Calcific metamorphosis of the pulp: Its incidence and treatment

Abstract

Periapical roentgenograms of 881 patients were examined and calcific metamorphosis of the pulp was diagnosed in forty-one teeth of thirty-four patients, an incidence of 3.86 per cent. These teeth were examined clinically and roentgenographically 4 years later for evidence of continuing calcification and periapical pathologic change. Only three teeth had developed periapical lesions, and in two of these cases the lesion was between the tooth exhibiting calcific metamorphosis and an adjacent pulpless tooth. An analysis of the data led to the following conclusions: 1. 1. There appears to be a significant correlation between calcific metamorphosis and a history of trauma, particularly if there is a history of tooth mobility as a result of the trauma. 2. 2. Teeth exhibiting calcific metamorphosis usually respond to the vitalometer, but generally more electric current is required. 3. 3. Not all such teeth become discolored; furthermore, there seems to be no correlation between the amount of discoloration and the degree of calcific metamorphosis. There also seems to be no correlation between the amount of discoloration and the response to the vitalometer. 4. 4. Calcific metamorphosis may be a pathologic deviation from the normal pulp, but during the first few years after trauma an accompanying periapical rarefaction on the roentgenogram is rare. 5. 5. The only definite criterion for endodontic or surgical intervention in calcific metamorphosis appears to be the appearance of periapical rarefaction on the roentgenogram.