3 Research Laboratory LR12ES11
Abstract 
Pulpal calcifications or also called pulpal calcium degeneration are small masses of calcified tissue that obliterates part or almost all of the endodontic network, the presence of these masses can further complicate endodontic treatment and requires an adaptation of the therapeutic approach. The objective of this article is to illustrate the difficulties and the keys to success of endodontic treatment in the presence of pulpal calcifications. Three patients with three levels of difficulty; a free coronary pulp stone, an adherent coronary pulp stone and diffuse root canal calcification required well-adapted treatment in order to eradicate these calcified masses. The discovery of pulpal calcifications during daily practice is particularly frequent. These calcifications can present different clinical forms and pose problems of diagnosis and management. The indication for endodontic treatment cannot be based solely on the presence of pulp stone but on a diagnosis confirmed by a clinical and radiological examination showing the pulp status of the tooth.
Keywords
Pulp-Stone, obliteration, dental microscope, catheterization
Introduction
Pulpal calcifications or also called pulpal calcium degenerations are small masses of calcified tissue that obliterates part or almost all of the endodontic network [1]. the exact cause of their formation remains unknown. Therefore, it is currently unclear whether their presence reflects a pathological manifestation or a normal physiological development of the dental pulp [2]. Thus, many factors predisposing to the development of pulpal calcification have been suggested, such as aging, caries, periodontal disease and orthodontic movements. On the other hand, some studies have tried to establish a relationship with other general diseases such as cardiovascular and renal diseases [3]. These masses of calcified tissue can be found at the level of the pulp chamber and/or at the level of the root canals, but the accessibility to the canal orifices which is an essential element for the success of any endodontic treatment can become more complicated by the presence of these pulpolites [4].
The objective of this article is to illustrate, through three clinical cases, the difficulties and the keys to the success of endodontic treatment in the presence of pulpal calcifications.
Materials and Methods
Clinical case N°1
A 22-year-old patient in good general condition consulted following spontaneous pain related to the first left mandibular molar (36). The clinical examination reveals a Sista 1.3 carious lesion. The radiological examination shows the presence of calcification which obliterates almost all of the pulp chamber with a cleavage plane (clear X-ray line) between the calcified tissue and the healthy dental tissue (Fig.1).