Association between diabetes and pulp stone prevalence and morphological characteristics: a CBCT-based retrospective study

Pulp stones are a common manifestation of pulp calcification, and their formation may correlate with systemic metabolic disorders. This study was designed to investigate the prevalence of pulp stones in diabetic patients in Southwest China and quantitatively evaluate the potential correlation between their morphological characteristics and diabetes. Cone-beam computed tomography (CBCT) scans of 240 patients aged 40 to 69 years, including 120 diabetic patients and 120 healthy controls, were evaluated for a total of 5920 teeth. Mimics software was utilized to construct three-dimensional models for the quantitative measurement of pulp stone volume (mm³) and surface area (mm²). Pearson chi-square test, nonparametric tests, logistic regression, and generalized linear model (GLM) were used for statistical analysis. Diabetic patients exhibited a significantly higher prevalence of pulp stones than non-diabetic individuals (81.67% vs. 52.50%, p < 0.001). Even across different genders, age groups, maxillary and mandibular regions, as well as their respective subregions, the diabetic group consistently demonstrated a higher prevalence rate. Diabetic patients also exhibited larger pulp stone volume (1.85 mm³, IQR = 0.83–4.17 vs. 1.46 mm³, IQR = 0.63–2.62) and surface area (10.05 mm², IQR 5.41–17.53 vs. 7.87 mm², IQR 4.86–12.99) compared to controls (p < 0.05 for both). Diabetes was recognized as an independent risk factor for pulp stones by logistic regression (adjusted odds ratio [aOR] = 2.92, 95% confidence interval [CI] = 2.34–3.63). GLM confirmed diabetes increased pulp stone volume (Exp(B) = 1.38, 95% CI = 1.16–1.63, p < 0.001). Diabetic patients have a significantly higher prevalence of pulp stones, with larger volume and surface area. By enabling precise three-dimensional modeling and measurement of pulp stones, this approach assists dentists in optimizing access cavity preparation and locating canal orifices, thereby providing a concrete basis for formulating informed clinical strategies.