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    Pulp Obliteration - A Histological Study

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    Pulp Obliteration - A Histological Study

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    Pulp Obliteration - A Histological Study

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    0099-2399/93/1905-02521503.

    00/0
    JOURNAL OF ENDODONTICS Printed in U.S.A.
    Copyright © 1993 by The American Association of Endodontists VOL. 19, No. 5, MAY 1993

    Pulp Obliteration: A Histological Study


    Adriano Piattelli, MD, and Paolo Trisi, DDS

    Pulp obliteration is a very rare occurrence that is


    most frequently caused by trauma. A 58-yr-old fe-
    male patient had a generalized pulp obliteration that
    involved all maxillary and mandibular teeth. One
    tooth was extracted due to an extensive carious
    lesion and it was processed by a cutting-grinding
    technique. It was possible to observe the complete
    obliteration of the pulp chamber, which was filled in
    part by reparative dentin and in part by a calcified
    tissue with a concentric layers structure with no
    tubular pattern. The root canals were almost com-
    pletely obliterated by an amorphous calcified mate-
    rial.

    FIG 1. Orthopantomogram: complete absence of the pulp chamber in


    almost all maxillary and mandibular teeth.
    Pulp stones may be classified as being false or true. The
    majority of the stones are probably of the false variety. These nearly all teeth (Fig. 1). The patient was in normo-occlusion,
    show a calcification layering rather than exhibiting the typical with no signs of attrition, no periodontal disease, had exten-
    structure of dentin (1). False stones are extremely frequent, sive carious lesions on two teeth, and a pulp vitality cold test
    involve about 90% of all teeth in individuals more than 50 yr was slightly positive on two others. The patient has been
    of age (2), and are mostly located in the coronal pulp. Another treated for the past 14 yr for rheumatoid arthritis with corti-
    type of calcification that is most frequent in the radicular pulp costeroids and nonsteroid anti-inflammatory drugs.
    is termed diffuse or linear calcification (1, 3, 4). Although Because of the extensive carious lesion, tooth 26 was ex-
    calcifications occur in the healthy uninflamed pulp, they tend tracted and placed for 24 h in buffered formalin. After dehy-
    to increase in frequency and dimension with age and irritation dration in an ascending series of graded ethanol rinses, the
    (1). specimen was infiltrated and polymerized in Technovit 7200
    Usually the number present and the size of each is directly VLC resin. Twenty-micrometer-thin slides were then pre-
    proportional to the age of the individual (5). Clinically, these pared by a cutting-grinding technique (6). The slides were
    calcifications have no particular significance (1) and stones in routinely stained with basic fuchsin and methylene blue and
    the pulp do not usually produce pulpal pathosis or subjective examined in a light microscope.
    symptoms (5). The histogenesis of pulp calcifications is un-
    known (4). Another condition that may occur is the pulp
    obliteration that may be due to irritation or damage to odon- RESULTS
    toblasts. As irritation increases, the amount of calcification
    may also increase and it may lead to partial or almost com- There was an almost complete absence of the pulp chamber
    plete radiographic, but not histological, obliteration of the (Fig. 2). The endodontic space was substituted by a calcified
    pulp chamber and root canal(s) (1). tissue of two types. In some sections reparative dentin was
    present (Fig. 3), whereas in other sections microscopic obser-
    vation showed the presence of a calcified tissue with no
    CASE R E P O R T tubular pattern and with a concentric layer structure (Fig. 4).
    Small lacunae, sometimes filled with aggregation of bacteria,
    A 58-yr-old woman came to the Dental School of the were evident inside the calcified tissue. The presence of an
    University of Chieti with a history of pain in the right lower extensive carious lesion created decalcified areas due to the
    quadrant of 1-wk duration. A panoramic radiograph showed bacterial products. In these spaces bacterial plaque was pres-
    the almost complete obliteration of the pulp chamber in ent. The progression of the carious lesion was different in
    252
    Vol. 19, No. 5, May 1993 Histology of Pulp Obliteration 253

    FIG 4. The obliteration of the pulp chamber is due to many rounded


    calcifications; the clear spaces between these calcifications are prob-
    ably due to the carious destruction. It is possible to see rounded
    concentric-layered calcifications. The black lines are artifacts due to
    the grinding process (basic fuchsin-methylene blue; original magnifi-
    cation x16).

    FIG 2. Complete obliteration of the pulp chamber. Carious lesion in


    the right lower portion (basic fuchsin-methylene blue; original magni-
    fication x6).

    FIG 5. Longitudinal section of the root canal. Complete obliteration of


    the pulp space by an amorphous calcified material that is clearly
    demarcated by reparative dentin. A small apical part of necrotic pulp
    tissue is still present.

    dentin and in the calcified tissue. In normal dentin, a linear


    front of decalcification was evident while in the calcified tissue
    it progressed along concentric layers or inside the small la-
    cunae or tubules. The root canals were almost completely
    obliterated by an amorphous calcified material that was sur-
    rounded by secondary dentin (Fig. 5). In some sections, small
    areas of radicular pulp canal were visible without any cells.
    Only in the apical third could some inflammatory cells be
    seen inside the root canal.

    DISCUSSION
    FIG 3. Complete obliteration of the pulp horn by reparative dentin.
    Magnification of the area limited by arrowheads in Fig. 2 (basic A cutting-grinding technique allows one to obtain very thin
    fuchsin-methylene blue; original magnification x30). (5- to 15-urn) slides of undemineralized hard dental tissues in
    254 Piattelli and Trisi Journal of Endodontics

    which it is possible to maintain a good structural relationship with the rheumatoid arthritis or the long-term anti-inflam-
    between the organic and inorganic components, to avoid matory therapy could be suggested even though up until now
    staining artifacts due to the use of acids, and to obtain a very it has not been possible to link pulp calcifications with any
    good microscopic resolution of all of the structures. systemic factor or disease.
    Pulp obliteration localized in one or a few teeth most This work was partially supported by grants from MURST (60%). We thank
    commonly follows after traumatic injury (fractures of the Dr. Fabiola Monaco and Dr. Antonio Scarano for technical assistance.
    crown and roots, luxation, fractures of the jaws, replantation Dr. Piattelli is associate professor of Oral Pathology and Dr. Trisi is Research
    procedures) (2, 7, 8), whereas generalized pulp obliteration is Fellow, Department of Dentistry, University of Chieti, Chieti, Italy. Address
    requests for reprints to Dr. Adriano Piattelli; Via F. Sciucchi 63, 66100 Chieti,
    much more rare (9) and could be age related or due to the Italy.
    presence of irritants of long-standing, such as abrasion, ero-
    sion, extensive dental restorations, periodontal disease, or
    carious lesions. References
    Generalized pulp obliteration is, moreover, present in den-
    1. Walton RE, Torabinejad M Principles and practice of endodontics.
    tal anomalies such as dentinogenesis imperfecta or dentinal Philadelphia: WB Saunders, 1989:162-3.
    dysplasia. Also, pulp stones may form in several teeth and 2. Schroeder HE. Pathobiologie oraler Strukturen. Basel: Karger, 1983:
    sometimes in every tooth in some individuals and this for- 98-103.
    3. Laurichesse JM, Maestroni F, Breillat J. Endodontie clinique. Paris:
    mation could be genetically controlled (4). In our case the Editions CDP, 1986:22-3.
    complete absence of the pulp chamber was due to the presence 4. Cohen S, Burns RC. Pathways of the pulp. St. Louis: CV Mosby, 1984:
    367-71.
    of reparative dentin and of concentric-layered calcifications 5. Clark JW. Clinical dentistry. Vol 4, Chap 11. Philadelphia: Harper and
    very similar to the histological structure of false pulp stones Row, 1985:5-9.
    6. Donath K, Breuner G. A method for the study of undecalcified bones
    or denticles. The root canal was filled by an amorphous and teeth with attached soft tissue. J Oral Pathol 1982;11:318-26.
    substance that was surrounded by reparative dentin: small 7. Tronstad L. Pulp reactions in traumatized teeth. In: Gutmann JL, Harrison
    parts of necrotic pulp tissue were present and these can cause JW, eds. Proceedings of the International Conference on Oral Trauma. Chicago:
    American Association of Endodontists and Memorial Foundation, 1986:
    a periapical infection. In the present case the obliteration was 55-77.
    certainly not due to the carious lesion because the absence of 8. Schindler WG, Gullickson DC. Rationale for the management of calcific
    metamorphosis secondary to traumatic injuries. J Endodon 1988;14:408-12.
    the pulp chamber affected all maxillary and mandibular teeth. 9. Ho~comb JB, Gregory WB. Catcific metamorphosis of the pulp: its
    Also, irritants of long-standing were absent. A relationship incidence and treatment. Oral Surg 1967;24:825-30.

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