Finding a Severely Calcified Canal

Terry Pannkuk, DDS, MScD Instructional, Complications: Advanced Management, Calcification

This step-by-step video shows a predictable way to find a severely calcified canal.

This patient presented with a history of trauma to the maxillary anterior central incisors. Both teeth appeared to be severely calcified on the preoperative radiographs (Figure 1)

The following sequence is detailed in the video:

  1. Initial access penetration with a #330 carbide bur just above the cingulum

  2. Smoothing with a #2 round bur reveals the dark tertiary dentine (the calcified canal) (Figure 2)

  3. Clearing with 17% EDTA maintains the perspective of the calcified dentine which should be penetrated at the most apical and lingual position

  4. Deeper penetration with a small Munce bur alternating with a #2 round bur while constantly clearing with 17% EDTA

  5. When a catch or "stick" is felt with an endodontic explorer, a small K-file may be placed. The value of a novel new pulp dehydrant (trichloracetic acid-based) is shown (Figure 3)

  6. Progress is made down the natural canal space with patience (Figure 4)

  7. The process is repeated with sequenced use of pre-curved files (recapitulations) and eventually the entire canal space is cleaned and shaped with patency established (Figure 5)

  8. Calcium hydroxide is place and a temporary is placed in the access cavity preparation (Figure 6)

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