Management of Calcified Root Canals in Endodontics

SUMMARY
Calcification is known as the apposition of third dentin at the surfaces or sclerotic masses in the dental pulp resampling dentin and is associated with many factors such as the patients’ age, the tooth condition (decay, periodontal disease, trauma, orthodontic treatment), various systematic diseases and syndromes. The prevalence of pulp calcification, histologically, has been reported to be around 90% so it is very often in endodontic treatment. Orifice location, negotiation and preparation of calcified root canals can be very challenging and may result in several procedural errors including massive loss of dental hard tissue, canal geometry alteration, perforation and broken instruments. Failure in managing calcified root canals affects the outcome of endodontic treatment.
Thorough knowledge of the root canal system morphology and carefull study of the preoperative xray lead to a more suitable access. “Guided endodontic access” is a new approach in finding calcified root canals. Combined with cone beam computed tomographic (CBCT), ultrasonics, magnification and illumination with a dental operating microscope may help reduce the dentin loss. After locating the orifices negotiation and preparation of the root canals is achieved gradually using mechanical and hand files with the aid of chelating agents.
Surgical endodontic treatment is the only solution in cases were all the meanings have failed and a periapical lesion is present.