Revascularization-associated Intracanal Calcification: Assessment of Prevalence and Contributing Factors

Minju Song; Yangpei Cao; Su-Jung Shin; Won-Jun Shon; Nadia Chugal; Reuben H Kim; Euiseong Kim; Mo K Kang

doi:10.1016/j.joen.2017.06.018

Revascularization-associated Intracanal Calcification: Assessment of Prevalence and Contributing Factors

J Endod. 2017 Dec;43(12):2025-2033. doi: 10.1016/j.joen.2017.06.018. Epub 2017 Sep 28.

Authors

Minju Song¹, Yangpei Cao², Su-Jung Shin³, Won-Jun Shon⁴, Nadia Chugal², Reuben H Kim², Euiseong Kim⁵, Mo K Kang⁶

Affiliations

¹ Section of Endodontics, Division of Constitutive and Regenerative Sciences, UCLA School of Dentistry, Los Angeles, California; Dankook University, School of Dentistry, Cheonan, South Korea.
² Section of Endodontics, Division of Constitutive and Regenerative Sciences, UCLA School of Dentistry, Los Angeles, California.
³ Yonsei University, School of Dentistry, Seoul, Korea.
⁴ Seoul National University, School of Dentistry, Seoul, Korea.
⁵ Yonsei University, School of Dentistry, Seoul, Korea. Electronic address: andyendo@yuhs.ac.
⁶ Section of Endodontics, Division of Constitutive and Regenerative Sciences, UCLA School of Dentistry, Los Angeles, California. Electronic address: mkang@dentistry.ucla.edu.

PMID: 28965774
DOI: 10.1016/j.joen.2017.06.018

Abstract

Introduction: Intracanal calcifications have been reported in endodontic cases after revascularization. The purpose of the current study was to determine the incidence of intracanal calcification and potential contributing factors in retrospective revascularization cases.

Methods: Among 37 patients who had undergone revascularization between 2010 and 2014, 29 cases were assessed with average follow-up period of 24.9 months. Clinical and radiographic examinations were performed to evaluate the treatment outcomes, eg, resolution of apical periodontitis (AP), root development, and occurrence of intracanal calcification. Radiographic assessment revealed varied calcification patterns, which were classified into calcific barrier or canal obliteration, collectively referred to as revascularization-associated intracanal calcification (RAIC).

Results: All 29 cases demonstrated resolution of AP, whereas continued root development with apical closure occurred in 23 of 29 cases (79.3%). RAIC was noted in 18 of 29 cases (62.1%), among which 5 of 18 cases (27.8%) were classified as calcific barrier and 13 of 18 cases as canal obliteration (72.2%). Higher frequency of RAIC was noted in the cases with induced bleeding (16 of 23 cases, 69.6%), whereas the 6 cases without induced bleeding showed RAIC at 33.4%. Also, RAIC occurred more frequently in cases medicated with Ca(OH)₂ (10 of 13 cases, 76.9%) than in those medicated with antibiotic pastes (6 of 13 cases, 46.2%).

Conclusions: This study indicated that RAIC is common (62.1%) among cases treated with revascularization. Multiple contributing factors may include the type of medicaments and induction of intracanal bleeding. Although RAIC does not interfere with resolution of AP, some cases may progress to complete obliteration of root canals and would impede normal function of dental pulp tissues.

Keywords: Bleeding induction; intracanal calcification; regenerative endodontics; revascularization; root development; type of medication.

MeSH terms

Adolescent
Child
Dental Pulp Calcification / epidemiology*
Dental Pulp Calcification / etiology*
Female
Humans
Incidence
Male
Prevalence
Retrospective Studies
Root Canal Therapy / adverse effects*