Static Guided Nonsurgical Approach for Calcified Canals of Anterior Teeth

  • Jørgen Buchgreitz
  • Lars Bjørndal
  • Antônio Paulino Ribeiro Sobrinho
  • Warley Luciano Tavares
  • Niraj KinariwalaEmail author
  • Lucas Moreira Maia


Pulp canal obliteration (PCO) is characterized by the deposition of hard tissue within the root canal space. This chapter gives a brief account of the significant characteristics of the partially and complete pulp canal obliteration of anterior teeth. Workflow of static guidance for nonsurgical endodontic treatment has been described in detail along with case reports. Review of literature of published case reports has been delineated. Clinical application of endodontic guide and canal scouting technique are crucial for successful guide endodontic case.


Guided endodontics Pulp canal obliteration Calcified canal Cone-beam computed tomography Endodontic guide 


  1. 1.
    McCabe PS, Dummer PMH. Pulp canal obliteration: and endodontic diagnosis and treatment challenge. Int Endod J. 2012;46:177–97.CrossRefGoogle Scholar
  2. 2.
    American Association of Endodontists. Contemporary endodontic microsurgery: procedural advancements and treatment planning considerations. In: Endodontics. Chicago, IL: Colleagues for Excellence; 2010.Google Scholar
  3. 3.
    Buchgreitz J, Buchgreitz M, Bjørndal L. Guided root canal preparation using cone beam computed tomography and optical surface scans – an observational study of pulp space obliteration and drill path depth in 50 patients. Int Endod J. 2019;52:559–68.PubMedCrossRefGoogle Scholar
  4. 4.
    Patel S, Durack C, Abella F, et al. Cone beam computed tomography in endodontics - a review. Int Endod J. 2015;48:3–15.PubMedCrossRefGoogle Scholar
  5. 5.
    Buchgreitz J, Buchgreitz M, Mortensen D, et al. Guided access cavity preparation using cone-beam computed tomography and optical surface scans - an ex vivo study. Int Endod J. 2016;49:790–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Zehnder MS, Connert T, Weiger R, et al. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. Int Endod J. 2016;49:966–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Shi X, Zhao S, Wang W. Novel navigation technique for the endodontic treatment of a molar with pulp canal calcification and apical pathology. Aust Endod J. 2018;44:66–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Wu D, Shi W, Wu J, et al. The clinical treatment of complicated root canal therapy with the aid of a dental operating microscope. Int Dent J. 2011;61:261–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Yang YM, Guo B, Guo LY, et al. CBCT-aided microscopic and ultrasonic treatment for upper or middle thirds calcified root canals. Biomed Res Int. 2016;2016:4793146.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Dawood A, Marti Marti B, Sauret-Jackson V, et al. 3D printing in dentistry. Br Dent J. 2015;219:521–9.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Mozzo P, Procacci C, Tacconi A, et al. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol. 1998;8:1558–64.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006;39:921–30.CrossRefGoogle Scholar
  13. 13.
    Guerrero ME, Jacobs R, Loubele M, et al. State-of-the-art on cone beam CT imaging for preoperative planning of implant placement. Clin Oral Investig. 2006;10:1–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Yatzkair G, Cheng A, Brodie S, et al. Accuracy of computer-guided implantation in a human cadaver model. Clin Oral Implants Res. 2014;26:1143–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Kühl S, Payer M, Zitzmann NU, et al. Technical accuracy of printed surgical templates for guided implant surgery with the coDiagnostiXTM software. Clin Implant Dent Res. 2015;17(Suppl 1):177–82.CrossRefGoogle Scholar
  16. 16.
    Krastl G, Zehnder MS, Connert T, et al. Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology. Dent Traumatol. 2016;32:240–6.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Connert T, Zehnder MS, Weiger R, et al. Microguided endodontics: accuracy of a miniaturized technique for apically extended access cavity preparation in anterior teeth. J Endod. 2018;43:787–90.CrossRefGoogle Scholar
  18. 18.
    Connert T, Zehnder MS, Amato M, et al. Microguided Endodontics: a method to achieve minimally invasive access cavity preparation and root canal location in mandibular incisors using a novel computer-guided technique. Int Endod J. 2018;51:247–55.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Torres A, Shaheen E, Lambrechts P, et al. Microguided endodontics: a case report of a maxillary lateral incisor with pulp canal obliteration and apical periodontitis. Int Endod J. 2019;52(4):540–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Buchgreitz J, Buchgreitz M, Bjørndal L. Guided endodontics modified for treating molars by using an intracoronal guide technique. J Endod. 2019;6:818–23.CrossRefGoogle Scholar
  21. 21.
    Lara-Mendes STO, Barbosa CFM, Machado VC, et al. A new approach for minimally invasive access to severely calcified anterior teeth using the guided endodontics technique. J Endod. 2018;44(10):1578–82.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Lara-Mendes STO, Barbosa CFM, Santa-Rosa CC, et al. Guided endodontic access in maxillary molars using cone-beam computed tomography and computer-aided design/computer-aided manufacturing system: a case report. J Endod. 2018;44(5):875–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Tavares WLF, Diniz Viana AC, Machado VC, et al. Guided endodontic access of calcified anterior teeth. J Endod. 2018;44(7):1195–9.CrossRefGoogle Scholar
  24. 24.
    Maia LM, Machado VC, Alves da Silva NRF, et al. Case reports in maxillary posterior teeth by guided endodontic access. J Endod. 2019;45:214–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Chong BS, Dhesi M, Makdissi J. Computer-aided dynamic navigation: a novel method for guided endodontics. Quintessence Int. 2019;50(3):196–202.PubMedGoogle Scholar
  26. 26.
    Connert T, Zehnder MS, Weiger R. Microguided endodontics: accuracy of a miniaturized technique for apically extended access cavity preparation in anterior teeth. J Endod. 2017;43:787–90.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    van der Meer WJ, Vissink A, Ng YL, et al. 3D Computer aided treatment planning in endodontics. J Dent. 2016;45:67–72.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    de Toubes KMS, de Oliveira PAD, Machado SN. Clinical approach to pulp canal obliteration: a case series. Iran Endod J. 2017;12(4):527–33.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Casadei BA, Lara-Mendes STO, Barbosa CFM, et al. Access to original canal trajectory after deviation and perforation with guided endodontic assistance. Aust Endod J. 2020;46:101. Scholar
  30. 30.
    Shi X, Zhao S, Wang W, et al. Novel navigation technique for the endodontic treatment of a molar with pulp canal calcification and apical pathology. Aust Endod J. 2017;44(1):66–70.PubMedCrossRefGoogle Scholar
  31. 31.
    Mena-Álvarez J, Rico-Romano C, Lobo-Galindo AB, et al. Endodontic treatment of dens evaginatus by performing a splint guided access cavity. J Esthet Restor Dent. 2017;29(6):396–402.PubMedCrossRefGoogle Scholar
  32. 32.
    Langeland K, Dowden WE, Tronstad L, et al. Human pulp changes of iatrogenic origin. Oral Surg Oral Med Oral Pathol. 1971;32:943–80.PubMedCrossRefGoogle Scholar
  33. 33.
    Holan G. Tube-like mineralization in the dental pulp of traumatized primary incisors. Endod Dent Traumatol. 1998;14(6):279–84.PubMedCrossRefGoogle Scholar
  34. 34.
    Amir FA, Gutmann JL, Witherspoon DE. Calcific metamorphosis: a challenge in endodontic diagnosis and treatment. Quintessence Int. 2001;32(6):447–55.PubMedGoogle Scholar
  35. 35.
    McCabe PS, Dummer PM. Pulp canal obliteration: an endodontic diagnosis and treatment challenge. Int Endod J. 2012;45(2):177–97.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    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;25:620–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Holcomb JB, Gregory WB Jr. Calcific metamorphosis of the pulp: its incidence and treatment. Oral Surg Oral Med Oral Pathol. 1967;24:825–30.PubMedCrossRefGoogle Scholar
  38. 38.
    Bjørndal L, Darvann T. A light microscopic study of odontoblastic and non odontoblastic cells involved in tertiary dentinogenesis in well-defined cavitated carious lesions. Caries Res. 1999;33:50–60.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Fleig S, Attin T, Jungbluth H. Narrowing of the radicular pulp space in coronally restored teeth. Clin Oral Investig. 2017;21:1251–7.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Agamy HA, Bakry NS, Mounir MM, et al. Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Pediatr Dent. 2004;26:302–9.PubMedGoogle Scholar
  41. 41.
    Andreasen FM, Zhijie Y, Thomsen BL, et al. Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition. Endod Dent Traumatol. 1987;3:103–15.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Flores MT, Andersson L, Andreasen JO, et al. Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth. Dent Traumatol. 2007;23:66–71.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Flores MT, Andersson L, Andreasen JO, et al. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol. 2007;23:130–6.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Delivanis HP, Sauer GJ. Incidence of canal calcification in the orthodontic patient. Am J Orthod. 1982;82:58–61.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Brodin P, Linge L, Aars H. Instant assessment of pulpal blood flow after orthodontic force application. J Orofac Orthop. 1996;57:306–9.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Johnstone M, Parashos P. Endodontics and the ageing patient. Aust Dent J. 2015;60(Suppl. 1):20–7.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    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 followup. Gerodontology. 2017;34:164–70.PubMedCrossRefGoogle Scholar
  48. 48.
    Allen PF, Whitworth JM. Endodontic considerations in the elderly. Gerodontology. 2004;21:185–94.PubMedCrossRefGoogle Scholar
  49. 49.
    Wu B, Hybels C, Liang J, et al. Social stratification and tooth loss among middle-aged and older Americans from 1988 to 2004. Community Dent Oral Epidemiol. 2014;42:495–502.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Robertson A, Andreasen FM, Bergenholtz G, Andreasen JO, Noren JG. Incidence of pulp necrosis subsequent to pulp canal obliteration from trauma of permanent incisors. J Endod. 1996;22:557–60.PubMedCrossRefGoogle Scholar
  51. 51.
    Naumann M, Sterzenbach G, Dietrich T, et al. Dentin-like versus rigid endodontic post: 11-year randomized controlled pilot trial on no-wall to 2-wall defects. J Endod. 2017;43:1770–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Lang H, Korkmaz Y, Schneider K, et al. Impact of endodontic treatments on the rigidity of the root. J Dent Res. 2006;85:364–8.PubMedCrossRefGoogle Scholar
  53. 53.
    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;40:223–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Tavares WL, Lopes RC, Menezes GB, et al. Non-surgical treatment of pulp canal obliteration using contemporary endodontic techniques: case series. Dent Press Endod. 2012;2:52–8.Google Scholar
  55. 55.
    Tavares WL. Management of clinical complications following pulp canal obliteration: a report of two cases. Dent Press Endod. 2016;6:54–62.CrossRefGoogle Scholar
  56. 56.
    Jacobsen I, Kerekes K. Long-term prognosis of traumatized permanent anterior teeth showing calcifying processes in the pulp cavity. Scand J Dent Res. 1977;85:588–98.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2021

Authors and Affiliations

  • Jørgen Buchgreitz
    • 1
  • Lars Bjørndal
    • 2
  • Antônio Paulino Ribeiro Sobrinho
    • 3
  • Warley Luciano Tavares
    • 3
  • Niraj Kinariwala
    • 4
    Email author
  • Lucas Moreira Maia
    • 3
  1. 1.AllerødDenmark
  2. 2.Section of Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Restorative Dentistry, Faculty of DentistryUniversidade Federal de Minas Gerais (UFMG)Belo HorizonteBrazil
  4. 4.Karnavati School of DentistryKarnavati UniversityGandhinagarIndia

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