De Cleen M. Obliteration of pulp canal space after concussion and subluxation: endodontic considerations. Quintessence Int. 2002; 33:661-669
Andreasen JO, Andreasen FM.Copenhagen: Munksgaard; 2007
Feiglin B. Dental pulp response to traumatic injuries – a retrospective analysis with case reports. Endod Dent Traumatol. 1996; 12:1-8
Neville BW, Damm DD, Allen CM, Bouquot JE.Philadelphia, USA: WB Saunders Co; 1995
Ngeow WC, Thong YL. Gaining access through a calcified pulp chamber: a clinical challenge. Int Endod J. 1998; 31:367-371
Gopikrishna V, Parameswaran A, Kandaswamy D. Criteria for management of calcific metamorphosis: review with a case report. Ind J Dent Res. 2004; 15:54-57
Abbott PV, Yu C. A clinical classification of the status of pulp and the root canal system. Aust Dent J. 2007; 52:S17-S30
Amir FA, Gutmann JL, Witherspoon DE. Calcific metamorphosis: a challenge in endodontic diagnosis and treatment. Quintessence Int. 2002; 1:61-69
Chicago: AAE; 2003
Andreasen JO. Luxation of permanent teeth due to trauma: a clinical and radiographic follow-up study of 189 injured teeth. Scand J Dent Res. 1970; 78:273-286
Holcomb JB, Gregory WB. Calcific metamorphosis of the pulp: its incidence and treatment. Oral Surg Oral Med Oral Path. 1967; 24:825-830
Oginni AO, Adekoya-Sofowora CA. Pulpal sequelae after trauma to anterior teeth among adult Nigerian dental patients. BMC Oral Health. 2007; 7
Selden HS. Radiographic pulpal calcifications: normal or abnormal – a paradox. J Endod. 1991; 17:34-38
Andreasen FM, Yu Z, Thomsen BL, Andersen PK. Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition. Endod Dent Traumatol. 1987; 3:103-115
Lundberg M, Cvek M. A light microscopy study of pulps from traumatized permanent incisors with reduced pulpal lumen. Acta Odontol Scand. 1980; 38:99-94
Robertson A. A retrospective evaluation of patients with uncomplicated crown fractures and luxation injuries. Endod Dent Traumatol. 1998; 14::245-256
Heithersay GS. Calcium hydroxide in the treatment of pulpless teeth with associated pathology. J Br Endod Soc. 1975; 8:74-93
Andresen FM. Pulpal healing after luxation injuries and root fracture in the permanent dentition. Endod Dent Traumatol. 1989; 5:111-131
Ten Cate AR.St Louis: Mosby; 1998
Avery J. Repair potential of the pulp. J Endod. 1981; 7:205-212
Torneck C. The clinical significance and management of calcific pulp obliteration. Alpha Omega. 1990; 83:50-54
Tyndall DA, Rathore S. Cone-beam CT diagnostic applications: caries, periodontal bone assessment, and endodontic applications. Dent Clin North Am. 2008; 52:825-841
Patel S. New dimensions in endodontic imaging: Part 2. Cone beam computed tomography. Int Endod J. 2009; 42:463-475
Mazzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone–beam technique: preliminary results. Euro Radio. 1998; 8:1558-1564
Ludlow JB, Davies-Ludlow LE, Brooks SL., Howerton WB. Dosimetry of 3 CBcr devices for oral and maxillofacial radiology: CB Mercuray, NewTom 3G and i-CAT. Dentomaxillofac Radiol. 2006; 35:219-226
Ludlow JB, Lester WS, See M, Bailey LJ, Hershey HG. Accuracy of measurements of mandibular anatomy in cone beam computed tomography images. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2007; 103:534-542
Cotton TP, Geisler TM, Holden OT, Schwartz SA, Schindler WG. Endodontic applications of cone-beam volumetric tomography. J Endod. 2007; 9:1121-1132
Macleod I, Heath N. Cone-beam Computed Tomography (CBCT) in dental practice. Dent Update. 2008; 35:590-598
Farman AG, Farman TT. A comparison of 18 different X-ray detectors currently used in dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2005; 99:485-489
Mora MA, Mol A, Tyndall DA, Rivera E. In vitro assessment of local tomography for the detection of longitudinal tooth fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2007; 103:825-829
Holan G. Tube-like mineralization in the dental pulp of traumatized primary incisors. Endo Dent Traumatol. 1998; 14:279-284
Nair M, Nair U. Digital and advanced imaging in endodontics: a review. J Endod. 2007; 33:1-6
Levin LG, Law AS, Holland GR, Abbott PV, Roda RS. Identify and define all diagnostic terms for pulpal health and disease states. J Endod. 2009; 35:1645-1657
Oginni AO, Adekoya-Sofowora CA, Kolawole KA. Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision. Dent Traumatol. 2009; 25:620-625
Jacobsen I, Kerekes K. Long-term prognosis of traumatized permanent anterior teeth showing calcifying processes in the pulp cavity. Scand J Dent Res. 1977; 85:588-598
Bauss O, Röhling J, Rahman A, Kiliaridis S. The effect of pulp obliteration on pulpal vitality of orthodontically intruded traumatized teeth. J Endod. 2008; 34:417-420
Patterson SS, Mitchell DF. Calcific metamorphosis of the dental pulp. Oral Surg Oral Med Oral Pathol. 1965; 20:94-101
Schindler WG, Gullickson DC. Rationale for the management of calcific metamorphosis secondary to traumatic injuries. J Endod. 1988; 14:408-412
Shuler SE, Howell BT, Green DB. Unusual pattern of pulp canal obliteration following luxation injury. J Endod. 1994; 20:460-462
Cvek M, Granath L, Lundberg M. Failures and healing in endodontically treated non-vital anterior teeth with post-traumatically reduced pulpal lumen. Acta Odontol. 1982; 40:223-228
Akerblom A, Hasselgren G. The prognosis for endodontic treatment of obliterated root canals. J Endod. 1988; 14:565-567
Patel S, Rhodes J. A practical guide to endodontic access cavity preparation in molar teeth. Br Dent J. 2007; 203:133-140
Plotino G, Pameijer CH, Grande NM, Somma F. Ultrasonics in endodontics: a review of literature. J Endod. 2007; 33:81-95
Khabbaz MG, Serefoglou MH. The application of the buccal object rule for the determination of calcified root canals. Int Endo J. 1996; 29:284-287
Weine FS. Periapical surgery; intraoral imaging and its use with surgery and other procedures. In: Weine FS (Ed). St Louis, USA: Mosby-Year Book Inc; 2004
Calcific metamorphosis (CM) is a commonly observed phenomenon following traumatic injuries like concussion, subluxation and luxation. Depending on the severity of the injury and the developmental stage of the tooth, there can be either complete or partial obliteration of root canals. However, histologically, there is always persistence of fine residual filaments of pulp tissue or tracts of organic material without the presence of any inflammatory component. A periodic clinical and radiographic follow-up examination is preferred and usually, for cosmetic reasons, only a conservative aesthetic treatment is required. Endodontic treatment is only advocated if there is development of apical periodontitis and, if executed properly, can be highly successful.
Clinical Relevance: Appropriate management of calcific metamorphosis can present a clinical dilemma to the clinician. Thus a judicious and prudent decision should be made between endodontic intervention for the involved tooth and other available restorative (and/or aesthetic) treatment options.
Article
Traumatic injuries to the teeth affect both the hard tissues (enamel, dentine and cementum) and the soft tissues surrounding the teeth (periodontal tissues). Following trauma, commonly encountered moderate injuries affecting the periodontium include concussion and subluxation and attenuated injuries include luxation:1,2
Pulpal reactions to traumatic injuries can vary from immediate pulpal death to long-term slow pulp canal mineralization.3 The prognosis of pulpal healing and survival, following trauma, depends on the degree and type of trauma, age of the patient and the condition of the tooth in the post-traumatic period.3 The pulpal reactions to traumatic injuries, based on the prognosis of pulpal healing, are classified into three main categories:3
As discussed (in categories 2 and 3), the obliteration of the pulp chamber and canal following traumatic injury to the affected tooth is termed as Calcific Metamorphosis (CM) or Pulp Canal Obliteration (PCO) or Pulp Canal Calcification (PCC).4–7Calcific metamorphosis is a pulpal response to trauma characterized by rapid deposition of hard tissue within the root canal space.8,9 There can be either partial or complete pulp canal obliteration. The frequency of this obliteration depends on the extent and severity of the luxation and the stage of the root development at the time of injury.1,2,10,11 Calcific metamorphosis has been found to develop more in teeth with concussion and subluxation injuries, whereas pulpal necrosis occurred more often in traumatized teeth with fractures.10,12 The incidence of obliteration following concussion is 3% in teeth with incomplete roots and 7% in teeth with completely formed roots. Following subluxation, it is 11% in teeth with incomplete root formation and 8% in teeth with completed root formation.1 Pulpal necrosis occurs in 3% of concussion and 6% of subluxation cases. In luxation injuries, CM is more prevalent in teeth with incomplete root formation.1,8,10
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