Pérola de esmalte: epidemiologia, morfopatogênese e relevância na clínica odontológica
Enamel pearl: epidemiology, morphopathogenesis and relevance in dental clinic
Castro-Silva, Igor Luco; Azevedo, Fabio Lopes de; Otero, Daniel
Resumo
Introdução: Distúrbios da odontogênese geram anomalias dentárias com relevância diagnóstica e terapêutica. Objetivo: O presente artigo teve como objetivos fazer uma revisão sistemática sobre a pérola de esmalte e discutir seu processo formativo, bem como a sua significância na clínica odontológica. Material e método: Três bancos de dados eletrônicos (Pubmed, Cochrane e Biblioteca Virtual em Saúde) foram usados para recuperar artigos científicos dos últimos 30 anos, usando o descritor enamel pearls. Resultado: O Brasil ocupa posição de destaque nas publicações temáticas existentes (18%). A etiopatogênese desta anomalia ainda permanece obscura, sendo necessários mais estudos acerca da contribuição de fatores envolvidos com amelogênese ectópica e cementogênese deficiente in situ. Dados epidemiológicos apontam uma frequência variável na população brasileira (0,8 a 8%) e mundial (0,2 a 6,2%), sendo os molares os dentes mais acometidos. Análise morfológica das pérolas de esmalte mostra que esta anomalia de forma e volume pode ser de dois tipos: simples (pérola verdadeira externa ou interna) ou composta (esmalte‑dentina ou esmalte-dentina-polpa). É importante o diagnóstico clínico-radiológico diferencial de pérolas de esmalte para permitir o tratamento odontológico adequado, que inclui a ameloplastia como conduta eficaz para minimizar o acúmulo de biofilme oral e a exarcerbação da doença periodontal. Conclusão: Faz-se necessária a publicação de pesquisas pormenorizadas sobre pérolas de esmalte, a fim de gerar evidências científicas no fazer profissional da Odontologia.
Palavras-chave
Abstract
Introduction: Disturbances in odontogenesis generate dental anomalies with diagnostic and therapeutic relevance. Objective: The aim of this article was to do the systemic review about pearl enamel, and discuss their formation process and its significance in clinical dentistry. Material and method: Three electronic databases (Pubmed, Cochrane and Biblioteca Virtual em Saúde) were used to retrieve scientific articles in the last 30 years, using the descriptor enamel pearls. Result: Brazil occupies a prominent position in existing thematic publications (18%). Etiopathogenesis of this dental anomaly remains obscure, and more researches are needed regarding factors involved in ectopic amelogenesis and deficient cementogenesis in situ. Epidemiological data show variable frequency in the Brazilian population (0.8-8%) and in the global population (0,2-6,2%), with a higher incidence in the molars. Morphological analysis of enamel pearls shows that this shape and volume anomaly can be of two types: simple (external or internal true pearl) or compound (enamel-dentine or enamel-dentine-pulp). It is important the clinical and imaginological differential diagnosis of enamel pearls to allow adequate dental treatment that include enameloplasty as an effective conduct to minimize oral biofilm accumulation and worsening of periodontal disease. Conclusion: It is necessary to publish detailed researches about enamel pearls in order to generate scientific evidence in dental practice.
Keywords
References
1. Espinal Botero G, Manco Guzmán HA, Aguilar Méndez G, Castrillón Pino L, Rendón Giraldo JE, Marín Botero ML. Retrospective study of dental anomalies and bone alterations of the jawbones in children 5 to 14 years old of the clinics of the Dental School, University of Antioquia. Rev Fac Odontol Univ Antioq. 2009;21:50-64.
2. Goldstein AR. Enamel pearls as contributing factor in periodontal breakdown. J Am Dent Assoc. 1979;99:210-1. PMid:287738.
3. Gridly MM, Daas HK. Enameloma, morphometric study. Egypt Dent J. 1984;30:119-24. PMid:6598619.
4. Tabari ZA, Kadkhodazadeh M, Khademi M. Enamel pearl as predisposing factor to localized severe attachment loss: a case report. Res J Med Sci. 2011;5:141-4.
5. Castro JFL, Oliveira SB, Sales RD. Prevalência das anomalias dentárias em pacientes submetidos a tratamento ortodôntico. Rev Dental Press Ortodon Ortop Facial. 2004;9:79-84. http://dx.doi.org/10.1590/S1415-54192004000500010
6. Versiani MA, Pécora JD,de Sousa-Neto MD. Root and root canal morphology of four-rooted maxillary second molars: a micro-computed tomography study. J Endod. 2012;38:977-82. PMid:22703664. http://dx.doi.org/10.1016/j.joen.2012.03.026
7. Vaughan MD, Rowland CC, Tong X, Srivastava DK, Hale GA, Rochester R, et al. Dental abnormalities in children preparing for pediatric bone marrow transplantation. Bone Marrow Transplant. 2005;36:863-6. PMid:16184186. http://dx.doi.org/10.1038/sj.bmt.1705111
8. Akgül N, Caglayan F, Durna N, Sümbüllü MA, Akgül HM, Durna D. Evaluation of enamel pearls by cone-beam computed tomography (CBCT). Med Oral Patol Oral Cir Bucal. 2012;17:e218-22. PMid:22143707 PMCid:3448323. http://dx.doi.org/10.4317/medoral.17475
9. Darwazeh A, Hamasha AA. Radiographic evidence of enamel pearls in jordanian dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:255-8. PMid:10673666. http://dx.doi.org/10.1067/moe.2000.103524
10. Romeo U, Palaia G, Botti R, Nardi A, Del Vecchio A, Tenore G, et al. Enamel pearls as a predisposing factor to localized periodontitis. Quintessence Int. 2011;42:69-71. PMid:21206935.
11. Sutalo J, Ciglar I, Bacic M. The incidence of enamel projections on the roots of the permanent teeth. Schweiz Monatsschr Zahnmed. 1989;99:174-80. PMid:2717905.
12. Chrcanovic BR, Abreu MHNG, Custódio ALN. Prevalence of enamel pearls in teeth from a human teeth bank. J Oral Sci. 2010;52:257-60. PMid:20587950. http://dx.doi.org/10.2334/josnusd.52.257
13. Lekkas D, Townsend G. Cervical enamel projections and enamel pearls in a collection of Australian extracted molars. Dental Anthropol Newslett. 1996;11:2-6.
14. Gaspersic D. Histogenetic aspects of the composition and structure of human ectopic enamel, studied by scanning electron microscopy. Arch Oral Biol. 1992;37:603-11. http://dx.doi.org/10.1016/0003-9969(92)90122-O
15. Kaugars GE. Internal enamel pearls: report of case. J Am Dent Assoc. 1983;107:941-3. PMid:6581220.
16. Mahajan S, Charan CR. An association of external and internal enamel pearls. Indian J Dent Res. 2005;16:17-8. PMid:16375232.
17. Saini T, Ogunleye A, Levering N, Norton NS, Edwards P. Multiple enamel pearls in two siblings detected by volumetric computed tomography. Dentomaxillofac Radiol. 2008;37:240-4. PMid:18460580. http://dx.doi.org/10.1259/dmfr/86859829
18. Kupietzky A, Rozenfarb N. Enamel pearls in the primary dentition: report of two cases. J Dent Child. 1993;60:63-6. PMid:8432951.
19. Risnes S. Ectopic tooth enamel. An SEM study of the structure of enamel in enamel pearls. Adv Dent Res. 1989;3:258-64. PMid:2640436.
20. Gaspersic D. Enamel microhardness and histological features of composite enamel pearls of different size. J Oral Pathol Med. 1995;24:153-8. PMid:7783004. http://dx.doi.org/10.1111/j.1600-0714.1995.tb01157.x
21. Anderson P, Elliott JC, Bose U, Jones SJ. A comparison of the mineral content of enamel and dentin in human premolars and enamel pearls measured by x-ray microtomography. Arch Oral Biol. 1996;41:281-90. http://dx.doi.org/10.1016/0003-9969(95)00122-0
22. Risnes S, Segura JJ, Casado A, Jiménez-Rubio A. Enamel pearls and cervical enamel projections on 2 maxillary molars with localized periodontal disease: case report and histologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:493-7. http://dx.doi.org/10.1016/S1079-2104(00)70131-4
23. Arys A, Dourov N. Enamel pearls in the deciduous teeth. J Biol Buccale. 1987;15:249-55. PMid:3483374.
24. Bohne W, Pouëzat JA, Kerebel B. Structural, ultrastructural and microanalytical study of multiple enamel pearls. Bull Group Int Rech Sci Stomatol Odontol. 1989;32:53-61. PMid:2924017.
25. Fonzi L, Belli M, Gasparoni A, Capezzuoli L, Carboncini S. Enamel pearls: the ultrastructural aspects and morphogenesis hypotheses. Bull Group Int Rech Sci Stomatol Odontol. 1992;35:85-92. PMid:1297474.
26. Bosshardt DD, Nanci A. Immunocytochemical characterization of ectopic enamel deposits and cementicles in human teeth. Eur J Oral Sci. 2003;111:51-9. http://dx.doi.org/10.1034/j.1600-0722.2003.00015.x
27. Kerebel B, Dard M, Le Cabellec MT, Kerebel LM. Dental enamel pearls: histopathological study. J Biol Buccale. 1986;14:239-48. PMid:3468105.
28. Martos J, Leonetti ACM, Netto MSG, César Neto JB, Nova Cruz LER. Anatomical evaluation of some morphological abnormalities related to periodontal diseases. Braz J Morphol Sci. 2009;26:77-80.
29. Kaminagakura E, Salmon CS, Fonseca DC, Lopes MCA, Tango RN. Prevalence and microscopic features of enamel pearls from permanent human molars. Braz J Oral Sci. 2011;10:268-71.
30. Vaughan MD, Rowland CC, Tong X, Srivastava DK, Hale GA, Rochester R et al. Dental abnormalities after pediatric bone marrow transplantation. Bone Marrow Transplant. 2005;36:725-9. PMid:16113667. http://dx.doi.org/10.1038/sj.bmt.1705136
31. Moskow BS, Canut PM. Studies on root enamel (2). Enamel pearls. A review of their morphology, localization, nomenclature, occurrence, classification, histogenesis and incidence. J Clin Periodontol. 1990;17:275-81. PMid:2191975. http://dx.doi.org/10.1111/j.1600-051X.1990.tb01089.x
32. Kocsis GS, Marcsik A. Forms and aetiology of the enamel formations in the cervical zone of teeth. Paleobios. 1983;1:53-8.
33. Diekwisch TG, Ware J, Fincham AG, Zeichner-David M. Immunohistochemical similarities and differences between amelogenin and tuftelin gene products during tooth development. J Histochem Cytochem. 1997;45:859-66. PMid:9199671. http://dx.doi.org/10.1177/002215549704500610
34. Schneck GW. A case of enamel pearls in a dog. Vet Rec. 1973;92:115-7. PMid:4693390. http://dx.doi.org/10.1136/vr.92.5.115
35. Hooijer DA, Eulderink F. Numberous radicular enamel pearls in a premolar of a wild sheep. Oral Surg Oral Med Oral Pathol. 1975;39:637-40. http://dx.doi.org/10.1016/0030-4220(75)90207-8
36. Machtei EE, Wasenstein SM, Peretz B, Laufer D. The relationship between cervical enamel projection and class II furcation defects in humans. Quintessence Int. 1997;28:315-20. PMid:9452694.
37. Koritzer, R. Enameloma in a prehistoric Indian skull. Am J Phys Anthropol. 1970;33:439-41. PMid:4923208. http://dx.doi.org/10.1002/ajpa.1330330319
38. Huang Z, Newcomb CJ, Bringas P Jr, Stupp SI, Snead ML. Biological synthesis of tooth enamel instructed by an artificial matrix. Biomaterials. 2010;31:9202-11. PMid:20869764 PMCid:2956865. http://dx.doi.org/10.1016/j.biomaterials.2010.08.013
39. Li W, Machule D, Gao C, DenBesten PK. Growth of ameloblast-lineage cells in a three-dimensional Matrigel environment. Eur J Oral Sci. 2006;114:159-65. PMid:16674679. http://dx.doi.org/10.1111/j.1600-0722.2006.00308.x
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email