Calcified Root canals have always been a nightmare for Dentists and Endodontists alike, they are difficult to locate and are very time taking to locate and prepare. As the name suggests, Calcified Root Canals are calcium deposited in the root canals which are usually hollow or with the pulp tissue in it. The cause of Calcification varies, might be due to prolonged infection, trauma etc. Let us have a look at how to treat calcified root canals and know why they are caused in the first case.
Why and When are Root Canals Calcified ?
Root canals are calcified in both anterior and posterior teeth alike without many variations in ratios; there are many reasons why Root canals can become calcified:
- Can be a result of Natural Process of Aging
- Prolonged Trauma
- Prolonged infection
- Non Vital tooth without Endodontic treatment for many years
- Dental Decay
- Dental Fillings or Crowns which are exerting constant force on tooth and root canal over a long period of time
- Gingival Recession that occurs in Coronal part of the tooth
How does the Calcification Progress in the Root Canal ?
- Calcification process often starts from the Coronal Portion of the Root canal, the coronal portion of the root canal is the first to calcify due to the many reasons mentioned above which are often seen mainly on the coronal part of the root canal.
- Hence the coronal portion is more calcified compared the Apical portion in a Calcified Root Canal, if you can go through the Corol 1/3 rd portion of the Calcified Root then it becomes very easy to reach the apex with the help of Files, Reamers (start with 06, 08 and 10 numbers) and some help from RC-Help (EDTA Paste with Carbamide peroxide) or any EDTA solution used alternatively with NaOCl irrigation to soften the Dentin in the Root canal.
How to Locate Calcified Root Canals:
- Locating Calcified canals in Anteriors is a rather easy process as we know the location and even the size of the root canal is rather large. But the trouble begins in case of Posteriors or teeth with multiple root canals where locating the Root canal openings becomes rather difficult and over cutting of the Dentin will often lead to Perforations in furcation as we have seen in many cases.
- While locating Calcified canals having Patience is of utmost importance
- Using the Radiograph get a mental picture of the supposed location of the calcified canal and start removing the Dentin covering.
- When you reach the location which you think was the canal opening earlier, isolate the cavity properly
- Now you can see the difference between the Primary and secondary Dentin which is slightly whiter
- And in the middle of the Secondary Dentin you can find a White Spot which is the remnant of the Root canal
- This is where you need to start exploring using either a “Micro canal Opener” or “Ultrasonic Tips” to slowly make way for the Files to be used.
- Once the Coronal part of Calcification is dealt with it is very easy to reach the apex without much difficulty taking help of files and Reamers starting from 06 n.o and progressing towards bigger numbers.
- There are many lubricants or De Calcifiers which are available in the market like RC-Help or any EDTA solution or gel which help in softening the calcified portion of the root canal to ease the way for doing BMP. While using EDTA the canal should be irrigated constantly with NaOCl.
Instruments used to Locate Calcified Root Canals:
- 6 n.o to 10 n.o K files – (Numerous until you achieve patency)
- Endodontic Probe – Very useful in locating the Pulp chamber
- Ultrasonic Scaler with Interdental Scaler Tip – This helps in removing any calcified tissue on top of the pulp chambers and achieve initial entry into the canal without damaging floor of the Pulp chamber.
- EDTA and and Sodium Hypochlorite Irrigants
- Lots of patience and time
Calcified Roots are an enigma in Dentistry for the Endodontist, treating such cases is a challenge but it sure brings in a lot of satisfaction after completing the case successfully. Main sutra of treating Calcified canals is to be patient and keep trying.