Clinical Approach to Pulp Canal Obliteration: A Case Series

This article describes four cases with safe and feasible clinical treatment strategies for anterior teeth with pulp canal obliteration (PCO) using cone-beam computed tomography (CBCT), digital radiography (DR), dental operating microscopy (DOM) and ultrasonic tips (US). Four anterior teeth with PCO were chosen. DR was taken with different angulations and analyzed with different filters. Subsequently, the access cavity was performed with the aid of DOM. If the canal was not identified, CBCT was requested. Sagittal and axial slices guided the direction of the ultrasonic tips. After identification of the canal, it was then negotiated and instrumented with the rotary instruments. All four canals were successfully identified, with no complications. In case 1, the canal was identified using DR, DOM and US tips. In cases 2, 3 and 4, the canals were identified with DR, DOM, US tips and CBCT. Complete root canal obliteration identified in radiography did not necessarily mean that pulp tissue was not visible clinically, either. The clinical evaluation of the access cavity with the aid of MO was crucial. If the canal was not identified, CBCT was mandatory in order to show more detailed view of the precise position of the canals, their directions, degrees of obstruction and dimensions. It served as a guide for the direction of the ultrasonic tips to keep them within the pulp chamber safely, with a low risk of iatrogenic injury.

[1]  Gabriel Krastl,et al.  Microguided Endodontics: Accuracy of a Miniaturized Technique for Apically Extended Access Cavity Preparation in Anterior Teeth , 2017, Journal of endodontics.

[2]  T. Connert,et al.  Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology. , 2016, Dental traumatology : official publication of International Association for Dental Traumatology.

[3]  M. Eghbal,et al.  The Applications of Cone-Beam Computed Tomography in Endodontics: A Review of Literature , 2014, Iranian endodontic journal.

[4]  Chandrasekhar Veeramachaneni,et al.  Calcific Metamorphosis , 2015 .

[5]  A. Lussi,et al.  The impact of loupes and microscopes on vision in endodontics. , 2014, International endodontic journal.

[6]  M. Walker,et al.  A comparison of dentin cutting efficiency of 4 round-tipped ultrasonic instruments. , 2013, Journal of endodontics.

[7]  K. Mala,et al.  Calcific metamorphosis. Literature review and clinical strategies. , 2013, Dental update.

[8]  L. Nanjannawar,et al.  Pulp stone--an endodontic challenge: successful retrieval of exceptionally long pulp stones measuring 14 and 9.5 mm from the palatal roots of maxillary molars. , 2012, The journal of contemporary dental practice.

[9]  Heather J. Conrad,et al.  Effect of surgical guide design and surgeon's experience on the accuracy of implant placement. , 2012, The Journal of oral implantology.

[10]  E. Nunes,et al.  Comparative analysis of accessory mesial canal identification in mandibular first molars by using four different diagnostic methods. , 2012, Journal of endodontics.

[11]  P. Dummer,et al.  Pulp canal obliteration: an endodontic diagnosis and treatment challenge. , 2012, International endodontic journal.

[12]  L. K. Prasad,et al.  A radiographic correlation between systemic disorders and pulp stones. , 2010, Indian journal of dental research : official publication of Indian Society for Dental Research.

[13]  Adeleke O Oginni,et al.  Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision. , 2009, Dental traumatology : official publication of International Association for Dental Traumatology.

[14]  Carlos Estrela,et al.  Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. , 2008, Journal of endodontics.

[15]  E. Whaites,et al.  The potential applications of cone beam computed tomography in the management of endodontic problems. , 2007, International endodontic journal.

[16]  Nestor Cohenca,et al.  Clinical indications for digital imaging in dento-alveolar trauma. Part 1: traumatic injuries. , 2007, Dental traumatology : official publication of International Association for Dental Traumatology.

[17]  H. Gröndahl,et al.  Imaging of root canal fillings: a comparison of subjective image quality between limited cone-beam CT, storage phosphor and film radiography. , 2007, International endodontic journal.

[18]  C. Pameijer,et al.  Ultrasonics in endodontics: a review of the literature. , 2007, Journal of endodontics.

[19]  Mijin Choi,et al.  Effects of varied dimensions of surgical guides on implant angulations. , 2004, The Journal of prosthetic dentistry.

[20]  H. Gröndahl,et al.  Radiographic manifestations of periapical inflammatory lesions How new radiological techniques may improve endodontic diagnosis and treatment planning , 2004 .

[21]  David Clark,et al.  The operating microscope and ultrasonics; a perfect marriage. , 2004, Dentistry today.

[22]  P. Krasner,et al.  Anatomy of the pulp-chamber floor. , 2004, Journal of endodontics.

[23]  M. de Cleen.  Obliteration of pulp canal space after concussion and subluxation: endodontic considerations. , 2002, Quintessence international.

[24]  J L Gutmann,et al.  Calcific metamorphosis: a challenge in endodontic diagnosis and treatment. , 2001, Quintessence international.

[25]  G. Holan.  Tube-like mineralization in the dental pulp of traumatized primary incisors. , 1998, Endodontics & dental traumatology.

[26]  Y. L. Thong,et al.  Gaining access through a calcified pulp chamber: a clinical challenge. , 1998, International endodontic journal.

[27]  A Robertson,et al.  Incidence of pulp necrosis subsequent to pulp canal obliteration from trauma of permanent incisors. , 1996, Journal of endodontics.

[28]  D. Green,et al.  Unusual pattern of pulp canal obliteration following luxation injury. , 1994, Journal of endodontics.

[29]  J. O. Roahen,et al.  The lateral radiograph: an aid to labiolingual position during treatment of calcified anterior teeth. , 1994, Journal of endodontics.

[30]  C. Torneck.  The clinical significance and management of calcific pulp obliteration. , 1990, The Alpha omegan.

[31]  W G Schindler,et al.  Rationale for the management of calcific metamorphosis secondary to traumatic injuries. , 1988, Journal of endodontics.

[32]  J. E. Van Cura,et al.  Pulpal dystrophic calcification. , 1984, Journal of endodontics.

[33]  M Cvek,et al.  Failures and healing in endodontically treated non-vital anterior teeth with posttraumatically reduced pulpal lumen. , 1982, Acta odontologica Scandinavica.

[34]  K. Kerekes,et al.  Long-term prognosis of traumatized permanent anterior teeth showing calcifying processes in the pulp cavity. , 1977, Scandinavian journal of dental research.

[35]  R. Hession.  Endodontic morphology. II. A radiographic analysis. , 1977, Oral surgery, oral medicine, and oral pathology.

[36]  J. Davis,et al.  Molar 4th canals: frequent cause of endodontic failure? , 1975, Illinois dental journal.

[37]  H. Levenstein.  Clinical endodontics. , 1973, Diastema.

[38]  J. Holcomb,et al.  Calcific metamorphosis of the pulp: its incidence and treatment. , 1967, Oral surgery, oral medicine, and oral pathology.

[39]  D. F. Mitchell,et al.  Calcific metamorphosis of the dental pulp , 1965 .