Root-like enamel pearl: a case report

Journal of Medical Case Reports, Jul 2014

Introduction In general, enamel pearls are found in maxillary molars as a small globule of enamel. However, this case report describes an enamel pearl with a prolate spheroid shape which is 1.8mm wide and 8mm long. The different type of enamel pearl found in my clinic has significantly improved our understanding of enamel pearl etiology and pathophysiology. Case presentation A 42-year-old Han Chinese woman with severe toothache received treatment in my Department of Endodontics. She had no significant past medical history. A dental examination revealed extensive distal decay in her left mandibular first molar, tenderness to percussion and palpation of the periradicular zone, and found a deep periodontal pocket on the buccal lateral. Vitality testing was negative. Periapical radiographic images revealed radiolucency around the mesial apex. Cone beam computed tomography detected an opaque enamel pearl in the furcation area with a prolate spheroid shape of 1.8mm wide and 8mm long. Conclusion The enamel pearl described in this case report is like a very long dental root. Cone beam computed tomography may be used for evaluating enamel pearls.

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Root-like enamel pearl: a case report

Journal of Medical Case Reports Root-like enamel pearl: a case report Xiao-quan Mao 0 0 Department of Endodontics, Stomatological Center, Affiliate Haikou Hospital, Xiangya Medical School, Central South University , Haikou 570208, Hainan , P.R. China Introduction: In general, enamel pearls are found in maxillary molars as a small globule of enamel. However, this case report describes an enamel pearl with a prolate spheroid shape which is 1.8mm wide and 8mm long. The different type of enamel pearl found in my clinic has significantly improved our understanding of enamel pearl etiology and pathophysiology. Case presentation: A 42-year-old Han Chinese woman with severe toothache received treatment in my Department of Endodontics. She had no significant past medical history. A dental examination revealed extensive distal decay in her left mandibular first molar, tenderness to percussion and palpation of the periradicular zone, and found a deep periodontal pocket on the buccal lateral. Vitality testing was negative. Periapical radiographic images revealed radiolucency around the mesial apex. Cone beam computed tomography detected an opaque enamel pearl in the furcation area with a prolate spheroid shape of 1.8mm wide and 8mm long. Conclusion: The enamel pearl described in this case report is like a very long dental root. Cone beam computed tomography may be used for evaluating enamel pearls. Cone beam computed tomography; Enamel pearl; Periapical radiographic images Introduction Enamel pearls are ectopic deposits of enamel which are located at the furcation area and near the cemento–enamel junction. In general, they are most commonly observed in molars, in particular maxillary molars. They appear as small globules of enamel firmly adherent to the tooth’s root surface and as well-defined radio-opaque nodules. Internal enamel pearls present as well-defined circular areas of radiodensity extending from the enamel–dentin junction to the underlying coronal dentin. Case presentation A 42-year-old Han Chinese woman with severe toothache received treatment in my Department of Endodontics. A dental examination revealed extensive distal decay in her left mandibular first molar, tenderness to percussion and palpation of the periradicular zone, and found a deep periodontal pocket on the buccal lateral. Vitality testing was negative. Periapical radiographic images revealed radiolucency around the mesial apex. Cone beam computed tomography (CBCT) detected an opaque enamel pearl in the furcation area with a prolate spheroid shape of 1.8mm wide and 8mm long (Figures 1, 2, and 3). The tooth was diagnosed with symptomatic apical periodontitis with necrotic pulp. After Scandonest® (mepivacaine hydrochloride; Septodont, Inc.) was administered, her tooth was isolated using a rubber dam. As usual, in the initial access cavity, three orifices were found. In addition, a root-like image was found on periapical imaging (Figure 4). Therefore the access cavity was further prepared into a square shape; however, no orifice was found after meticulous exploration of the pulp chamber floor with a hand K-file. Three canals were instrumented with stainless-steel hand K-files accompanied by X-Smart™ Motor (Dentsply, USA) rotary instrumentation using a crown-down technique. Her root canals were irrigated with sodium hypochlorite 5.25% and dried completely. Camphor phenol was placed as an intracanal dressing. Then, the access cavity was sealed temporarily with zinc oxide. One week later, she was completely asymptomatic. Her root canals were obturated with gutta-percha (Dentsply, USA) after the working length was radiographically confirmed with gutta-percha. Subsequently, she was referred to the restorative department for final restoration. Three months later, she had no symptoms. Discussion Enamel pearls are anomalies of enamel on primary and permanent teeth roots that usually appear at furcation areas, especially in maxillary second and third molars [ 1 ]. They usually occur as solitary lesions, but two to four enamel pearls have been observed on the same tooth [ 2 ]. The prevalence of enamel pearls has been reported to vary between 1.1 and 9.7% [ 3 ]. Enamel pearls are not common in teeth with a single root, although there are rare reports of them occurring on the roots of premolars, canines and incisors [ 4-6 ]. It is generally accepted that enamel pearls are usually found adherent to the external root surface of the tooth, but on rare occasions they may be detected within the dentin [ 7 ]. They vary in size, ranging from 0.3mm to 4mm in diameter [ 8 ]. But in this case report, the enamel pearl in our patient was unusually large, 1.8mm wide and 8mm long. Three types of enamel pearls have been described [ 9,10 ]: (1) true enamel pearls, consisting entirely of enamel; (2) composite enamel pearls, or enamel-dentin pearls, containing a core of tubular dentin; and (3) enamel-dentinpulp pearls, containing a pulp horn, probab (...truncated)


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Xiao-quan Mao. Root-like enamel pearl: a case report, Journal of Medical Case Reports, 2014, pp. 248, 8, DOI: 10.1186/1752-1947-8-248