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)