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

A "borderline" dental trauma with 12 y of evolution justifying CBCT as diagnostic method

“…The PCO is a well-recognized sequela of luxation injuries [16,17], more frequent in extrusions, lateral luxations and intrusions than in concussions or subluxations [20]. This condition is recognized as an outcome after revascularization of an injured pulp when immature teeth survived trauma, demonstrating the high healing capacity of a young pulp [6,15,20].…”

“…The apposition of this new hard tissue is resumed a certain period after of the event, however with an abnormal structure containing cell inclusions and vascular inclusions that resemble bone and cementum ("cellular dentin") [12]. Other authors have used the term "dystrophic calcification", "metaplasia" and "osteodentine" [16]. Either repairing tooth luxation injuries or fusing dislocated root fragments, this deposition of hard tissue represents a particular response of the cells resulting in an abnormal and reparative in nature tissue with specific characteristics and dynamics [15][16][17]20].…”

“…Other authors have used the term "dystrophic calcification", "metaplasia" and "osteodentine" [16]. Either repairing tooth luxation injuries or fusing dislocated root fragments, this deposition of hard tissue represents a particular response of the cells resulting in an abnormal and reparative in nature tissue with specific characteristics and dynamics [15][16][17]20]. This condition seems to be a time-dependent chronic response, with additional traumas acting as "triggers" for reparation and resorption [14][15][16][17].…”

“…When CBCT is compared with bisecting and parallel intraoral radiography, CBCT has the highest diagnostic accuracy for root fractures at any angle [18,19]. However, since the sequelae can arise several years after the injury (with the obvious difficulties in collecting information about the event or its immediate treatment), or complicating the clinical picture with unclear response to vitality tests, discolorations and/or pulp obliterations, the diagnosis can be challenging for even experienced practitioners [16].…”

“…PCO of apical fragment alone is seen most often in cases of healing with hard tissue, while PCO of the apical and coronal fragments is frequently found in cases of healing by CT, as well as in teeth with interposition of CT+B [6]. Although PCO is reportedly found in intra-alveolar root-fractured permanent incisors as a post-healing complication, it still represents an important diagnosis and clinical challenge for the odontologist, and therefore must be investigated more extensively [7,[14][15][16][17].…”