Root canal treatment
Dealing with calcified chambers
Calcified chambers: Pain points and main challenges
In endodontics, calcified chambers can pose a challenge during treatment.1,2
Calcified chambers can be difficult to visualize due to their narrow and intricate nature. The limited visibility makes it challenging to accurately locate and navigate the canals within the chamber, increasing the risk of missed canals or incomplete treatment.2
This type of chamber may have constricted or tortuous canals, making it difficult to gain access and navigate the root canal system. The narrow spaces and calcified obstructions make it challenging to effectively clean, shape, and disinfect the canals.1,3
Dealing with calcified chambers can prolong treatment time and increase the complexity of the procedure. Dentists may need to employ various techniques and instruments to overcome the challenges posed by calcifications, which can require additional expertise and skill.2
To address these challenges, dentists may utilize advanced tools and techniques such as microscopes, ultrasonic instruments, rotary files, and magnification aids to enhance visualization, improve access, and increase precision. Additionally, continuing education and keeping up to date with the latest advancements in endodontics can help dentists effectively manage calcified chambers and achieve favorable treatment outcomes.1,2,4
The use of the microscope in my professional life has been of great help because I have been able to solve complex cases that on many occasions, without its help, could have taken me more than 3 appointments. In addition to this, magnification also allows me to perform my work in my endodontic practice without developing musculoskeletal problems. I opted to start using magnification in my endodontic practice in 2009, and it has been a great support in my day-to-day work ever since.
When dealing with calcified chambers in endodontics microscopes provide several clinical solutions
Improved chamber localization: The microscope’s high magnification and illumination allow the calcified chamber to be precisely located. The enhanced visualization helps identify subtle anatomical details, making it easier to pinpoint the exact location of the chamber within the tooth.5,7
Accurate canal negotiation: The microscope's magnification enables improved visualization of narrow and tortuous canals within the calcified chamber. This allows the endodontist to negotiate the canals more accurately, reducing the risk of missed canals or procedural errors.6,7
Enhanced instrumentation: The precise focus and fine adjustments of the microscope enable endodontists to perform intricate instrumentation within the calcified chamber. This includes accessing and shaping canals, removing calcifications, and preparing the root canal system for disinfection and obturation.5,7,8
Thorough cleaning and disinfection: The magnification provided by the microscope permits a detailed view of the root canal walls and intricate anatomical complexities within the calcified chamber. This ensures thorough cleaning and disinfection, as the endodontist can effectively remove debris, infected tissue, and bacteria from the entire canal system.7,8
Reduced risk of perforation: The microscope's high magnification helps the endodontist accurately assess the thickness of dentinal walls within the calcified chamber. This reduces the risk of perforation during instrumentation, as the operator can precisely navigate the canals without damaging the surrounding tooth structure.6,7,8
Precise obturation: The microscope enables precise evaluation and placement of the obturation material within the calcified chamber. This ensures optimal sealing of the root canal system, reducing the chances of post-treatment complications and promoting long-term success.7,8
Opening access to identify the calcified chamber.
Identifying the entrance of the canals using ultrasonic tips.
Field of view under lower magnification (0.4x).
Field of view under higher magnification (1.0x).
Identifying the MB and DB canals through the calcified chamber under 1.6x magnification.
Identifying the MB and DB canals through the calcified chamber under 0.4x magnification.
Identifying the MB and DB canals through the calcified chamber under 1.0x magnification.
Identifying the MB 1 under 1.6x magnification.
Indentifying the MB 1 under 1.0x magnification.
Identifying the 4 MB canals completely after removing the calcification under 0.6 magnification.
Goga R., et al, Pulp stones: a review, IEJ 41, 457-468, 2008
Chaini Kallirroi and Georgopoulou Maria, General pulp calcification : Literature review and case report ENDO, Lond. Engl. 2016; 10 (2) : 69-75
Nupura, Vibhute, Daule, Bansal and Mahalle, J Pat Care 2016, 2:1
Moss – Salentijin Letty, Calcified Structures in Human Dental Pulps , JOE , Vol. 14 No. 4 April 1988
Wu Daming, et al, The clinical treatment of complicated root canal therapy with the aid of a dental operting microscope , IDJ 2011 ; 61:261-266
Iandolo A. Et al, Calcification detection and management in the obliterated endodontic space , JO March 2023 ; 15(1)
Carr Gary B., The use of the operating microscope in endodontics , Dent Clin N Am 54 (2010) 191–214
Del Fabbro Massimo, Endodontic therapy using magnification devices : A systematic review, Journal of dentistry 38(2010)269 – 275