[1] Several theories of enamel pearl development exist, although no definitive mechanism has been established.

However, when HERS remains adherent to the root surface, these fragments have the potential to develop into functional ameloblasts, which then deposit enamel onto the root surface, thereby forming enamel pearls.

[1] This theory is considered inconclusive as it does not account for the dentin component seen in some enamel pearls.

[1] Intradental enamel pearls may form during tooth formation, when ameloblasts are invaginated inside the developing dentin.

[1] The highest prevalence of enamel pearls is found in the maxillary third molar, with an incidence of approximately 75%.