Dental pulp calcification can lead to root canal stenosis or obliteration. It is usually difficult to negotiate the root canal if the affected tooth needs to be treated and intraoperative complications are easily brought about during the root canal treatment. The etiologies of dental pulp calcification are complicated and careful considerations should be given to the diagnosis and treatment. Only by weighing the advantages and disadvantages can appropriate treatment plan be chosen. Based on the literature and authors' clinical experiences, the present article summarizes the causes, pathogenesis, diagnosis and treatment strategies of dental pulp calcification, in order to provide some references in diagnosis and treatment for the dental clinicians.
Dental Pulp Calcification/therapy* ; Humans ; Root Canal Therapy

OBJECTIVETo evaluate the prognosis of luxated permanent teeth and analyze the associated factors of pulp healing after luxation injuries.

METHODSThe dental records of patients presented for treatment due to luxation injuries at the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology from January 2000 to December 2006 were collected, and the follow-up period was not shorter than six months. The following information was recorded, age and gender; type of injury; location of injured tooth; stage of root development; time elapsed between the injury and the first dental care; emergency treatment or not; pulp healing. Logistic regression was used to compare qualitative data and determine the associated factors of pulp healing after luxation injuries.

RESULTSThe study was comprised of 157 patients with 238 luxated permanent teeth. The frequency of pulp necrosis was 16.0%, dental pulp calcification 2.1% and pulp survival 81.9%. The frequency of pulp necrosis was highest in intrusion (66.7%). The factors significantly affecting pulp healing were stage of root development and type of injury.

CONCLUSIONSThe risk of pulp necrosis was greatest in intrusion. The stage of root development and the type of injury were significant factors related to pulp healing after luxation injuries.

Adolescent ; Child ; Child, Preschool ; Dental Pulp ; injuries ; Dental Pulp Calcification ; diagnosis ; etiology ; Dental Pulp Necrosis ; diagnosis ; etiology ; Female ; Humans ; Male ; Prognosis ; Retrospective Studies ; Tooth Avulsion ; complications ; diagnosis ; therapy

The present report presents a case of dens invaginatus (DI) in a patient with 4 maxillary incisors. A 24-year-old female complained of swelling of the maxillary left anterior region and discoloration of the maxillary left anterior tooth. The maxillary left lateral incisor (tooth #22) showed pulp necrosis and a chronic apical abscess, and a periapical X-ray demonstrated DI on bilateral maxillary central and lateral incisors. All teeth responded to a vitality test, except tooth #22. The anatomic form of tooth #22 was similar to that of tooth #12, and both teeth had lingual pits. In addition, panoramic and periapical X-rays demonstrated root canal calcification, such as pulp stones, in the maxillary canines, first and second premolars, and the mandibular incisors, canines, and first premolars bilaterally. The patient underwent root canal treatment of tooth #22 and non-vital tooth bleaching. After a temporary filling material was removed, the invaginated mass was removed using ultrasonic tips under an operating microscope. The working length was established, and the root canal was enlarged up to #50 apical size and obturated with gutta-percha and AH 26 sealer using the continuous wave of condensation technique. Finally, non-vital bleaching was performed, and the access cavity was filled with composite resin.
Abscess ; Bicuspid ; Dental Pulp Calcification ; Dental Pulp Cavity ; Dental Pulp Necrosis ; Female ; Gutta-Percha ; Humans ; Incisor ; Tooth ; Tooth Bleaching ; Ultrasonics ; Young Adult

PURPOSE: This study was performed to investigate the relationship between sleep bruxism (SB) and pulpal calcifications in young women. MATERIALS AND METHODS: A total of 100 female participants between 20 and 31 years of age who were referred to our radiology clinic for a dental check-up, including 59 SB and 41 non-SB patients, were sampled for the analysis. SB was diagnosed based on the American Academy of Sleep Medicine criteria. All teeth were evaluated on digital panoramic radiographs to detect pulpal calcifications, except third molars, teeth with root canal treatment, and teeth with root resorption. Binary logistic regression analysis was used to determine the risk factors for pulpal calcifications. The Spearman correlation coefficient was applied and the Pearson chi-square test was used for categorical variables. To test intra-examiner reproducibility, Cohen kappa analysis was applied. P values < .05 were considered to indicate statistical significance. RESULTS: A total of 2800 teeth were evaluated (1652 teeth from SB patients and 1148 from non-SB patients), and 61% of patients had at least 1 dental pulpal calcification. No statistically significant relationship was found between SB and pulpal calcifications (P>0.05). In SB patients, the total number of pulpal calcifications was 129, while in non-SB patients, it was 84. Binary logistic analysis showed that SB was not a risk factor for the presence of pulpal calcifications (odds ratio, 1.19; 95% CI, 0.52–2.69, P>.05). CONCLUSION: No relationship was found between SB and pulpal calcifications.
Dental Pulp ; Dental Pulp Calcification ; Dental Pulp Cavity ; Female ; Humans ; Logistic Models ; Molar, Third ; Radiography, Panoramic ; Risk Factors ; Root Resorption ; Sleep Bruxism ; Sleep Medicine Specialty ; Tooth

OBJECTIVETo isolate Nanobacteria from dental pulp stone and perform culturing and the identification of Nanobacteria.

METHODSFreshly collected 27 dental pulp stones were divided into nine samples. Each sample contained three dental pulp stones. All samples were used for the isolation and culture of Nanobacteria. The shape and the growth characteristics of the cultured bacteria were observed. Nanobacteria were identified by von Kossa staining, immunohistochemical staining and indirect immunofluorescence staining, double staining including Hoechst staining and von Kossa staining.

RESULTSThe characteristics growth and morphology of the bacteria detected in seven samples were similar to Nanobacteria. von Kossa staining, immunohistochemical staining, indirect immunofluorescent staining were positive for Nanobacteria. In double staining method, Hoechst staining of the samples was negative for Nanobacteria, but von Kossa staining was positive. Hoechst staining of the dental pulp cells was positive. No Nanobacteria was found in the other two samples.

CONCLUSIONSThe bacteria isolated from dental pulp stone in this study was similar to Nanobacteria in terms of growth rate, morphology and staining properties. These unusual properties of the bacteria may play an important role in the formation of pulp stone.

Bacteria ; isolation & purification ; Dental Pulp Calcification ; microbiology ; Humans ; Immunohistochemistry ; In Vitro Techniques

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.
Cone-Beam Computed Tomography ; Dental Pulp Calcification ; Humans ; Molar ; Prevalence ; Radiography ; Radiography, Panoramic ; Tooth

The aim of this study was to analyze the specific influence of root canal anatomy on the accessibility of working length during root canal therapy. Four hundred seventy-six root canal therapy cases (amounting to a total of 1 005 root canals) were examined. The anatomy risk factors assessed in each case included: tooth type (tooth location), root canal curvature, and root canal calcification, as well as endodontic retreatment. The investigation examined the correlation between each of these anatomic factors and the working length, with statistical analysis consisting of Chi-square tests and multiple logistic regression analysis. In an independent factor analysis, tooth type (tooth location), root canal curvature, canal calcification, and endodontic retreatment were determined to be the primary risk factors. In a multiple-factor regression model, root curvature and canal calcification were found to most significantly influence root canal working length accessibility (P<0.05). Root canal anatomy increases the difficulty of root canal preparation. Appropriate consideration of tooth anatomy will assist in accurate determination of preparation difficulty before instrumentation. This study alerts clinical therapists to anatomical factors influencing the working length accessibility, and allows for a direct estimate of success rate given in situ measurements of tooth factors during the root canal treatment procedure.
Chi-Square Distribution ; Dental Pulp Calcification ; pathology ; Dental Pulp Cavity ; anatomy & histology ; diagnostic imaging ; Humans ; Logistic Models ; Odontometry ; Radiography ; Retreatment ; Risk Factors ; Root Canal Preparation ; instrumentation ; Tooth Apex ; Tooth Root ; anatomy & histology

Deletion or mutation of dentin matrix protein 1 (DMP1) leads to hypophosphatemic rickets and defects within the dentin. However, it is largely unknown if this pathological change is a direct role of DMP1 or an indirect role of phosphate (Pi) or both. It has also been previously shown that Klotho-deficient mice, which displayed a high Pi level due to a failure of Pi excretion, causes mild defects in the dentinal structure. This study was to address the distinct roles of DMP1 and Pi homeostasis in cell differentiation, apoptosis and mineralization of dentin and enamel. Our working hypothesis was that a stable Pi homeostasis is critical for postnatal tooth formation, and that DMP1 has an antiapoptotic role in both amelogenesis and dentinogenesis. To test this hypothesis, Dmp1-null (Dmp1(-/-)), Klotho-deficient (kl/kl), Dmp1/Klotho-double-deficient (Dmp1(-/-)/kl/kl) and wild-type (WT) mice were killed at the age of 6 weeks. Combinations of X-ray, microcomputed tomography (μCT), scanning electron microscopy (SEM), histology, apoptosis and immunohistochemical methods were used for characterization of dentin, enamel and pulp structures in these mutant mice. Our results showed that Dmp1(-/-) (a low Pi level) or kl/kl (a high Pi level) mice displayed mild dentin defects such as thin dentin and a reduction of dentin tubules. Neither deficient mouse line exhibited any apparent changes in enamel or pulp structure. However, the double-deficient mice (a high Pi level) displayed severe defects in dentin and enamel structures, including loss of dentinal tubules and enamel prisms, as well as unexpected ectopic ossification within the pulp root canal. TUNEL assay showed a sharp increase in apoptotic cells in ameloblasts and odontoblasts. Based on the above findings, we conclude that DMP1 has a protective role for odontoblasts and ameloblasts in a pro-apoptotic environment (a high Pi level).
Ameloblasts ; pathology ; Amelogenesis ; physiology ; Animals ; Apoptosis ; physiology ; Cell Differentiation ; physiology ; Dental Enamel ; pathology ; Dental Pulp ; pathology ; physiology ; Dental Pulp Cavity ; pathology ; Dentin ; abnormalities ; pathology ; Dentinogenesis ; physiology ; Extracellular Matrix Proteins ; genetics ; physiology ; Glucuronidase ; genetics ; Homeostasis ; physiology ; Hyperphosphatemia ; physiopathology ; Immunohistochemistry ; Mice ; Mice, Knockout ; Microscopy, Electron, Scanning ; Odontoblasts ; pathology ; Odontogenesis ; physiology ; Ossification, Heterotopic ; genetics ; pathology ; Phosphates ; physiology ; Tooth Calcification ; physiology ; X-Ray Microtomography

The time domain entombment of bacteria by intratubular mineralization following orthograde canal obturation with mineral trioxide aggregate (MTA) was studied by scanning electron microscopy (SEM). Single-rooted human premolars (n=60) were instrumented to an apical size #50/0.06 using ProFile and treated as follows: Group 1 (n=10) was filled with phosphate buffered saline (PBS); Group 2 (n=10) was incubated with Enterococcus faecalis for 3 weeks, and then filled with PBS; Group 3 (n=20) was obturated orthograde with a paste of OrthoMTA (BioMTA, Seoul, Korea) and PBS; and Group 4 (n=20) was incubated with E. faecalis for 3 weeks and then obturated with OrthoMTA-PBS paste. Following their treatments, the coronal openings were sealed with PBS-soaked cotton and intermediate restorative material (IRM), and the roots were then stored in PBS for 1, 2, 4, 8 or 16 weeks. After each incubation period, the roots were split and their dentin/MTA interfaces examined in both longitudinal and horizontal directions by SEM. There appeared to be an increase in intratubular mineralization over time in the OrthoMTA-filled roots (Groups 3 and 4). Furthermore, there was a gradual entombment of bacteria within the dentinal tubules in the E. faecalis inoculated MTA-filled roots (Group 4). Therefore, the orthograde obturation of root canals with OrthoMTA mixed with PBS may create a favorable environment for bacterial entombment by intratubular mineralization.
Aluminum Compounds ; therapeutic use ; Calcification, Physiologic ; physiology ; Calcium Compounds ; therapeutic use ; Crystallization ; Dental Pulp Cavity ; microbiology ; Dentin ; microbiology ; Drug Combinations ; Enterococcus faecalis ; ultrastructure ; Humans ; Methylmethacrylates ; therapeutic use ; Microscopy, Electron, Scanning ; Oxides ; therapeutic use ; Root Canal Filling Materials ; therapeutic use ; Root Canal Obturation ; methods ; Root Canal Preparation ; instrumentation ; Silicates ; therapeutic use ; Time Factors ; Zinc Oxide-Eugenol Cement ; therapeutic use

OBJECTIVETo investigate the effects of pro-inflammatory cytokine interleukin-1β (IL-1β) on mineralization potential of dental pulp stem cells (DPSC).

METHODSRat DPSC were cultured in vitro and randomly divided into three groups, IL-1β (10 µg/L), osteogenic inductive medium and non-osteogenic inductive medium. After 3, 7, and 12 days of treatment, the cultures were evaluated for cell proliferation and calcium deposit. Real-time polymerase chain reaction was used to detect the gene expression levels of osteocalcin (OC), bone sialoprotein (BSP), dentin sialophosphoprotein (DSPP) and dentin matrix protein 1 (DMP-1). In vivo test, after 3 day's treatment with IL-1β, the cell-scaffold complexes were implanted subcutaneously in mice for 8 weeks. Histological analysis was performed to evaluate hard tissue formation.

RESULTSIn vitro test, after 3-day's treatment, IL-1β improved cell proliferation to 137.22 DNA µg/L and cell viability becomes (97.12 ± 7.18)% of control. The gene expression levels of OC, BSP, DSPP and DMP-1 are (378.19 ± 16.22)%, (427.12 ± 18.22)%, (247.19 ± 10.11)% and (198.29 ± 10.23)% respectively. The results of IL-1β's group was notable increased compared with non-osteogenic induction medium and the statistical differences are significant. IL-1β induced the odontogenic differentiation of DPSC. However, these effects tended to continuously decrease with treatment time. Histological analysis demonstrated that in the group treated with IL-1β hard tissue was markedly formed in vivo.

CONCLUSIONSIL-1β may induce the mineralization of DPSC and play an important role in host defenses and tissue repair.

Animals ; Calcification, Physiologic ; drug effects ; Cell Proliferation ; drug effects ; Cell Survival ; drug effects ; Cells, Cultured ; Dental Pulp ; cytology ; Extracellular Matrix Proteins ; metabolism ; Integrin-Binding Sialoprotein ; metabolism ; Interleukin-1beta ; pharmacology ; Mesenchymal Stromal Cells ; cytology ; metabolism ; Osteocalcin ; metabolism ; Phosphoproteins ; metabolism ; Rats ; Rats, Wistar ; Sialoglycoproteins ; metabolism