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 procedures
for 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.