Introduction : Calculus Bridge
The mass formation can be because of partially erupted 38 and also due to the absence of opposing teeth (27, 28) and also the adjoining tooth (37). Further, there are missing teeth 37 and 27 which was not prosthetically replaced may have led the patient not to utilize the left side ultimately leading to the formation of such a large mass of calculus without any hindrances. Presence of large chunk of calculus made the patient, further difficulty in cleansing the area and thereby leading to formation of calculus to the present size. Moreover, tooth eruption is hampered by various reasons such as cyst, thickened bone, thickened gingiva, and supernumerary teeth, but calculus has not been mentioned in the literature.[8] The presence of large hard mass of calculus could have been a confounding factor along with mesial drift of 28, due to missing 27 and also leading to incomplete eruption, which has not been reported so far in literature.
Schroeder in his classic in vitro studies showed biochemical evidence of the presence of calcium and phosphates in the calculus specimen he examined. Saliva has been the source of the inorganic content and also upon biochemical analysis of saliva revealed more concentration of inorganic content such as calcium, phosphates, and oxylates which are more suggestive of calculus (Moskow). Saliva is the source for mineralization of supragingival calculus. It has been shown that the level of calcium in calculus is 20% more than in the saliva In this case report, when the hard mass which is present supragingivally, when analyzed biochemically it was found out that there was the presence of higher concentrations of calcium and phosphates which correlates well with the studies of Schroeder[9] and Hidaka et al.[10]
With the availability of state-of-the-art dental care and more effective oral hygiene practices along with personal pride, the report of calculus deposition in such grandeur is rarely seen nowadays. This case report is one of the rarest and unusual presentations especially in the retromolar area along with an embedded molar tooth which led to the deposition of calculus, which is normally seen in natural teeth positions. Moreover, the size of the calculus is the largest to best of our knowledge as reported in the literature so far.
CONCLUSION
This case report gives us a glimpse about the deposition of calculus not only in regular tooth positions but also in such unusual areas too. Elimination of predisposing factors such as embedded deciduous teeth or broken fragments and regular oral prophylaxis and maintenance shall prevent such formation of calculus in the oral cavity. Regular follow-up and maintenance should be the utmost aim of any periodontal treatment for treating such patients with poor oral hygiene.