MODULE 4: PULPAL ABNORMALITIES

AGE CHANGES IN PULP

Increase in number of collagenous bundles

• Calcium (32.1%)

• Phosphate (14.7%)

– Fluoride, sodium, magnesium

– Traces of potassium, chlorine, manganese, zinc, iron

PULP CALCIFICATION:

PULP STONES / DENTICLES

Localized mass of calcified tissue

Pulp stones

Compact degenerative masses of calcified tissues

Denticles

Alternative term to pulp stone; centrally filled with epithelial remnants and surrounded peripherally by:

true denticles

false denticles

denticles surrounded by:

TRUE DENTICLES:

• Dentin layer (resemble dentinal tubules)

• Made of dentin and fibroblasts

FALSE DENTICLES:

• Dystrophic calcified tissue, made up of concentric layers which are deposited around central fluids.

• Do not exhibit dentinal tubules

• Formed from degenerating cells which mineralized

free pulp stone

adherent pulp stone

embedded pulp stone

TYPES OF PULP STONES

free pulp stone

• Lies completely within the pulp tissue.

• Not attached to dentin walls.

• Stone not related to pulp space wall, surrounded by soft tissue

adherent pulp stone

• Attached to the dentin wall of the pulp chamber or root canal.

• Partly fused with dentin.

• Stone attached to wall of pulp

embedded pulp stone

• Completely surrounded by dentin.

• Becomes trapped as dentin continues forming.

• Free = floating inside pulp

• Adherent = stuck to dentin wall

• Embedded = buried in dentin

summarize the types of pulp stones

diffuse calcification

• Found in root canal

• Generally parallel to blood vessel

• Amorphous and unorganized linear strands of calcifications

internal root resorption

• Inflammatory hyperplasia of the pulp

• Response to pulpal injury

• idiopathic

pink hue on the crown

clinical significance of internal root resorption

• Resorption lacunae with osteoclast

• Chronic inflammatory cells

histologic feature of internal root resorption

• Radiolucency (usually big)

• On root chamber or canal

radiograph of internal root resorption

• Generally asymptomatic

symptoms of internal root resorption

• RCT (permanent)

• Pulpotomy (primary)

treatment for internal root resorption

unknown

etiology of internal root resorption

EXTERNAL ROOT RESORPTION

• Resorption of the teeth from external surfaces

• Periapical inflammation

• Tumors and cyst

• Reimplanted teeth

• Impacted third molar

• Excessive force

• idiopathic

- Observe first (you don’t know when it will stop)

etiology of external root resorption

Ruffled borders made by osteoclast

histologic feature of external root resorption

external root resorption

is a rapid process of losing the calcified dental tissues arising as a result of prolonged insult in the periodontal or pericoronal tissue.

resorption of tooth

is a pathologic condition that still remains a mystery in many aspects as most cases of resorption are asymptomatic in nature, it may go unnoticed over many years.

RCT

treatment for external root resorption