Katedra i Zakład Ortodoncji Pomorskiej Akademii Medycznej w Szczecinie al. Powstańców Wlkp. 72, 70-111 Szczecin
Kierownik: dr hab. n. med. Krzysztof Woźniak
Streszczenie
Cel: Ocena częstości występowania zębiniaków i ich lokalizacji w odniesieniu do grup zębowych oraz jam zębów na zdjęciach pantomograficznych losowo wybranej grupy osób.
Materiał i metody: Materiał badawczy stanowiło 165 zdjęć pantomograficznych osób w wieku 9–76 lat, 111 kobiet i 54 mężczyzn. Zęby stałe poddano ocenie w świetle negatoskopu.
Oceniano występowanie i lokalizację zębiniaków w odnie-sieniu do grup zębowych i poszczególnych części jamy zęba.
Wyniki: Zębiniaki stwierdzono na 51,5% zdjęć panto-mograficznych. Na 51,8% były one obecne w obu łukach zębowych. Łącznie znaleziono 248 zębiniaków, w tym 61,7%
w łuku zębowym górnym. Na 69,4% zdjęć pantomograficz-nych kamienie miazgowe stwierdzono tylko w komorach miazgi, zwykle w trzonowcach z wypełnieniami. Ponad 50% wszystkich zębiniaków stwierdzono w pierwszych trzonowcach.
Wnioski: 1. Częstość występowania zębiniaków prze-kracza 50%. 2. U 69,4% występują one w komorach miazgi.
U 91,6% pacjentów stwierdza się je w zębach wielokorze-niowych, głównie w pierwszych trzonowcach i zwykle pod wypełnieniami. Potwierdza to powstawanie zębiniaków w następstwie podrażnienia miazgi zęba spowodowanego obecnością próchnicy lub wypełnienia w przebiegu prze-wlekłego stanu zapalnego.
H a s ł a: pulpolity – kamienie miazgowe – zdjęcia panto-mograficzne.
Summary
Objective: Assessment of the prevalence of denticles and their location with respect to teeth groups and to dental cavities on panoramic radiographs in a randomly selected group of individuals.
Material and methods: The material consisted of 165 panoramic radiographs of individuals aged 9–76 years (111 females and 54 males). Permanent teeth were studied using a negatoscope. The presence and location of denticles was determined with respect to groups of teeth and particular parts of dental cavities.
Results: Denticles were found in 51.5% of panoramic radiographs. They were present in both dental arches in 51.8% of radiographs. Altogether, 248 denticles were found,
out of which 61.7% were located in the upper dental arch.
Pulp stones were found in pulp chambers only, usually in filled molars, in 69.4% of radiographs. Over 50% of all denticles were found in the first molar teeth.
Conclusions: 1. The prevalence of denticles exceeds 50%. 2. Denticles occurred in pulp chambers in 69.4% of the individuals. In 91.6% of cases, denticles were found in multirooted teeth, mainly in the first molars and usually under fillings. These findings are a confirmation that denti-cles appear during chronic inflammation as the consequence of pulp irritation caused by caries or fillings.
K e y w o r d s: pulpolits – pulp stones – panoramic radio-graphs.
56 MARIA SYRYŃSKA, MAGDALENA DURKA-ZAJĄC, JOANNA JANISZEWSKA-OLSZOWSKA
Introduction
Denticles, also called pulp stones or pulpolits, are the result of progressive changes caused by irritation of the dental pulp and represent calcium degeneration caused by intensified activity of odontoblasts in the pulpal area. Den-ticles appear in coronal and radical pulp, in normal dentin protruding onto its internal surface in the direction of the pulp, or loosely in the pulp. Thus one can distinguish loosely lying, parietal, and intraparietal denticles [1, 2]. The lat-ter type is situated in the dentin and extends to the dental cavity hindering endodontic treatment. Growth of denticles can be the cause of pain.
The etiology of denticles has not been elucidated so far.
Denticles appear in greater numbers in adults resembling the deposition of secondary dentin during orthodontic treatment up to total obliteration of the dental cavity [2]. According to some authors, the presence of multiple denticles suggests dentin dysplasia type II [3, 4].
The aim of the study was to assess the prevalence of denticles and their location with respect to teeth groups and to dental cavities on panoramic radiographs in a randomly selected group of individuals.
Material and methods
The research material consisted of panoramic radio-graphs of 165 individuals aged 9–76 years (111 females and 54 males). Permanent teeth were studied using a negato-scope. The prevalence and location of denticles was deter-mined with respect to groups of teeth and particular parts of dental cavities.
Results
Denticles were found in 85 of 165 panoramic radio-graphs (51.5%), in 57 females (51.4%), and 28 (51.9%) males.
No radiograph demonstrated radiologic features of hereditary dentin dysplasia. Altogether, 248 denticles were found. The highest number of pulpolits was 9 in a 31 -year -old person.
On the average, 2.92 denticles occurred per person with denticles. The location of denticles with regard to dental arches and to the dental cavity is presented in table 1 and table 2, respectively. Denticles which appeared in both parts of the dental cavity were found in the same teeth in three females and one male.
More denticles (153, 61.7%) were found in the maxilla than the mandible; 61% (107) in females and 62% (46) in males. Denticles were mainly disclosed in multirooted teeth:
91.6% (163) of all denticles in females and 87% (67) of all denticles in males. They usually occurred under fillings:
114 (64.8%) denticles in females and 46 (63.9%) in males.
Most of all the denticles (138, 55.6%) were found in first molars and none were revealed in lateral incisors.
Discussion
The prevalence of denticles in this study was 51.5%.
Stafne [2] states that if the examination is carried out micro-spically, denticles will be disclosed in 66% of individuals aged 10–20 years and in 90% aged 50–70 years. It seems that this discrepancy is due to lower sensitivity of the radio-logic examination which fails to reveal denticles with a low degree of mineralisation.
No studies analysing the location of denticles in the dental cavity were published. According to some authors, denticles occur mainly in the crowns of teeth [5, 6], a find-ing which has been corroborated by us. In the present study denticles were most often located in the first molars as reported by Różyło and Różyło -Kalinowska who also found that radiologically distinguishable pulpal calcifications occur particularly often in the cavities of molar teeth and rarely in canines and incisors [5].
The highest number of denticles was found by us in teeth with fillings, confirming the definition of denticles as progressive changes occurring under the influence of irri-tation of dental pulp. Consequently, pulp stones should be classified as calcium degenerations. Wysokińska -Miszczuk and Grajewska [6] searched for calcium degenerations in the dental pulp of patients with adult and juvenile para-dontitis. Denticles occurred in 84% of adults whereas only some fine calculi called pulpoliths were demonstrated in juveniles, supporting the suggestion that the number of denticles increases with age [5] as a consequence of pulp degeneration.
T a b l e 2. Prevalence of denticles with regard to parts of the dental cavity
T a b e l a 2. Występowanie zębiniaków w odniesieniu do części jamy zęba
Tylko komory 39 (68.4%) 20 (71.7%) 59 (69.4%) Canal only
Tylko kanały 2 (3.5%) 1 (3.6%) 3 (3.5%) Chamber and canal
Komory i kanały 16 (28%) 7 (25%) 23 (27%) T a b l e 1. Prevalence of denticles with regard to dental arches T a b e l a 1. Występowanie zębiniaków w poszczególnych łukach
zębowych
Tylko górny 18 (31.3%) 12 (42.9%) 30 (35.3%) Lower only
Tylko dolny 7 (12.3%) 4 (14.2%) 11 (12.9%)
Some authors [4, 5] observed pulp degeneration in the form of pulpal calculi in the whole dentition of monozy-gotic twins inferring that such calcifications may sug-gest their hereditary origin indicating dentin dysplasia.
Piatelli [3] states that the total obliteration of the den-tal cavity through denticles is an extremely rare type of pulp degeneration which can be caused by various factors, including type I or II dentin dysplasia characterized by expansion toward the apex of the flame - or thistle -shaped dental cavity and its partial obliteration by one or more denticles [7, 8]. In the present study, we failed to find features of hereditary dentin dysplasia in any of the 165 panoramic radiographs, confirming the rare occurrence of this disease.
Conclusions
The prevalence of denticles exceeds 50%.
1. 2. Denticles occur in dental cavities in 69.4% of indi-viduals and in multirooted teeth, mainly in the first molar teeth and usually under fillings in 91.6% of individuals.
This finding indicates that denticles are due to pulp
irrita-tion caused by caries or fillings, probably in the course of chronic pulp inflammation.
References
Shields E.D., Bixler D., El -Kafrawy A.M.
1. : A proposed classification
for heritable human dentine defects with a description of a new entity.
Arch Oral Biol. 1973, 18 (4), 543–553.
Stafne E.C.
2. : Oral rentgenographic diagnosis. WB Saunders, Phila-delphia 1963.
Piatelli A.
3. : Symmetrical pulp obliteration in mandibular first molars.
J Endod. 1992, 18 (10), 515–516.
Van Den Berghe J.M., Panther B., Gound T.G.
4. : Pulp stones throughout
the dentition of monozygotic twins: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999, 87 (6), 749–751.
Różyło K., Różyło -Kalinowska I.
5. : Częstość występowania uchwytnych
radiologicznie zwapnień w komorach zębów stałych. Prz Stom Wieku Rozw. 2000, 3/4, 31–32.
Wysokińska -Miszczuk J., Grajewska I.
6. : Zwyrodnienia wapniowe w
miaz-dze zębów u pacjentów z zapaleniem przyzębia dorosłych (AP) oraz młodzieńczym zapaleniem przyzębia (JP). Mag Stom. 1999, 12, 64–66.
Giansantis J.S., Allen J.D.
7. : Dentin dysplasia type II, or dentin dysplasia, coronal type. Oral Surg Oral Med Oral Pathol. 1974, 38 (6), 911–917.
Melnick M., Eastman J.R., Goldblatt L.I., Michaud M., Biler D.
8. : Dentin
dysplasia, type II. A rare autosomal dominant disorder. Oral Surg.
1997, 44 (4), 592–599.
A N N A L E S A C A D E M I A E M E D I C A E S T E T I N E N S I S
R O C Z N I K I P O M O R S K I E J A K A D E M I I M E D Y C Z N E J W S Z C Z E C I N I E 2010, 56, 2, 58–69
BETINA SIUDMAK