Journal of Operative Dentistry & Endodontics

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VOLUME 6 , ISSUE 2 ( July-December, 2021 ) > List of Articles

CASE REPORT

Endodontic Management of Calcified Maxillary Central Incisors Using CBCT: A Report of Two Cases

Nagammai Meyappan, Arvind Kumar, Benin Paulaian, MS Ravisankar

Keywords : Calcified canal, Cone-beam computed tomography, Dental trauma, Root canal therapy

Citation Information : Meyappan N, Kumar A, Paulaian B, Ravisankar M. Endodontic Management of Calcified Maxillary Central Incisors Using CBCT: A Report of Two Cases. J Oper Dent Endod 2021; 6 (2):74-77.

DOI: 10.5005/jp-journals-10047-0119

License: CC BY-NC 4.0

Published Online: 24-05-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aim: The application of cone-beam computed tomography (CBCT) in the management of calcified root canal system. Background and objectives: Dental trauma to the permanent dentition can lead to various clinical complications and its management may be considerably challenging for a dental clinician. One such complication is intracanal obliteration. Root canal calcification occurs commonly following traumatic injuries to permanent teeth in approximately 4–24% of cases which is characterized by the apparent loss of the pulp space radiographically and discoloration of the clinical crown. These teeth provide an endodontic treatment challenge in locating the root canal orifice and negotiating the canal to its full working length. Iatrogenic errors such as instrument separation and root perforation are more prone to occur in such cases. Case description: Two patients were reported to the department with the chief complaint of discolored teeth in the upper front tooth region. On radiographic examination, pulp canal obliteration (PCO) was identified and the two cases were managed successfully with the help of CBCT. Conclusion: With the application of CBCT as a guide, it is helpful in orienting the burs angulation within the pulp chamber with fewer chances of iatrogenic injury. Clinical significance: Cone-beam computed tomography (CBCT) is considered the third eye of an endodontist which provides images in sliced sections in all the three planes without overlapping the adjacent structures and it facilitates the identification of the canal orifices, canal directions, degrees of obstruction, and also their dimensions.


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  1. Andreasen FM, Zhjie Y, Thomsen BL, et al. Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition. Dent Traumatol 1987;3(3):103–115. DOI: 10.1111/j.1600-9657.1987.tb00611.x.
  2. Oginni AO, Adekoya-Sofowora CA, Kolawole KA. Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision. Dent Traumatol 2009;25(6):620–625. DOI: 10.1111/j.1600-9657.2009.00819.x.
  3. Lee R, Barrett EJ, Kenny DJ. Clinical outcomes for permanent incisor luxations in a pediatric population. II. Extrusions. Dent Traumatol 2003;19(5):274. DOI: 10.1034/j.1600-9657.2003.00208.x.
  4. Langeland K, Dowden WE, Tronstad L, et al. Human pulp changes of iatrogenic origin. Oral Surg Oral Med Oral Pathol 1971;32(6):943–980. DOI: 10.1016/0030-4220(71)90183-6.
  5. Kiefner P, Connert T, ElAyouti A, et al. Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up. Gerodontology 2017;34(2):164–170. DOI: 10.1111/ger.12238.
  6. Pettiette MT, Zhong S, Moretti AJ, et al. Potential correlation between statins and pulp chamber calcification. J Endod 2013;39(9):1119–1123. DOI: 10.1016/j.joen.2013.06.005.
  7. Carvalho L, Fundação R, Cruz O. Operative microoscopy-indispensable resource for the treatment of pulp canal obliteration: a case report. 2009. Available from: https://www.researchgate.net/publication/228475177.
  8. Danforth RA. Cone beam volume tomography: a new digital imaging option for dentistry. J Calif Dent Assoc 2003;31(11):814. PMID: 14696832.
  9. Kiarudi AH, Eghbal MJ, Safi Y, et al. The applications of cone-beam computed tomography in endodontics: a review of literature. Iran Endod J 2015;10(1):16–25. PMID: 25598804.
  10. Huumonen S, Gröndahl H-G. Radiographic manifestations of periapical inflammatory lesions. Endod Topics 2004;8(1):55–67. DOI: 10.1111/j.1601-1546.2004.00082.x.
  11. Estrela C, Bueno MR, Leles CR, et al. Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. J Endod 2008;34(3):273–279. DOI: 10.1016/j.joen.2007.11.023.
  12. Soğur E, Baksi BG, Gröndahl HG. Imaging of root canal fillings: a comparison of subjective image quality between limited cone-beam CT, storage phosphor and film radiography. Int Endod J 2007;40(3):179–185. DOI: 10.1111/j.1365-2591.2007.01204.x.
  13. Khanna AB. Applications of cone beam computed tomography in endodontics. Evidence-Based Endod 2020;5(1):1. DOI: 10.1186/s41121-020-00020-4.
  14. Patel S, Dawood A, Pitt Ford T, et al. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J 2007;40(10):818–830. DOI: 10.1111/j.1365-2591.2007.01299.x.
  15. AAE Position Statement. Scope of endodontics: regenerative endodontics. J Endod 2013;39(4).
  16. Foreman PC, Barnes IE. A review of calcium hydroxide. Int Endod J 1990;23(6):283–297. DOI: 10.1111/j.1365-2591.1990.tb00108.x.
  17. Cvek M, Granath L, Lundberg M. Failures and healing in endodontically treated non-vital anterior teeth with posttraumatically reduced pulpal lumen. Acta Odontol Scand 1982;40(4):223–228. DOI: 10.3109/00016358209019816.
  18. Jacobsen I, Kerekes K. Long-term prognosis of traumatized permanent anterior teeth showing calcifying processes in the pulp cavity. Eur J Oral Sci 1977;85(7):588–598. DOI: 10.1111/j.1600-0722.1977.tb02119.x.
  19. Holcomb JB, Gregory WB. Calcific metamorphosis of the pulp: its incidence and treatment. Oral Surg Oral Med Oral Pathol 1967;24(6):825–830. DOI: 10.1016/0030-4220(67)90521-x.
  20. Amir FA, Gutmann JL, Witherspoon DE. Calcific metamorphosis: a challenge in endodontic diagnosis and treatment. Quintessence Int (Berlin, Germany : 1985) 2001;32(6):447–455. PMID: 11491624.
  21. McCabe PS, Dummer PMH. Pulp canal obliteration: an endodontic diagnosis and treatment challenge. Int Endod J 2012;45(2):177–197. DOI: 10.1111/j.1365-2591.2011.01963.x.
  22. Raghuvanshi S, Jain P, Kapadia H. Endodontic management of traumatized permanent anterior teeth with radiographically calcified root canal–report of two cases. IJOCR 2015;3(3):76–80.
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