IJARR, 8(3), 2023; 34-39

International Journal of Advanced Research and Review

www.ijarr.in

MANAGEMENT OF CALCIFIED CANAL

Kaif ali afsar1, Abhisheik khare2, Faraz ali3, Mohammad imran khan4
1
oral pathology, [email protected]
2
oral pathology, [email protected]
3
oral pathology, [email protected]
4
oral pathology, [email protected]
Corresponding author name: Dr. KAIF ALI AFSAR, 529/291ka near metro grinding, khurram nagar lucknow.
Email: [email protected]
ABSTRACT
Dental traumatic injuries may lead to several clinical complications. pulp canal calcifications is
one of the complication of dental trauma.1 Pulpal calcifications are calcified masses in dental
pulps of healthy, diseased, and even unerupted teeth. They are not only difficult to locate, but
their negotiation and the creation of a glide path takes considerably long time.
Ztooth becomes symptomatic endodontic treatment needed to be done.3
Keywords: Calcified canal, c files, chelators.

INTRODUCTION
Goal of endodontic treatment is to completely eradicate micro-organisms and disinfect root
canal. This is obtained by biomechanical preparation, use of irrigants, intracanal medicament. A
complete disinfection of calcified canal, complex root anatomy is quite difficulte.4 Calcification
which is uncontrolled due to failure of enzyme pyrophosphatase, reduction in capillary
permeability and blood supply causes calcifications. Root canal in teeth in which calcific
deposits blocking access to the canal (s), treatment efforts are often hindered. An effort to locate
the residual canal might remove large amounts of dentin and there is a risk of root fracture and
perforation. American Association of Endodontists defined Calcific Metamorphosis as “Apulpal
response to trauma characterised by rapid deposition of hard tissue within the canal space.” This
is also known as obliteration of pulp canal, Dystrophic Calcification, Diffuse Calcification and
Calcific Degeneration. calcified canals Negotiation is a challenge and requires patience, proper
access opening of canal orifice , good magnification, illumination and proper armamentarium.
Calcification of canal is defined as deposition of calcified material within the pulp chamber
partially or completely. It may ends in complete calcification asa result of dentin deposition
inside the tooth.5 the exact cause of the formation of pulpal calcifications are not well
understood. Dental trauma, aging, various systemic diseases such as cardiovascular diseases
could be causes of calcifications. May be due to the chronic irritation to the pulp due to deep
cries and restoration and some pulp capping agent such as Ca(OH)2 have been proposed as
possible implicated factors in the development of pulpal calcifications.6-8

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Case report
A male patient reported to the private clinic with chief complains of discoloration of upper front
teeth. Xray was done and found that calcified root canal was associated with upper anterior
teeth. Root canal treatment was planned for tooth no 21. Access opening was carried out using
round bur To achieve patency within canal, file 10 were used, but initally patency could not be
achieved due to calcified canal. With help of chelating agents 17% EDTA gel and 3% Naocl
solution and small size C file #6 , 8, 10 canal negotiation was carried out to achieve patency.
Working lengh was then determined and canal was instrumented. Naocl, EDTA was used as
intermittent irrigant. Canal was obturated using cold lateral condensation technique followed by
permanent restoration.

Management
x ray examination was done and on radiographic examination calicification occurs at middle of
canal of tooth no 21. Local anesthesia was administered “2% lignocaine with 1:80,000
epinephrine”.(2)Access preparation was done with high speed round bur (BR 45) and modified
using EX24 bur. No canal orifice was visible upon access opening initially. On exploration the
orifice founds more towards lingually. File. No. 10k file was inserted to confirm the opening of
canal. File was in canal but not upto working length. File was 8- 9 mm short of working length
due to calcification of canal. (figure 1)Isolate the tooth ad filled the canal with3% Naocl and
agitates for 40 - 45 sec white cheesy material coming out I increments, washed the canal with
normal saline and then agitated by pitting 3% Nalco in canal.

With the help of 17% EDTA gel 6 no C file inserted into the canal, C file # 6 (wind and watch
motion) was reaching approximate length , took an xray by keeping C file #6 in the canal and
found that the file had reached the till working length. Figure 2

Then canal prepare with C file # 8 and #10 with the help of 17 % EDTA gel and intermittent
irrigation done with normal saline. After this canal prepare with K fike #10 #15 , #20 , during
this normal saline and 17 % EDTA gel used as intermittent irrigant. Final canal prepration done
with F3 hand protaper system till working length and obturate the canal with gutta percha.

DISCUSSION
Calcified metamorphosis is commonly seen in patients who have had injuries like concussion
and subluxation16 These obliterations were found to be either fibrotic or bone like in primary
teeth or bone like.9 Mechanism behind canal calcification is not clear. It is believed when trauma
occurs it leads to disruption of blood vessel. Clot formation occurs which acts as source for
calcification in root canal. 4 - 24% teeth show varying degree of calcification due to trauma.
Radiographically loss of pulpal space, discoloration of teeth is suggestive of calcification in
teeth.10

Root canal treatment of calcified canal is quite challenging for dentist. Iopar with correct
angulation play a very important role in determining the location of calcification. Access cavity
preparation should be made such that excessive loss of dentin is avoided.11 Law of color change,
i.e pulp chamber will be darker compared to root dentin. This will help to identify entry in pulp
chamber. While using 3 % Naocl keep in mind that the tooth should be properly isolate and do
not put Naocl in canal with forcefully otherwise it may cause periapical irritation and pain that

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can be lead to hypo accident in some cases. 3) Multiple angulated radiograph should be taken in
deep access preparation to ensure central alignment and no loss of excessive dentin or
perforation. Negotiation of calcified canal, narrow constricted canal is a challenge toward
dentist. Usually negotiation is done with use of file #6,8,10 which has small diameter therefore
used as pathfinder files. Due to small diameter these files lack rigidity and may fracture if
excessive watch winding force is applied. So to prevent fracture of this file and further
complication alternate use of file # 6,8,10 should be done.12 -13 Gentle watch winding motion to
file with slight push pull motion should be used. Files should be checked before insertion and
discarded when sign of distortion appears. Negotiation of calcified canal in this case done with C
file #6 ,#8 , #10 with the help 17 % EDTA gel ( chelating agent ) and normal saline used as
intermittent irrigant. There is different file systemic proposed for negotiation of calcified. Such
file has quadrangular cross section to increase rigidity of file to prevent its breakage.14
Decalcifying, chelating agents and irrigants should be used during biomechanical preparation to
soften canal dentin and facilitate passage of file like 17 % EDTA gel, 17% EDTA irrigant.15
Calcification usually occurs from corona to apical direction. Therefore if file is negotiated well at
coronal and middle third, instrumentation in apical third becomes easier. Schindler & Gullickson
stated if negotiation of canal is not achieved and tooth is symptomatic. root end resection under
microscope should be treatment of choice.16-18

CONCLUSION
Calcifications of tooth could be a consequence of trauma, aging or may arise from chronic
inflammation of the pulp due to caries, trauma or medication in close proximity; such as using
Ca(OH) 2 in pulp capping.2 Negotiation and management of calcified canals can be challenging,
they can be managed if a proper protocol is followed. Operator's skill, patience, and a proper
armamentarium are the requisites to overcome the difficulties posed by these unforgiving canals
for their successful treatment. The calcification of root canals is a challenge for the dentist and
causes a lot of difficulty due to its calcification. The locating of the canal becomes difficult due
to calcification and hence instrumentation also. These difficulties can however be managed by
using various instruments to negotiate the canal.

The prognosis of root canal treatment in these cases depends on continued health of the pulp or
periapical area on the apical side of the blockage. In the absence of symptoms or evidence of
apical pathogenesis. It is satisfactory to instrument and fill the canal to the level that was
negotiated followed by regular recall of the patient (after 1,3,6 &12 month respectively). If there
is evidence of persistent symptoms and periapical pathogenesis it will be appropriate to undergo
a periapical surgery with a retrograde filling.

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Fig.1- Diagnostic
Fig.3-file #6 till apex
radiograph

Fig.2 – file #10 short of

Fig.4- GP fit with 21
apex 8-9 mm

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Fig.5-oturation with 21

Fig. 6-part of calcified material

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