Treatment of teeth with pulp canal calcification
presents a dilemma. A number of authors have
proposed that for endodontic technical reasons and for
prevention of tooth discolouration, these teeth should
be root filled once the calcification process is detected.
Endodontic procedures are certainly easier if under-taken at this stage.
However, most of the recent
literature indicates that endodontic treatment is
unnecessary unless the tooth is symptomatic or there is
radiographic evidence of pulp necrosis and infection–
i.e., a periapical radiolucency. Proponents of the latter
course of action base their opinions on histological
studies which indicate that the calcific changes do not
warrant pulp extirpation and that a remnant of the
canal is always present.
The presence of a periapical radiolucency implies
that a canal is present. Although the location and
negotiation of the canal may be difficult, it is invariably
present and is negotiable in almost all cases. With care,
the orifice to a trauma-induced calcified canal can
invariably be located in the crown of the tooth, above
the cervical margin. A “catch” on the floor of the pulp
chamber, felt with an endodontic explorer or file, will
generally indicate the position of the canal, as will a
colour change in the middle of the root. As the calcific
material is generally softer than regular dentine,
carefully “picking away” at this softened material with
a suitable explorer and/or the use of rotary nickel
titanium instruments will often remove sufficient
material to reveal the opening of the root canal system.
Negotiation of the canal requires patient exploration of
the floor of the pulp chamber with a bright light and
radiographic assessment. Transillumination using a
light source placed on the cervical area of the tooth
under the rubber dam is invaluable. Pre-operative
radiographs can assist in determining the level at which
the canal is to be found. Increasing the exposure of the
pre-operative radiograph may reveal the canal outline
more clearly.
Where difficulty is experienced in locating a calcified
canal in a traumatized tooth, it is usually because the
canal has been bypassed rather than that the canal is
not present at the level of the search. If an undetected
canal is visible radiographically at the level of
exploration, it must be assumed that the canal has been
bypassed and exploration deeper in the root is not
advisable. As lingual access to a root canal often directs
instrumentation in a labial direction, a more lingual
approach may assist in locating the canal. Dentine
softening agents have been proven to be ineffective as
aids for the location of calcified canals. Early referral to
a specialist endodontist is recommended if difficulties
are experienced in locating canals in calcified teeth. A
surgical approach to the management of these cases has
also been advocated but this should only be considered
when conservative attempts to locate and negotiate the
canal have been unsuccessful, and such surgery should
only be carried out by practitioners with appropriate
training, such as a specialist endodontist.