cataract. PRACTICAL IMPLICATIONS: This is the first report of distal RTA, autoimmune thyroiditis, tooth agenesis, enamel hypomaturation, and pulp stones associated with an SLC4A4 mutation. It is important for dentists to be aware that amelogenesis imperfecta in patients may be a sign of systemic diseases including RTA, nephrocalcinosis, or nephrolithiasis.

Association between Pulp Stones and Kidney Stones: A Systematic Review and Meta-analysis.

INTRODUCTION: A systematic review and meta-analysis were performed to evaluate the association between pulp stones and kidney stones. METHODS: A search for observational studies was performed in PubMed, Scopus, Web of Science, Biblioteca Virtual em Saúde, and the gray literature. The Newcastle-Ottawa Scale for Risk of Bias criteria were used to evaluate the internal quality of the included studies. A fixed-effects meta-analysis was performed to evaluate the association between the conditions. RESULTS: A total of 213 studies were identified after the removal of duplicates. Of these, 9 studies were selected after screening the titles and abstracts. Finally, after full-text reading for qualitative analysis, 7 studies were selected, and of these, 2 were used in the meta-analysis. A significant association was found between pulp stones and kidney stones (1.97 [95% confidence interval, 1.21-3.18]; P < .05). CONCLUSIONS: This study revealed an association between pulp stones and kidney stones. Further well-designed studies should be conducted in order to confirm whether pulp stones are predictive indicators of undiagnosed kidney stones.

Guided Endodontic Access of Calcified Anterior Teeth.

Pulp canal calcification is characterized by the deposition of calcified tissue along the canal walls. As a result, the root canal space can become partially or completely obliterated. Recently, "guided endodontics" has been reported as an alternative solution in cases of partial or completed canal obliteration. Although this technique can enhance minimally invasive access to the calcified canal, it has been shown that the incisal surfaces are often removed during the access of anterior teeth. This report describes 2 cases of guided endodontics using conventional palatal access in calcified anterior teeth and discusses the applicability of this approach in cases of pulp canal calcification with apical periodontitis and acute symptoms. The method demonstrated high reliability and permitted proper root canal disinfection expeditiously, without the unnecessary removal of enamel and dentin in the incisal surface.

Pulp stones can help in detection of calculus in the kidneys and/or in the bile--fact or fiction?

BACKGROUND: Pulp stones or denticles are frequently found in the dental pulp; there is, however, scarce evidence about this phenomenon. Regardless of the obvious endodontic problem of inhibiting access to the canals and their further treatment, they have not been given great importance. The latest experiences of scientific and practical research, including examinations of dental calcifications and their association with calcifications/calculi in the organism, have not been included in the literature. AIM: To investigate the possible association between dental calcifications and calculi in the kidney and/or bile. METHODS: The study group included 200 patients diagnosed with pulptits chronica. All patients underwent dental and systematic examinations. Dental examination included x-rays, which detected the presence of calcifications in the dental pulps. Histopathological analysis of extirpated pulps was also made. Clinical examination comprised ultrasound that detected calculi. RESULTS: The results of the histopathological analysis of the extirpated pulps from the group of patients without denticles, but with calculi in their kidneys, bile and/or other organs, showed a regular presence of "sand" in large quantities in dental pulps. The presence of "sand" was depicted as presence of dystrophic calcifications. There was a percentage difference between the two groups: calculi in the organism (kidney and bile) and denticles--70% and calculi in the organism without denticles--30%. The Student's t-test showed a statistically significant difference for P=0.0000. This study defines the association between the calculi in the organism and the presence of dental calcifications, as well as their possible bacterial association.

Calcific metamorphosis. Literature review and clinical strategies.

UNLABELLED: Calcific metamorphosis (CM) is a commonly observed phenomenon following traumatic injuries like concussion, subluxation and luxation. Depending on the severity of the injury and the developmental stage of the tooth, there can be either complete or partial obliteration of root canals. However, histologically, there is always persistence of fine residual filaments of pulp tissue or tracts of organic material without the presence of any inflammatory component. A periodic clinical and radiographic follow-up examination is preferred and usually, for cosmetic reasons, only a conservative aesthetic treatment is required. Endodontic treatment is only advocated if there is development of apical periodontitis and, if executed properly, can be highly successful. CLINICAL RELEVANCE: Appropriate management of calcific metamorphosis can present a clinical dilemma to the clinician. Thus a judicious and prudent decision should be made between endodontic intervention for the involved tooth and other available restorative (and/or aesthetic) treatment options.

Vasculitis of dental pulp associated with cryoglobulinemia in hepatitis C virus patients: case report.

INTRODUCTION: This report presents a case of impacted lower third molar extracted for surgical reasons in patient with uncontrolled hepatitis C. After decalcification, dental pulp vasculature and its tissue quality were investigated. METHODS: Serial sections of 4-µm thickness along the midline buccolingually for the demineralized specimen were obtained, mounted on a glass slide, stained with hematoxylin-eosin, covered, and viewed under the light microscope. RESULTS: The histologic investigation of the pulp tissue revealed thickening, stenosis, and occlusion of the vessel wall, ectopic calcification of the pulp tissue in close association with pulpal blood vessels, interrupted and vacuolated odontoblastic layer in the coronal pulp chamber, with an inflammatory cell infiltrate throughout the pulpal tissue. CONCLUSIONS: Cryoglobulinemia associated with uncontrolled hepatitis C virus infection in patients endangers the dental pulp vasculature and alters its normal tissue architecture.

Not to be forgotten: denticles. Case reports and review of the literature.

Denticles are foci of calcification in the dental pulp located mostly in pulp chambers. Their etiology is not fully understood. They occur mostly in molars and lower incisors. Denticles vary in size, ranging from microscopic particles to larger masses that almost obliterate the pulp chamber and are visible on radiographs. In the absence of pain, observation is recommended. The aim of this study was to present a case of a denticle in tooth 21 which possibly lead to pulp necrosis and two cases when denticles were detected accidentally during management of dental caries. Denticles are usually found on plain radiographs taken for other reasons.

Association of pulp stones with coronary artery stenosis.

BACKGROUND: Dental pulp stones are discrete calcifications in the pulp chamber which are often seen in deciduous and permanent teeth. It has been hypothesised that atherosclerosis can be associated with their development. OBJECTIVE: To determine whether a higher prevalence of dental pulp stones is correlated with coronary artery stenosis. CLINICAL SETTING: Sixty-one patients aged 20-55 years referred to Afshar Heart Center for invasive coronary angiography were invited to undergo panoramic dental radiography. The panoramic radiographs were independently examined for the presence of pulp stones. RESULTS: Pulp stones were present in 82% (31/38) of patients with at least one clinically significant coronary artery stenosis and in 48% (11/23) of patients with normal coronary angiography. They were present in 13% of the teeth in the former group and in 5% of the teeth in the latter. The findings show a statistically significant association between coronary artery stenosis and presence of pulp stones (odds ratio 4.83, 95% confidence interval 1.5-15.4). CONCLUSION: Coronary artery stenosis and dental pulp calcification are significantly associated. Dental radiography has the potential to be used as a rapid screening method for the early detection of coronary artery stenosis.

A radiographic correlation between systemic disorders and pulp stones.

AIM: The purpose of this study was to determine the correlation between pulp stones and cardiovascular disorders, Type II diabetes mellitus, autoimmune disorders and dental wear defects. This study also aims to evaluate the frequency of pulp stone in population of Dakshina Kannada district (Karnataka, India) and to determine association of pulp stones in different sexes, tooth type, dental arches and sides. PATIENTS AND METHODS: A total of 1432 teeth of five groups were examined, comprising of patients with C.V.S. disorders; Type II diabetes mellitus, autoimmune disorders, dental wear defects and control group. Teeth were examined under 2Χ magnification on radio visiograph (RVG) and conventional intra-oral periapical radiograph. The presence or absence of pulp stones were recorded. STATISTICAL ANALYSIS USED: Chi-square analysis was used to compare the frequency of occurrence of pulp stones between sexes, tooth type, dental arches and sides. RESULTS: Pulp stones were found in 134 (9.35%) of 1432 teeth detected. Significantly, higher numbers of pulp stones were recorded in patients with cardiovascular disorder (15.86%) than other groups. The occurrence of pulp stones were significantly higher in molars (18.29%) than premolars (6.6%) and in maxillary arch (12.36%) than in mandibular arch (5.95%). No significant difference was found between sexes and sides. CONCLUSION: Positive correlation was found between systemic disorder and pulp stones. Cardiovascular patients had maximum number of pulp stones followed by dental-wear defects and least number of pulp stones were evident in control group.

Prevalence of carotid and pulp calcifications: a correlation using digital panoramic radiographs.

OBJECTIVE: To compare the prevalence of pulp calcification with that of carotid calcification using digital panoramic dental radiographs. STUDY DESIGN: Digital panoramic radiographs of patients at a dental oncology clinic were included if (1) the carotid artery bifurcation region was visible bilaterally and (2) the patient had non-restored or minimally restored molars and/or canines. An endodontist evaluated the images for pulpal calcifications in the selected teeth. An oral and maxillofacial radiologist independently evaluated the same images for calcifications in the carotid bifurcation region. Odds-ratio and Pearson chi(2) were used for data analysis. Presence of pulpal calcification was also evaluated as a screening test for the presence of carotid calcification. RESULTS: A total of 247 panoramic radiographs were evaluated. 32% (n = 80) had pulpal calcifications and 25% (n = 61) had carotid calcifications with 12% (n = 29) having both carotid and pulp calcifications. A significantly higher prevalence of both pulp and carotid calcification was found in subjects older than age 60 years compared to younger age groups. Accuracy of pulpal calcification in screening for carotid calcification was 66.4%. CONCLUSIONS: Both pulp and carotid calcifications were more prevalent in older individuals. The presence of pulp calcification was not a strong predictor for the presence of carotid calcification.

Pulp vitality in teeth suffering trauma during orthodontic therapy.

OBJECTIVE: To examine pulpal vitality in teeth suffering dental trauma during orthodontic therapy with fixed appliances. MATERIALS AND METHODS: Pulpal condition was evaluated in 59 teeth that had suffered dental trauma during orthodontic treatment (TO-group), in 800 orthodontically treated teeth without previous dental trauma (O-group), and in 193 orthodontically untreated teeth with previous dental trauma (T-group). Pulpal vitality was examined clinically and with radiographs. Degree of pulp obliteration was rated as absent, partial, or total. All teeth in the TO-group showed a positive sensibility test prior to resumption of orthodontic therapy. RESULTS: Teeth in the TO-group revealed a significantly higher frequency of pulp necrosis than teeth in the O-group or teeth in the T-group (P < .001, respectively). In the TO-group, teeth with extrusive or lateral luxation (P = .031) and teeth with intrusive luxation (P = .015) injuries showed a significantly higher rate of pulp necrosis than teeth with fracture of enamel. In addition, teeth with total pulp obliteration showed a significantly higher frequency of pulp necrosis than teeth without pulp obliteration (P = .013). CONCLUSION: Teeth with severe periodontal injury during orthodontic therapy and subsequent total pulp obliteration have an increased risk of pulp necrosis during additional orthodontic treatment stages.

Internal bleaching of teeth: an analysis of 255 teeth.

BACKGROUND: Studies about bleaching have not analysed factors that affect the outcome. This aim of this study was to analyse the outcome of, and the factors associated with bleaching. METHODS: Internal bleaching was done on 255 teeth in 203 patients. Colour was assessed pre-operatively, postoperatively and at recalls. The cause and type of discolouration, number of applications, bleaching outcome, and colour stability were assessed. RESULTS: The most common teeth were upper central (69 per cent) and lateral (20.4 per cent) incisors. Trauma was the most common cause (58.8 per cent), followed by previous dental treatment (23.9 per cent), pulp necrosis (13.7 per cent) and pulp canal calcification (3.6 per cent). Dark yellow and black teeth required more applications of bleach than light yellow and grey teeth. Colour modification was "good" (87.1 per cent) or "acceptable" (12.9 per cent). Teeth restored with glass ionomer cement/composite resin had good colour stability, but this was less predictable with other restorations. No teeth had external invasive resorption. CONCLUSIONS: Bleaching endodontically treated teeth was very predictable, especially for grey or light yellow discolourations. Glass ionomer cement/composite restorations were effective at preventing further discolouration. Patient age and tooth type did not affect treatment outcome and no cases of external invasive resorption were observed.

The effect of pulp obliteration on pulpal vitality of orthodontically intruded traumatized teeth.

Limited information exists on the impact of pulp obliteration on pulpal vitality of orthodontically treated traumatized teeth. Pulpal condition was examined in 269 traumatized maxillary incisors after orthodontic intrusion (OT group) and in 193 traumatized maxillary incisors without subsequent orthodontic treatment (C group). According to the degree of initial pulp obliteration, the teeth were divided into three categories: teeth without, teeth with partial, and teeth with total pulp obliteration. Teeth in the OT group revealed a significantly higher rate of pulp necrosis than teeth in the C group (p < 0.001). In addition, teeth in the OT group with total pulp obliteration showed a significantly higher rate of pulp necrosis than teeth without (p < 0.001) or only partial pulp obliteration (p = 0.025). The results indicate that traumatized teeth with total pulp obliteration have a higher susceptibility to pulpal complications during orthodontic intrusion than traumatized teeth without or only partial pulp obliteration.

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.

Pilot study of correlation of pulp stones with cardiovascular disease.

We propose that calcification of dental pulp may have a similar pathogenesis as calcified atheromas and could lead to use of routine dental radiographs as a rapid screening method for early identification of potential cardiovascular disease (CVD). Fifty-five dental patients ages 20 to 55 were chosen because pulp stones in pulpally noninflamed teeth were not expected in this age group. They completed a questionnaire regarding their CVD status and that of their parents and siblings. Entry criteria included at least one asymptomatic, minimally restored, noncarious molar and no history of gout, renal disease, or renal lithiasis. Patients' periapical radiographs of record were viewed to determine the presence of pulp stones. There was a significant relationship between pre-existing CVD and pulp stones (odds ratio of 4.4 with a 95% confidence interval of 1.1, 18.7), but no relationship was found for family history of CVD and pulp stones (odds ratio of 1.7 with a 95% confidence interval of 0.5, 5.5). Seventy-four percent (14/19) of patients with reported CVD had detectable pulp stones while only 39% (14/36) of patients without a history of CVD had pulp stones. This pilot study demonstrates that patients with CVD have an increased incidence of pulp stones in teeth with noninflamed pulps compared to patients with no history of CVD. No relationship was found between presence of pulp stones and family history of CVD. The findings suggest that dental radiographic determination of the presence or absence of pulp stones may have possibilities for use in CVD screening.

Combined endodontic and surgical treatment of a three-rooted maxillary first premolar.

A case is reported in which endodontic treatment of a maxillary first premolar was complicated by the fact that the tooth had three roots. One of the roots was completely calcified and therefore could not be negotiated with endodontic files. There was a large periapical lesion associated with the tooth and this was surgically removed. During the surgical procedure a retrograde cavity was prepared on the calcified root using ultrasonic instruments and this was filled using Super EBA cement. Twelve months later the tooth was asymptomatic and the periapical tissues had completely healed.

Obliteration of pulp canal space after concussion and subluxation: endodontic considerations.

Concussion and subluxation injuries to permanent teeth lead to obliteration of the pulp canal space in 3% to 11% of cases, depending on the severity of the injury and the developmental stage of the tooth. Obliteration of the pulp canal space may make root canal treatment necessary because of the development of apical periodontitis or for cosmetic reasons. If carefully executed, root canal treatment in teeth with an obliterated pulp canal space is highly successful and may act as a basis for internal bleaching.

Abnormal pulp calcification in primary molars after fluoride supplementation.

Forty-five caries-free primary molars from children with continuous fluoride supplementation (n = 28) after birth and from children without fluoride prophylaxis (n = 17) were investigated by light microscopy. The following results were obtained: The prophylaxis group evidenced a special form of calcification consisting of fibrodentin-like hard tissue developing intramurally in the dentin wall especially at the pulp floor and spreading irregularily into the pulp cavity by displacing the degenerating pulp tissue (n = 24). These teeth were ankylosed in the bi- and trifurcation area as well as inside the roots. This kind of hard tissue was not observed in the teeth from untreated children. Only 5 children had greater calcifications attached at the pulp wall. Nevertheless, this difference was statistically significant (p = 0.001) and indicates a relationship between fluoride prophylaxis, the special form of pulp calcification and tooth ankylosis.