|Year : 2017 | Volume
| Issue : 1 | Page : 64-66
Multiple calcifying hyperplastic dental follicles
Sonal Grover, George Koshy, Deepti Sharma, Bhushan Sharma
Department of Oral and Maxillofacial Pathology, Christian Dental College, CMC, Ludhiana, Punjab, India
|Date of Web Publication||19-Dec-2016|
Department of Oral and Maxillofacial Pathology, Christian Dental College, CMC, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
Hyperplastic dental follicles are very commonly seen associated with an impacted tooth. Multiple calcifying hyperplastic dental follicles (MCHDF), a term used for multiple unerupted teeth with abundant calcifications and rests of odontogenic epithelium in enlarged dental follicles is a rare entity. Varied pattern of calcifications have been observed in such follicles. We report one such case with four patterns of calcifications and odontogenic epithelium associated with bilaterally impacted canines.
Keywords: Dental follicle with calcifications, hyperplastic dental follicle, impacted teeth, multiple calcifying hyperplastic dental follicle
|How to cite this article:|
Grover S, Koshy G, Sharma D, Sharma B. Multiple calcifying hyperplastic dental follicles. CHRISMED J Health Res 2017;4:64-6
|How to cite this URL:|
Grover S, Koshy G, Sharma D, Sharma B. Multiple calcifying hyperplastic dental follicles. CHRISMED J Health Res [serial online] 2017 [cited 2020 Jan 28];4:64-6. Available from: http://www.cjhr.org/text.asp?2017/4/1/64/196073
| Introduction|| |
Multiple calcifying hyperplastic dental follicles (MCHDFs) are rare but a well-known pathological entity. It was first described by Sandler et al. but the term MCHDF was given by Gardener and Radden for multiple unerupted teeth with abundant calcifications and rests of odontogenic epithelium in enlarged dental follicles.  Till date, eleven cases of MCHDF have been reported in the literature (excluding the two cases of contiguous enlarged dental follicles reported by Lukinmaa et al., which were later declared by Cho et al. as single calcifying hyperplastic dental follicle).  According to the histological appearances, the calcifications seen in all these cases have been classified into either of the two classifications proposed by Gardner and Radden and Cho et al., respectively. According to Gardner and Radden,  these have been classified as type A [calcification arranged in whorled structure, [Figure 1]a and b and type B [Figure 1]c and d. Cho et al.  classified these calcifications as type I [acellular and relatively homogenous calcifications, [Figure 2]a and b and type II [cellular calcifications, resembling woven bone, [Figure 2]c and d].
|Figure 1: Type A and type B calcifications. Type A calcifications - whorls of calcification (black arrows) seen in the background of loose fibrovascular connective tissue. An odontogenic rest (red arrow) is also seen (a, ×100). Magnified (inset) view of a single whorl (b, ×400). Type B calcifications - calcifications with peripheral tufts within fibrous connective tissue stroma (c, ×100). Magnified (inset) view (d, ×400)|
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|Figure 2: Type I and type II calcifications. Type I calcification - acellular and relatively homogenous calcification. Odontogenic rests (black arrows) can also be seen (a, ×100). Magnified (inset) view (b, ×400). Type II calcification - cellular calcification resembling woven bone. Whorl of calcification (black arrow) can also be seen (c, ×100). Magnified (inset) view of a woven bone-like calcification (d, ×400)|
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| Case report|| |
A 21-year-old boy reported to the Department of oral surgery for the extraction of his bilaterally impacted canines as a prophylactic measure recommended by an orthodontist. Intraoral examination revealed bilaterally missing canines. Oral hygiene status was compromised as the patient had been wearing orthodontic braces for 3 months. Mandibular right first molar had class I caries. There was no other clinical abnormality detected. As a routine measure before the extraction of any impacted tooth, an orthopantograph was taken which revealed bilaterally impacted canines associated with pericoronal radiolucencies [Figure 3]a and b. Provisional diagnosis of dentigerous cyst was made. Transalveolar extraction of the impacted teeth was carried out under local anesthesia, and the extracted teeth along with the soft tissue attached were sent for histopathological examination. The histopathological examination revealed loose to dense fibrovascular connective tissue with numerous odontogenic rests [Figure 3]c and calcifications [Figure 1] and [Figure 2]. A few odontogenic islands exhibited juxta-epithelial hyalinization, suggestive of epithelial-mesenchymal interaction [Figure 3]d. After correlating the histopathological features with radiographic findings, we arrived at the final diagnosis of MCHDFs. The patient was scheduled for regular follow-up. There was no sign of recurrence reported for 2 years.
|Figure 3: (a and b) Radiographs - impacted bilateral mandibular canines with pericoronal radiolucency <2.5 mm (the right side canine - black arrow, left side canine - red arrow) seen in computed tomography scan (cropped, a, ×100) and periapical radiograph (b, ×100). (c and d): Histopathology - numerous odontogenic rests seen in the background of loose fibrovascular connective tissue (c, ×100). Odontogenic islands with clear cell changes, calcification, and juxta-epithelial hyalinization (d, ×400)|
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| Discussion|| |
Calcification usually progresses in long-standing dental follicles since the mesenchymal cells of dental follicles have the potential to differentiate into cementoblasts or osteoblasts. According to Gardner, type I calcification is an aberrant form of afibrillar cementum originating from mesenchymal cells. , While many researchers hold a different opinion and believe it to be a form of dystrophic calcification derived from degenerative epithelial rests.  The exact pathogenesis is still unclear and warrants further studies in this respect.
The varied appearances of these calcifications observed in our case, persuaded us to review the literature in this context. Although many cases of MCHDF revealing some kind of calcifications have been reported,  but our case stands apart, as the diversity of calcifications (all the four types) observed in one case is unique in itself. All the cases reported so far revealed either two of the four types of calcification. Thus, the purpose of this letter is to highlight the diversities in the patterns of calcifications observed in MCHDF associated with bilateral impacted mandibular canines.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Gomez RS, Silva EC, Silva-Filho EC, Castro WH. Multiple calcifying hyperplastic dental follicles. J Oral Pathol Med 1998;27:333-4.
Cho YA, Yoon HJ, Hong SP, Lee JI, Hong SD. Multiple calcifying hyperplastic dental follicles: Comparison with hyperplastic dental follicles. J Oral Pathol Med 2011;40:243-9.
Gardner DG, Radden B. Multiple calcifying hyperplastic dental follicles. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:603-6.
Aydin U, Baykul T, Yildirim B, Yildirim D, Bozdemir E, Karaduman A. Multiple calcifying hyperplastic dental follicles: A case report. Imaging Sci Dent 2013;43:303-8.
Kotrashetti VS, Kale AD, Bhalaerao SS, Hallikeremath SR. Histopathologic changes in soft tissue associated with radiographically normal impacted third molars. Indian J Dent Res 2010;21:385-90.
[Figure 1], [Figure 2], [Figure 3]