pulp calcification

pulp

a soft, delicate, specialized connective tissue containing thin-walled blood vessels, nerve, nerve endings enclosed within dentin

dentin

pulp is a soft, delicate, specialized connective tissue containing thin-walled blood vessels, nerve, nerve endings enclosed within —

aging process, orthodontic tooth movement, circulatory disturbance of the pulp, periodontal disease, bacterial infection, caries, systemic disease, genetics

etiology of pulp calcification

blood supply decreases, pulp becomes more fibrotic, cells become less active, tissue undergoes degeneration

etiology of pulp calcification

• Aging process - as we age:

teeth are subjected to continuous forces, blood flow in the pulp may temporarily change, mild pulpal irritation can occur

etiology of pulp calcification

• orthodontic treatment - during orthodontic treatment:

tissue injury, degeneration, cell death

etiology of pulp calcification

• circulatory disturbance of the pulp - anything that reduces or disrupts blood flow can cause:

blood supply entering the apical foramen, surrounding tissues supporting the tooth

etiology of pulp calcification

• periodontal disease - severe periodontal disease may affect: — this chronic inflammation can eventually affect the pulp

toxins, inflammatory products, hard tissue deposition

etiology of pulp calcification

• bacterial infection - bacteria release — that can irritate the pulp and trigger inflammation. the pulp attempts to protect itself through —

bacteria move closer to the pulp, odontoblasts become stimulated, reparative dentin is formed, excessive calcification

etiology of pulp calcification

• caries - as caries progresses: —. long standing irritation can lead to —

calcium metabolism, tissue metabolism, blood circulation

etiology of pulp calcification

• systemic disease - certain systemic conditions may alter: —, these changes can predispose a person to calcification

hereditary

etiology of pulp calcification

• genetics - some individuals simple have a — tendency to develop pulp stones

central nidus

injury to the pulp triggers the formation of a — of collagen fibers, ground substance, or remnants of necrotic cell

successive circular layers of calcified material deposited around the central nidus

What are concentric rings?

the central focus or starting point around which calcium salts are deposited during pulp stone formation

What is a nidus?

injury or irritation of the pulp

formation of pulp stone

• step 1

pulp attempts to protect itself by initiating a defense response against the injury or invading microorganisms

formation of pulp stone

• step 2

confine the bacteria, prevent the spread of infection to the surrounding healthy tissues

formation of pulp stone

• the goal of immune system or defense response against the injury or invading microorganisms is to: —

formation of a central nidus

formation of pulp stone

• step 3

localized focus where the injury, degeneration, or inflammatory process is concentrated

formation of pulp stone

• the central nidus acts as a —

degenerating collagen fibers, necrotic cells, tissue debris, degenerated blood vessels, small hemorrhages or thrombi

components of central nidus

calcification around the central nidus

formation of pulp stone

• step 4

calcium, concentric rings of calcification

formation of pulp stone

• — begins to accumulate around the nidus in successive layers = these layers form — around the central core

formation of a discrete calcified mass

formation of pulp stone

• step 5

denticle

formation of pulp stone

• as more calcium is deposited, a well-defined calcified mass develops and this is called

only the area surrounding the nidus undergoes calcification

formation of pulp stone

• step 6

incidental radiographic finding, can cause pulp canal obliteration, difficulty during root canal treatment, increased risk of procedural errors during endodontics, may occasionally produce symptoms, evidence of previous pulpal injury or chronic irritation, may be associated with certain systemic conditions

clinical significance of pulp calcification / pulp stones

usually asymptomatic

clinical significance of pulp calcification / pulp stones

• why most pulp stones are discovered accidentally during routine radiographic examination

as calcification continues, pulp chamber becomes smaller and root canals become narrowed

clinical significance of pulp calcification / pulp stones

• why pulp stones can cause pulp canal obliteration?

missed canals, ledge formation, instrument separation, perforation

clinical significance of pulp calcification / pulp stones

• because the canals are difficult to locate, the dentist may encounter: —

compress nerve fibers, reduce pulpal space

clinical significance of pulp calcification / pulp stones

• although pulp stone is usually asymptomatic, large calcifications may —. possible manifestations: sensitivity, mild discomfort, occasional pain

based on location

classification of pulp stone

• relationship of the pulp stone to the dentin wall

based on structure

classification of pulp stone

• what pulp is made microscopically

based on morphology

classification of pulp stone

• the shape or pattern of calcification

free

classification of pulp stone based on location

• entirely surrounded by pulp tissue

attached

classification of pulp stone based on location

• partly fused within dentin

embedded

classification of pulp stone based on location

• entirely surrounded by dentin

true

classification of pulp stone based on structure

• rare

• made of dentin

• contains dentinal tubules and odontoblast-like cells involved in formation

dentinal tubules, odontoblast-like cells

true pulp stone contains — and involved — in formation

false

classification of pulp stone based on structure

• common

• made from calcified degenerating cells and tissue arranged in concentricular layer

calcified degenerating cells and tissue arranged

false pulp stone is made from — in concentricular layer

discrete

classification of pulp stone based on morphology

• a well-defined calcified mass

• round or oval

diffuse

classification of pulp stone based on morphology

• irregular calcifications scattered throughout the pulp

• common in root canals

pulp chamber

epidemiology of pulp stones

• occur with higher frequency in the —

because pulp chamber contains more pulp tissue, more blood vessels, more cells, a larger space

why pulp stones occur with higher frequency in the pulp chamber?

maxillary molars

epidemiology of pulp stones

• mostly affected —

because it erupt early, stay in the mouth longer, experience more chewing and are frequently restored due to caries

why pulp stone mostly affects maxillary molars?

female

epidemiology of pulp stones

• — are more commonly affected

dentin dysplasia, dentinogenesis imperfecta

epidemiology of pulp stones

• noted in patients with systemic or genetic diseases such as —

bur and ultrasonic instruments

how is the pulp stone removed?

sodium hypochlorite

used as synergistic effect