Calcific Metamorphosis with Pathological Root Resorption in Permanent Teeth: Morphohistometric Evaluation of Two Cases

Abstract

Calcific Metamorphosis (CM) is a pulpal response to dental traumacharacterized by a deposition of hard tissue within the canal space. Atooth with CM usually presents a discoloration and a partial or totalobliteration of the pulp canal space, and its vital pulp tests andsymptoms are difficult. Since pulp necrosis cannot be supposed even thenegative responses, the periradicular status is the only reliablecriterion. Two permanent teeth diagnosed as CM and pathological rootresorption, extracted from two males (22 and 53 years of age) due tosevere mobility were prepared and sectioned for histological andhistometrical evaluation. Images were captured, processed and measuredin a total mapping of each specimen with software Pinnacle Studio 9.4(R) (Pinnacle Systems Inc.), Adobe (R) Photoshop (R) (CS 8.0.1, AdobeSystems Inc.) and Image J (R) (National Institute of Health, Bethesda,MD, USA). The images showed the simultaneous occurrence of CM and rootresorption. The means of the total measurements showed that the area ofradicular affection (R) was higher than the coronal affection (C), bothin quantity (R: 13.75 mm(2) -28.75%-/C: 4.7 mm(2) -5.47%-) and quality(R: absence of CM/C: presence of CM). CM showed a fibrotic pattern, acortical bone-like pattern and a cancellous bone-like pattern,representing a kind of reparative reaction probably initiated by theresorption process. Concurrent CM and pathological root resorption areuncommon in the same tooth, and the possibility to obtain specimens ofpermanent teeth to make histological and histometric evaluations of themrepresents a situation even more infrequent. This morphohistometricevaluation can expand the spectrum of useful variables to make clinicaland therapeutic odontological decisions.