Calcific metamorphosis: A challenge in endodontic diagnosis and treatment

Calcific metamorphosis (CM) is seen commonly in the dental pulp after traum atic tooth injuries and is recognized clinically as early as 3 months after injury. Calcific metamorphosis is characterized by deposition of hard tiss ue within the root canal space and yellow discoloration of the clinical cro wn. Opinion differs among practitioners as to whether to treat these cases upon early detection of CM or to observe them until symptoms or radiographi c signs of pulpal necrosis are detected. In this review, the clinical. radi ographic, and histopathologic appearance of CM is described; a review of th e literature is presented to address these issues in an attempt to establis h a sound rationale for treatment. Approximately 3.8% to 24% of traumatized teeth develop varying degrees of CM. Studies indicate that of these, appro ximately 1% to 16% will develop pulpal necrosis. Most of the literature doe s not support endodontic intervention unless periradicular pathosis is dete cted or the involved tooth becomes symptomatic. It may be advisable to mana ge cases demonstrating CM through observation and periodic examination.