Calcified Canals Research Articles

Management of Calcified Root Canal: A Case Report

Background: Calcification of root (calcific metamorphosis) is usually seen as defensive reaction of pulp totrauma. Intensity of trauma/hit, time span since trauma, pulp response to trauma are multiple factor decidingdegree of calcification. Calcification may be seen partially or entirely in root canal. Usually calcifiedtooth remain asymptomatic, but when tooth becomes symptomatic endodontic treatment need to be done.Treatment of calcified canal is challenge to dentist.Case report: A female patient reported to the department of conservative dentistry and endodontics at sharadpawar dental college with chief complain of pain in upper front region of jaw. On radiographic examinationcalcified root canal was associated with upper anterior teeth. Root canal treatment was planned for calcifiedtooth. Access opening was carried out using BR45. To achieve patency within canal file#8, 10 were used, butinitally patency could not be achieved due to calcified canal. With help of chelating agents 17% EDTA liquidand gel and small size K file #8,10 canal negotiation was carried out to achieve patency. Working lengh wasthen determined and canal was instrumented. Naocl, EDTA was used as intermittent irrigant. Final rinse wasdone using 2%CHX. Canal was obturated using cold lateral condensation technique followed by permanentrestoration. Entire procedure was carried out under magnification.Conclusion: Calcified canal treatment is bit tedious then routine endodontic procedure. But it can bemanaged if procedure is carried out under proper illumination, magnification, CBCT, understanding rootcanal anatomy, use of dye, modified access bur, files, chelating agent, irrigants and irrigation activationsystem.

Clinical decision‐making and importance of the AAE/AAOMR position statement for CBCT examination in endodontic cases

To compare conventional radiographic and cone beam computed tomography (CBCT) findings with reference to the American Association of Endodontics and American Academy of Oral and Maxillofacial Radiology (AAE/AAOMR) joint position statement and to determine the effect of the CBCT on the initial diagnoses and treatment plans in a single-centre Postgraduate Endodontic Programme. The clinical CBCT scans of patients, treated at the Endodontic Department of the University of British Columbia, were reviewed for CBCT referrals by comparing them with corresponding radiographs. The features considered were periapical lesions, missed/extra canals, root fractures, complex anatomy, calcified canals and root resorption of tooth/teeth in question. Reasons for the CBCT prescriptions were assigned to 3 groups: to formulate the primary diagnosis, to confirm the diagnosis achieved by clinical examination and conventional radiographs, and to assist in treatment planning. Variables were compared statistically using chi-square and McNemar tests. A total of 128 CBCT examinations were performed on 110 patients. No CBCT examination was performed more than once on the same tooth. Overall, 76% of CBCT examinations were performed on previously root filled teeth. CBCT images revealed a significantly higher incidence of periapical lesions (P=0.002), missed canals (P<0.001), vertical root fractures (P=0.004) and complex anatomy (P=0.008) than periapical radiographs. CBCT was prescribed most frequently to assist surgical treatment planning (62%) rather than for generating a diagnosis (9%) or confirming diagnoses (29%). Both the diagnosis (P=0.001) and the treatment plan (P=0.005) initially made by examining periapical radiographs were altered significantly by the subsequent CBCT examination by revealing information such as new periapical lesions, missed canals or involvement of buccal or lingual cortical bone. CBCT examinations were prescribed mainly to assist treatment planning rather than for diagnosis. The majority of CBCT examinations were performed on previously root filled teeth. The additional information obtained from CBCT scans resulted in the alteration of the initial diagnoses as well as subsequent treatment plans in 59 out of 128 cases.

Guided endodontic access of calcified root canal by laser melting templates

The aim of this study is to treat calcified root canal and assess the accuracy of guided endodontics using laser melting templates. Two cases with calcified anterior teeth were treated with laser melting templates. Cone beam computed tomography (CBCT) was used to scan the maxillary teeth of patients before surgery to establish the root canal system model. The maxillary impression of the patient was made and it was scanned by a 3D scanner. The CBCT scans were matched with surface scans of plaster model. Mimics 19.0 and 3-matic 11.0 software were used to design the virtual planning to access cavities. The templates were produced by laser melting 3D printing. Access cavity was prepared under the guidance of laser melting template. Then the deviations of planned and prepared cavities in three dimensions and angle were measured. The two teeth obtained satisfactory results. The first case had a angle deviation of 1.77°, a drilling base deviation of 0.403-0.497 mm, and a tip of 0.433-0.537 mm. The second case had a angle deviation of 3.26°, a drill base deviation of 0.18-0.347 mm, and a tip of 0.310-0.463 mm. Laser melting template-guided endodontics is an effective technique for the treatment of calcified root canal and can be used as a new strategy for the treatment of calcified canal.

Comparative analysis of various obturation techniques in mandibular molars: A retrospective clinical outcome study

The primary objective of root canal treatment is the ability to remove irritants, to clean, shape and fill the root canal system three-dimensionally and prevent recontamination from bacterial irritants. Various Obturation techniques used for filling the root canals include lateral condensation, vertical compression, and thermoplastic gutta-percha techniques. The retrospective study aimed to evaluate the various obturation techniques used in mandibular molars. For this retrospective study data collection was based on patient records of Saveetha Dental College, Chennai and consisted of a total of 1903 cases evaluated based on the obturation technique within the time frame of 10th June 2019 to 1st March 2020. In this study, the obturation technique was evaluated based on the patients age, gender, procedure and based on the tooth in which obturation was done. Inclusion criteria consisted of the tooth that underwent endodontic treatment in patients within the age group of 18 to 60 yrs, a tooth with irreversible pulpal disease or chronic apical periodontitis, permanent tooth and mandibular molars. Exclusion criteria consisted of patients above 60 years, primary tooth, teeth in which root canal treatment was not undertaken, teeth with the presence of huge periapical lesions, severely calcified canals etc., severe periodontal disease, teeth apart from mandibular molars. All the values were then statistically analysed. In this study, 1930 patients (848 are females, and 1055 were males with a mean age of 24 years) were included. It was observed in this retrospective study that there was a significant difference between the various types of obturation technique used in mandibular molars. Matched single cone obturation technique was the preferred technique of obturation in the majority of the cases (62.4%). Single cone obturation technique has advantages over other techniques of obturation due to the fewer stress forces implied apically, thereby preventing an excess of sealer extrusion.

Dynamically Navigated versus Freehand Access Cavity Preparation: A Comparative Study on Substance Loss Using Simulated Calcified Canals

IntroductionThe aim of this in vitro study was to compare the speed, qualitative precision, and quantitative loss of tooth structure with freehand and dynamically navigated access preparation techniques for root canal location in 3-dimensional–printed teeth with simulated calcified root canals. MethodsForty maxillary and mandibular central incisors (tooth #9 and tooth #25) were 3-dimensionally printed to simulate canal calcification. Under simulated clinical conditions, access preparations were randomly performed with contemporary freehand and dynamically navigated techniques. Qualitative precision and quantitative loss of tooth structure were assessed on postoperative cone-beam computed tomographic scans using ITK-SNAP open-source segmentation (http://www.itksnap.org/). The associations between jaw, technique, volume of substance loss, and operating time were determined using analysis of variance models with Tukey-adjusted post hoc pair-wise comparisons. The kappa statistic was used to determine agreement between 2 independent, blinded raters on the qualitative assessment of the drill path. The association between the technique and jaw and qualitative assessment scoring was compared using the Fisher exact test. The significance level was set at .05. ResultsDynamically navigated accesses resulted in significantly less mean substance loss in comparison with the freehand technique (27.2 vs 40.7 mm3, P < .05). Dynamically navigated accesses were also associated with higher optimal precision (drill path centered) to locate calcified canals in comparison with the freehand technique (75% vs 45%, P > .05). Mandibular teeth were associated with a negligible difference in substance loss between the access techniques (19.0 vs 19.1 mm3, P > .05). However, qualitatively the freehand technique was still prone to 30% higher chance of suboptimal precision (drill path tangentially transported) in locating calcified canals. Overall, dynamically navigated accesses were prepared significantly faster than freehand preparations (2.2 vs 7.06 minutes, P < .05). ConclusionsWithin the limitations of this in vitro study, overall dynamically navigated access preparations led to significantly less mean substance loss with optimal and efficient precision in locating simulated anterior calcified root canals in comparison with freehand access preparations.

Accuracy and Efficiency of a Dynamic Navigation System for Locating Calcified Canals

IntroductionCalcified canals present a challenge during endodontic treatments. The purpose of this study was to compare the accuracy and efficiency of a dynamic navigation system (DNS) to the freehand (FH) method for locating calcified canals in human teeth. MethodsSixty human single-rooted teeth with canal obliteration were selected and mounted in dry cadaver jaws. Based on cone-beam computed tomographic scans of the jaws, the drilling path and depth were virtually planned to use X-Guide software (X-Nav Technologies, LLC, Lansdale, PA). Access preparation was made with navigation in the DNS group and without guidance in the FH group by 2 operators with different levels of experience. Postoperative cone-beam computed tomographic scans were taken of all teeth. Linear and angular deviations and reduced dentin thickness at 2 levels were measured. The time for locating the canal, the number of mishaps, and the unsuccessful attempts were determined and analyzed. ResultsThe mean linear and angular deviations, reduced dentin thickness (at both levels), the time for access cavity preparation, and the number of mishaps in the DNS group were significantly less than the FH group (P ≤ .05). The unsuccessful attempts were not different between the 2 groups (P > .05). The time for access preparation was significantly shorter for the board-certified endodontist in the FH group (P ≤ .05). ConclusionsThe DNS was more accurate and more efficient than the FH technique in locating calcified canals in human teeth. This novel DNS can help clinicians avoid catastrophic mishaps during access preparation in calcified teeth.

3-Dimensional Accuracy of Dynamic Navigation Technology in Locating Calcified Canals

IntroductionThis study aimed to present a novel dynamic navigation method to attain minimally invasive access cavity preparations and to evaluate its 3-dimensional (3D) accuracy in locating highly difficult simulated calcified canals among maxillary and mandibular teeth. MethodsThree identical sets of maxillary and mandibular 3D-printed jaw models composed of 84 teeth in their anatomic locations with simulated calcified canals (N = 138 canals) were set up on dental manikins. The Navident dynamic navigation system (ClaroNav, Toronto, Ontario, Canada) was used to plan and execute access preparations randomly with high-speed drills by a board-certified Endodontist. Two-dimensional (2D) and 3D horizontal, vertical, and angulation discrepancies between the planned and placed access preparations were digitally measured using superimposed cone-beam computed tomographic scans. Analysis of covariance models were used to evaluate the associations and the interaction between tooth type and jaw, the canal orifice depth, and the discrepancies between planned and prepared access cavities. The significance level was set at .05. ResultsThe mean 2D horizontal deviation from the canal orifice was 0.9 mm, and it was significantly higher on maxillary compared with mandibular teeth (P < .05). The mean 3D deviation from the canal orifice was 1.3 mm, and it was marginally higher on maxillary teeth in comparison with mandibular teeth (P ≥ .05). The mean 3D angular deviation was 1.7 degrees, and it was significantly higher in molars compared with premolars (P < .05). The 3D and 2D discrepancies were independent of the canal orifice depths (P > .05). The average drilling time was 57.8 seconds with significant dependence on the canal orifice depth, tooth type, and jaw (P < .05). ConclusionsThis study shows the potential of applying dynamic 3D navigation technology with high-speed drills to preserve tooth structure and accurately locate root canals in teeth with pulp canal obliteration.

Endodontic Management of Canal Calcification in Maxillary Central Incisor Using 3D Prototyping Technique: A Case Report

Teeth with calcific metamorphosis pose a challenge to the endodontist in achieving proper access, identification, and debridement of the root canal. With the conventional technique, radiographs and bur orientation have dictated the access cavity preparation, which leads to the removal of more sound tooth structure and iatrogenic errors. To overcome these issues, the recent diagnostic imaging techniques such as cone beam computed tomography followed by three-dimensional fabrication of template have been proposed, which aid the clinician to accurately locate and negotiate the obliterated canal. The present case report describes the importance of conservative access cavity preparation with the use of the guided endodontic technique for the treatment of calcified canals in the maxillary central incisor.

Ultrasonic Tips in Surgical and Non Surgical Root Canal Therapy:A Review of Literature

Dentistry has been revolutionized by the development of ultrasonic tips. It gives a minimally invasive approach, and with optimum magnification it can favor a successful conservative treatment. Ultrasonics are ideal for endodontic use and offers many applications and advantages like improved techniques and use of materials, and helps enrich the way endodontics is being practiced beginning from access preparation to re-treatment and also surgical treatment. They offer numerous advantages over conventional methods and a viable option employed by the dentists. Most frequent applications of ultrasonics in endodontics are access refinement, finding calcified canals, and removal of attached pulp stones and intracanal obstructions, increased action of irrigating solutions, condensation of gutta-percha, placement of mineral trioxide aggregate, in surgical endodontics and root canal preparation. Due to its efficiency there is an increased focus on the use and possible consequences of ultrasonics. This review article describes the various uses of ultrasonics in surgical and non surgical root canal treatment in a clinical perspective.

English

The aim of this study was to evaluate the technical procedural iatrogenic errors, especially to determine the frequency of dental perforation made by undergraduate students in Sofia, Faculty of Dentistry, Bulgaria, in the school years of 2014/2015 and 2015/2016. The assessment was by examination of periapical radiographs of completed endodontically treated teeth, performed by last year dental students. A total of 748 teeth were evaluated and 30 perforations were found. From 285 treated in 2015, 10 perforations were found. From 493 teeth treated in 2016, 20 perforations were found. The overall frequency of perforations was 3.9% for 2015 and 4.1% for 2016. The frequency of perforations made by postgraduate Bulgarian students established by us is low and it is similar to that made by general practitioners and found by other Bulgarian researches. Perforation frequency found in this study is due to the large number of retreatments (36% of all cases) and the prevailing number of elderly patients with calcified canals that come to be treated in our facility. And yet it is not significantly different from other published data. &nbsp; Key words: Dental education, iatrogenic perforations, quality of root canal treatment.

Guided Endodontic Access of Calcified Anterior Teeth

Pulp canal calcification is characterized by the deposition of calcified tissue along the canal walls. As a result, the root canal space can become partially or completely obliterated. Recently, “guided endodontics” has been reported as an alternative solution in cases of partial or completed canal obliteration. Although this technique can enhance minimally invasive access to the calcified canal, it has been shown that the incisal surfaces are often removed during the access of anterior teeth. This report describes 2 cases of guided endodontics using conventional palatal access in calcified anterior teeth and discusses the applicability of this approach in cases of pulp canal calcification with apical periodontitis and acute symptoms. The method demonstrated high reliability and permitted proper root canal disinfection expeditiously, without the unnecessary removal of enamel and dentin in the incisal surface.

Guided Endodontic Access in Maxillary Molars Using Cone-beam Computed Tomography and Computer-aided Design/Computer-aided Manufacturing System: A Case Report

The aim of this study was to describe a guided endodontic technique that facilitates access to root canals of molars presenting with pulp calcifications. A 61-year-old woman presented to our service with pain in the upper left molar region. The second and third left molars showed signs of apical periodontitis confirmed by the cone-beam computed tomographic (CBCT) scans brought to us by the patient at the initial appointment. Conventional endodontic treatment was discontinued given the difficulty in locating the root canals. Intraoral scanning and the CBCT scans were used to plan the access to the calcified canals by means of implant planning software. Guides were fabricated through rapid prototyping and allowed for the correct orientation of a cylindrical drill used to provide access through the calcifications. Second to that, the root canals were prepared with reciprocating endodontic instruments and rested for 2 weeks with intracanal medication. Subsequently, canals were packed with gutta-percha cones using the hydraulic compression technique. Permanent restorations of the access cavities were performed. By comparing the tomographic images, the authors observed a drastic reduction of the periapical lesions as well as the absence of pain symptoms after 3 months. This condition was maintained at the 1-year follow-up. The guided endodontic technique in maxillary molars was shown to be a fast, safe, and predictable therapy and can be regarded as an excellent option for the location of calcified root canals, avoiding failures in complex cases.

Calcified Canal and Negotiation-A Review

Pulp canal obliteration occurs commonly following traumatic injuries to teeth. Dental trauma to the permanent dentition can lead to clinical complications and its management may considerably challenge a practitioner. One such complication is Calcific Metamorphosis (CM) which can complicate entry in to the root canal system in the future due to difficulty in accessing the canal. It is the Calcific deposits of the pulp chamber that causes the darker hue, translucency loss and the yellowish appearance of the tooth's crown. Locating the canal and negotiating it to full working length may lead to iatrogenic errors such as fractured instrument and perforation. It is characterised by the deposition of hard tissue within the root canal space and a yellow discolouration of the crown. The affected teeth do not always react to sensibility tests for some time. Teeth undergoing pulpal obliteration are generally asymptomatic. The negotiation of small calcified canals is challenging.

The use of cone-beam computed tomography in localizing calcified canals during endodontic treatment

Canal calcification and obliteration is considered a challenge during root canal treatment. The present case report demonstrates a successful management of calcified pulp chamber and coronal third of the root canals of lower right first molar tooth of a 17-year-old patient that was diagnosed as previously initiated with symptomatic apical periodontitis treated by pulpotomy for a long period. It also emphasizes the use of the aiding tools to negotiate such calcification including intraoperative cone-beam computed tomography. This technology, along with chelating agents, magnification, illumination, and ultrasonic instruments helped in assessing the extent and the depth of the calcification and guided the clinician to the correct location, angle, and depth to negotiate the patent part of the canals, and therefore adequately treated.

Application of dental microscope in endodontic treatment procedure.

1. Diagnosis Diagnosis of Crack, Direct pulp capping 2. Access opening Find the calcified canal orifice Removal of dentin shelf Obtaining the MB2 canal (MB2, MB3, DB2) 3. Perforation repair during endodontic treatment 4. Removal of the separated files 5. Open apex treatment 6. Void removal on CWT procedure 7. Re-endodontic treatment Removal of restorative material filled in pulp chamber Post removal Identification and removal of residual gutta-perch 8. Surgical endodontic treatment In each case will overview how to use a dental microscope.

Outcome of One and Two Visit Root Canal Treatment of Irreversible Pulpitis

Objective: The present prospective comparative clinical trial was undertaken to compare the outcomes of single and two-visit root canal treatment of irreversible pulpitis.&#x0D; Methodology: This prospective study was conducted in the Department of Conservative Dentistry and Endodontics of Dhaka Dental College on patients who presented with pain due to irreversible pulpitis. Patients with single-rooted teeth with uncomplicated canal and full-formed apex having irreversible pulpitis were included. However, pregnant women or patients under treatment of antibiotics, cortiosteiods or suffering from any systemic diseases or immuno-compromised patients or patients having teeth with calcified canal or periodontal disease were excluded. A total of 80 patients who met the eligibility criteria were consecutively included and were randomly assigned to either one-visit (n = 40) or two-visit (n = 40) treatment groups. Data were kept on pulp vitality status, the presence or absence of pre-operative pain and degree of post obturation pain at 6, 12, 24, 48 hours and 1 week postoperatively. The outcome variable was intensity of pain which was measured using a visual analogue scale (VAS) as 0 = no pain, 1 = slight pain or discomfort, 2 = moderate pain relieved by analgesic, 3 = moderate to severe pain not completely relieved by analgesics and 4 = severe pain or swelling not relieved by analgesics and required unscheduled visit.&#x0D; Result: Forty percent of the patients in the two-visit group did not have any pain (measured in terms of visual analogue scale) at 12 hours compared to 25% in the single visit group, although the difference did not turn significant (p = 0.580). Likewise the proportion of patients without pain in the two-visit group was considerably higher (52.5%) at 24 hours than that in the single-visit group (45%) (p = 0.852). Improvement in pain sensation was reported to be significantly higher in the two-visit group (as 95% of the patients did not complain any pain) at 48 hours than that in the single-visit group (80% of the patients did not complain any pain) (p = 0.015). None of the patients of either group complained of pain one week postoperatively.&#x0D; Conclusion: Compared to single-visit, two-visit root canal treatment showed better results in terms of intensity of post-obturation pain at 12, 24 and 48 hours after root canal treatment for irreversible pulpitis.&#x0D; Ibrahim Card Med J 2015; 5 (1&amp;2): 45-48

Evaluation of the use of dental operating microscope in the treatment of calcified canals

Evaluation of the use of dental operating microscope in the treatment of calcified canals

Intraoperative Use of CBCT for Identification and Localization of Calcified Canals: A Clinical Technique

Localization of calcified canals has always been a challenge in the field of endodontics. The following report of three cases describes a technique for the identification and negotiation of obliterated canals by use of cone beam computed tomography (CBCT) intraoperatively. Canal orifices could not be found clinically in all three cases. Gutta-percha points were placed and compacted at the position where the canal orifices were estimated to be. Intraoperative CBCT was taken, and the distance between the gutta-percha points and the canal orifices was calculated at all planes of space in the first two cases. In the third case, only one canal orifice could be identified due to obliteration of the other canals.

Management of a Previously Treated, Calcified, and Dilacerated Maxillary Lateral Incisor: A Combined Nonsurgical/Surgical Approach Assisted by Cone-beam Computed Tomography

Teeth with calcified canals, dilacerated roots, and associated large periradicular lesions involving both cortical plates pose a challenge to dentists. In addition to the nonsurgical endodontic treatment, such teeth may require surgical intervention with concomitant use of bone grafting materials and barrier techniques. These techniques, when combined with the use of a host modulating agent such as platelet-rich fibrin (PRF), may improve the chances of success. A 26-year-old woman was referred for dental treatment with a recurrence of an intraoral sinus tract 2 months after periradicular surgery in the upper anterior region. Clinical and radiographic examinations revealed a calcified and perforated maxillary left lateral incisor with a severely dilacerated root as well as an associated large radiolucent lesion surrounding the roots of the maxillary left central and lateral incisors. A cone-beam computed tomographic scan of the anterior maxilla showed erosion of the labial and palatal cortical plates in the same region. A calcified canal in the lateral incisor was negotiated up to the straight line portion of the canal. Periradicular surgery with root-end resection was performed, and root-end filling was performed with mineral trioxide aggregate. The perforation present on the middle third of the labial surface of the root was repaired with mineral trioxide aggregate, and the canal was cleaned, shaped, and obturated. A PRF scaffold was prepared and used with a collagen membrane and a freeze-dried bone allograft. Follow-up visits after 3 months, 6 months, and 1 year revealed satisfactory clinical and radiographic healing. The combined use of nonsurgical and surgical modes of treatment cannot be overemphasized in this case. The use of PRF along with a bone graft and a barrier membrane may have enhanced the speed of healing and the resolution of periradicular radiolucency by enhancing bone regeneration.

Cone-beam Computed Tomography: A Resolution to Paradoxical Judgments in Endodontic Diagnosis

ABSTRACT Recently, various diagnostic tools have emerged with a view to enhance endodontic treatment. Cone-beam computed tomography (CBCT) is presented as a new endodontic tool. The narrow field CBCT reduces the negative effects of anatomic noise, geometric distortion, and technique sensitivity observed on two-dimensional images. It can be used to identify canal morphology, numbers of canals, and relative positioning even in the presence of calcific metamorphosis (CM) and dystrophic calcifications. Calcific metamorphosis is characterized by the deposition of hard tissue within the pulp canal space. Most of the literature advices the treatment of CM through observation and periodic examination. Thus, it is imperative for the clinician to identify calcified canals preoperatively for conservative treatment approach. This case series illustrates about the versatility of CBCT over the conventional radiology for detecting calcified canals. How to cite this article Chougule AR, Kundabala M, Mohan RP, Shetty N. Cone-beam Computed Tomography: A Resolution to Paradoxical Judgments in Endodontic Diagnosis. World J Dent 2016;7(2):100-106.