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Reticular atrophy of pulp
Pulp calcification

Reticular atrophy of pulp

Characterized by presence of large vacuolated spaces in the

pulp, with a reduction in the number of cellular elements.

Associated with degeneration and disappearance of the
It is seen in elderly people, as the age changes. There is no
clinical significance
It can be produced by improper fixation of the tooth and pulp
after extraction followed by histological sectioning
Most investigators feel it as artifact but not degenerative change

Occurs in any portion of the teeth
Depending on the morphologic forms of pulp calcifications

1-Discrete pulp stones( denticles, pulp nodules)

2-Diffuse calcifications.
Depending on microscopic structure

True stones
False stones
Localized mass of calcified tissue that resemble dentine because of their
tubular structure.
Resemble secondary dentine, because of few dentinal tubules and
irregular arrangement.
Site : More common in pulp chambers than root canals.

True denticles -- Depending on attachment 2 types

Attached denticles attach to the dentinal wall
Free denticles- Not attached to the dentinal wall

False denticles:
Dont exhibit dentinal tubules
They are larger than true denticles
Nodules appear to be made up of concentric layers or
lamellae deposited around the nidus
2.Attached type
3. Interstitial denticle


Diffuse denticles/ calcific degeneration:

Seen in Root canals
Pattern of calcification is in amorphous, unrecognized linear

strands or columnar paralleling the blood vessel and nerves of

the pulp

1)Increases with age of the patient
2)It is not associated with inflammation,caries or trauma since
pulpal calcifications are also seen in unerupted teeth.
3)There is also certain hypothesis about various local or
systemic diseases which include cholelithiasis, acromegaly,
hypercementosis, toruspalatinus or mandibularis. But none of
there relationship is not clear.
4)There is high percentage of pulp stones resulting in growth of
streptococci bacteria upon culturing. This hypothesis was not
true, as the bacteria were forced in to the pulpal tissue at the
time of tooth extraction .

Local metabolic dysfunction
Hyalinization of injured cells


Mineralization (Nidus formation)

Growth with time
Pulp stone

Types: External resorption
Internal resorption
(Chronic perforating hyperplasia of pulp, Internal granuloma,
Odontoclastoma, Pink tooth of mummery.)
Characteristic feature:
Unusual form of tooth resorption that begins centrally with in
the tooth associated with peculiar inflammatory hyperplasia
of pulp.
Cause pulpal inflammation / unknown.

Two main patterns

Inflammatory resorption
Replacement or metaplastic absorption.

Resorbed dentin is replaced by inflamed granulation tissue.
Site cervical zone
Resorption continues as long as vital pulp remains
Coronal pulp necrotic and apical pulp vital
Appear as uniform , well circumscribed symmetric

radiolucent enlargement in the pulp chamber or canal

Involvement of coronal pulp - pink tooth of mummery
as the vascular resorptive process approaches the surface.
When the root surface is perforated, it is impossible to
determine whether the lesion began externally or


Inflammatory Internal resorption


Here portion of pulpal dentinal wall are resorbed and replaced
with bone or cementum like bone
R/F :
Enlargement of the canal that is filled with bone or
cementum like bone will be less radiolucent than the
surrounding dentin.
So the central zone appears partially obliterated. The out
line of destruction is less defined than that seen in
inflammatory resorption.

Variable degree of resorption of the inner or pulpal surface
of the dentine and proliferation of pulp tissue filling the
Lacunae shows - odontoclasts or osteoclasts so called as
Ch. Inflammatory cells are present.
Lacunae like areas in the dentin or osteodentin
Enamel is also resorbed when the internal resorption occurs
in the crown portion.

Resorption begins on the external surface of teeth

Periapical inflammation
Reimplantation of teeth
Tumors and cysts
Excessive mechanical or occlusal forceses
Impaction of teeth
Dental trauma
Hormonal imbalance
Intra coronal bleaching of pulp less teeth
Local involvement of herpes zoster
Paget's disease of bone
PDL treatment

- Resorption associated with periapical inflammation:

Infection or trauma

periapical granuloma

Early stages - slight raggedness or blunting of the root

Later stages resorption is apparent.

Bone is resorbed first than the tooth structure:

High vascularity
Less mineralized

Reimplanted tooth:
Severe resorption of root
Replaced by bone ankylosis
Complete resorption exfoliation
Tumors and cysts:
Pressure phenomenon
Benign lesions displacement of tooth
Common in epithelial tumors

C.T between the tumor and the teeth


Occasionally , neoplastic cells are found adjacent to and with
in the ragged resorption lacunae on the root surface.
Displacement is more common than resorption
Pulp infection
apical periodontal cyst
CT bet cysts
Excessive mechanical or occlusal forceses:
Orthodontic treatment - multiple areas of root resorption
irrespective of manner of treatment
Resorption is variable
First bone resorption occurs

Presents of small lacunae on the surface of tooth extending to

dentine indicate early tooth resorption

Soon repaired by deposition of bone or cementum in the
ragged lacunae

Impacted tooth:
Resorption of crown or resorption of both crown and root may
C.T coming in contact with the tooth due to resorption of
epithelium initiates resorptive process
Cuspid > molars
Mesodense - prone for resorption
Horizontal/ mesoangular impaction resorption of the
adjacent tooth

Idiopathic resorption:
82% men & 91% women resorption
Max cuspids most common
Man incisors and molars least common
Normally less than 4 mm at the apex
May be due to systemic disorders endocrine disturbances
Genetic disturbances
May begin at CEJ or root apex
ER begins in the cervical area and extend from a small

opening to involve a large area of dentin

The cervical pattern of external resorption is rapid and is

HYPER CEMENTOSIS (cemental hyperplasia)

Characteristic feature :
Non neoplastic condition in which excessive cementum is
deposited in continuation with normal radicular cementum.
Local factors
Systemic factors
Idiopathic factors
Conditions which favor the deposition of excessive amount of
Accerlated elongation of tooth
Inflammation around the tooth
Tooth repair
Ostitis deformans or pagets disease of bone

Accerlated elongation of tooth:

Loss of antagonist
hyperplasia of cementum ( to
maintain the normal width of periodontal ligament)
Site : apex of the tooth

Inflammation at the apex of a tooth root:

Cause pulpal infection
Cementum is laid down on the root surface at some
distance above the apex as the cementoblasts are
induced by inflammatory reaction
Deposition of cementum doesnt occur immediately
adjacent to the area of inflammation since the
cementoblasts and their precursors in this area have
been lost as a result of the inflammatory process

Tooth repair:
Occlusal trauma results in mild root resorption which is
repaired by secondary cementum
Root fracture repaired by deposition of cementum
between the tooth fragments and the periphery.
Cemental tear, detachment of strip of cementum from
the root due to trauma are repaired by cementum growing
in to and filling the defect and uniting with the torn
Ostitis deformans/ pagets disease:
Generalized skeletal disease characterized by deposition of
excess amount of secondary cementum on the roots of the
teeth and by apparent disappearance of laminadura.
Generalized hyper cementosis is suggestive of osteitis

Spike formation:
Characterized by the occurrence of small spikes or out
growths of cementum on the root surface.
Cause :
Excessive occlusal trauma
May occur due to deposition of irregular cementum in focal
groups of periodontal ligament fibers
Exact mechanism not known
No significant clinical signs and symptoms
When these teeth are extracted roots appear larger in
diameter than normal and present round apices

Thickening and apparent blunting of roots by loss in their
typical sharpened or spiked appearance.
It is impossible to distinguish it from dentine so diagnosis is
made on shape or out line of root.

Cementicles are small foci of calcified tissue which are not

true cementum but lie free in the periodontal ligament of

the lateral & apical root areas.
These represent the areas of dystrophic calcifications
Cementicles are round globules of calcium salts which arise
from focal calcification of connective tissue between
sharpeys bundles with no apparent central nidus.
There is small spicules of cementum torn from the root
surface known as cemental tears, if lying free in the
periodontal ligament may resemble cementicles
Cementicles appear through calcification of thrombosed
capillaries in the pdl.
Clusters of cementicles at the apices of teeth may be called
No clinical significance.

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