Guided endodontic access of severe calcified tooth without incisal edge case report

Abstract

Pulp tissue may suffer calcification because of trauma, operative procedures or carious lesions. This paper aimedto report and discuss the guided endodontic access as an alternative treatment. A 52 years old female patient hadsevere root canal calcification of tooth #11 associated with a radiolucent periapical lesion. Firstly, the crown andmetal post and core were removed. A digital impression and cone-beam computed tomography “CBCT” scanswere performed and imported to implant planning software (SimPlant Version 11; Materialise Dental, Leuven,Belgium).The guided endodontic access template was designed to allow the drill to reach a distance of 2 mmshort of the apical foramen, once printed, it was tested in the mouth to evaluate its insertion and stability in thedental arch. The calcified root canal was penetrated using the access drill rotating by a low-speed hand-piece(10,000 rpm) under saline solution irrigation through advancing movements. Then, the apical foramen wasnegotiated with C-Pilot files #10 and #15. The working length was measured using the iPex-II apex locator.The instrumentation was carried out with Reciproc R50 and 2.5% sodium hypochlorite. One week later, a fullceramiccrown preparation was performed, and polyvinyl siloxane impression was carried out. A total of threefollow-up sessions were performed after one week, one and twelve months. Bone neoformation was observed inthe site of the periapical lesion and the patient had no signs or symptoms of any discomfort. Therefore, guidedendodontics is indicated for severe calcified root canals.KEYWORDSGuided endodontics; Calcified root canals; Access cavity.