The aesthetic and endodontic dilemmas of calcific metamorphosis

Traumatic injuries to dentition can initiate either a resorptive or calcific pulpal response. In the sequelae of calcific degeneration, the clinical crown frequently becomes discolored, requiring an aesthetic correction to restore the tooth to its natural color. Four potential solutions are currently available to achieve this goal. The learning objective of this article is to describe the etiology of calcific metamorphosis, discuss the four potential solutions, and present the responses of endodontists polled as to the treatment indications. While the posterior dentition may experience the identical pathologic response to trauma and crown discoloration, this article focuses on the restoration of the anterior dentition. Several cases are presented to illustrate the four treatment modalities, and recommendations for follow-up of traumatic injuries are indicated.