Denticles of the pulp chamber – diagnostics and management. Case studies

Abstract

Introduction: Denticles are mineralized formations found in the dental pulp of deciduous and permanent dentition. Topographically, they can be classified as free, adjacent, or intratissular. Denticles rarely occur; however, their presence is considered clinically relevant due to the difficulties they cause during endodontic treatment.The aim of this study was to describe clinical cases of denticles located in the tooth pulp chamber. Various methods for their removal are also discussed. Emphasis was placed on the diverse appearance of pulp stones in microscope-captured images and on the necessity of maintaining appropriate clinical proceduresfor highly specialized endodontic treatment, such as working with rubber dams and magnification, to avoid serious complications.Materials and methods: Four cases of molar teeth with suspected intraventricular denticles were subjected to specialised endodontic treatment. Removal procedures were performed in aseptic conditions after dental dam placement and with the use of a dental operative microscope. To remove denticles, carbide long shank rose burs, Munce Discovery Burs, and an ultrasonic device with tips for finishing canal access and locating their orifices were used. Following preparation of a straight line access, the canals were chemically and mechanically cleaned and shaped according to accepted standards of modern endodontics. After obturation of the canal system, control radiographs were performed. Results: During all treatments, the denticles were removed completely, allowing further preparation and obturation of the entire canal system.Conclusions: Removal of denticles from the pulp chamber is a complicated, difficult procedure, requiring knowledge of the anatomy of the root canal system, professional operation skills, magnification of the operating site, and appropriate equipment. Such preparation allows clinicians to avoid potential complications such as perforation and/or excessive weakening of the tooth structure due to excessive removal of hard tissues.

Denticles: study diagnostic and perspectives of treatment (a review, part II)

“…Дентикли большого размера изменяют внутреннюю анатомию зуба, отклоняя наконечник инструментов и препятствуя обработке корневого канала, что приводит к неадекватному удалению ткани пульпы. Для преодоления препятствий, создаваемых камнями пульпы при лечении корневых каналов, необходимо надлежащее оборудования, такое как ультразвуковые наконечники, пилочки C-pilot и увеличительные устройства [ 1,11,41 ] .…”

“…Большие петрификаты обычно иссекают бором в коронковой части. Для обработки дна полости зуба и атравматичного удаления дентиклей используются боры Мюнса [ 41 ] . Но инструменты с ультразвуковыми наконечниками с алмазным покрытием значительно облегчают их извлечение.…”

“…Ультразвуковые наконечники можно использовать как с водяным охлаждением, так и без него. При использовании в сухих условиях рекомендуется сделать несколько орошений полости пульпы раствором NaOCl или ЭДТА [ 1,41 ] .…”

The Pulp Stones: Morphological Analysis in Scanning Electron Microscopy and Spectroscopic Chemical Quantification

“…Clinical relevance of pulp mineralizations relates to technical difficulties in locating, accessing and preparing root canals [19]. These obstacles may result in complications such as zipping, ledging or perforations.…”