Enamel pearl with severe consequences for the tooth and periodontium

Abstract

Enamel pearls are developmental anomalies caused by enamel formation in atypical locations during tooth development. While the exact etiology of these developmental anomalies remains unclear, they occur in approximately 2-6 % of the population. In this case report, a 15-year-old female presented with pain in the region of the right maxillary first molar. Radiographic imaging showed a periapical radiolucency and an opaque mass in the furcation area. Cone-beam computed tomography (CBCT) identified a round radiodensity consistent with an enamel-dentin pearl, which probably promoted the development of periodontal destruction due to a lack of periodontal attachment from the cemento-enamel junction to the furcation area. Due to its unfavorable location, tooth extraction was unavoidable. Histologic examination confirmed a large enamel pearl connected to the crown enamel via an enamel spur. Alternating layers of enamel, cementum-like tissue, and cementicles were observed. Enamel-dentin pearls, although rare, can lead to severe periodontal destruction. Advanced imaging, such as CBCT, is vital for accurate diagnosis and treatment planning. In this case, despite precise localization, conservative treatment was unfortunately not possible.