Identify – Calcified Canal

[gunjan_dhorajiya]

For the treatment of 11. (Pic 1)
Single root, single canal, no crown, you would think that this would be an easy root canal. However, notice the calcification of the canal. Sometimes when the crown is gone, it is difficult to determine the long axis of the tooth. You can see the the original access is getting slightly off centered toward the distal & lingual. This wise dentist knew to stop before a perforation occured.

If you look closely (select the image to enlarge), you can see the difference in color between the primary and secondary dentin. (Pic 2) You can actually see where the canal used to be, before it calcified in. Right in the center of that secondary dentin is a small white speck. This is where the dentinal chips have accumulated in the canal. That little white spot is the remnant of the canal.

Micro-opener used to open the canal. (Pic 3)

The rest of the case goes without a glitch.

        

[sushantpatel_doc]

How can one utilize ultrasonics to facilitate locating calcified canals?

Piezoelectric ultrasonics in conjunction with the ProUltra ultrasonic instruments (Dentsply Tulsa Dental) provide a breakthrough in exploring for and identifying calcified, aberrant or previously missed canals. Ultrasonic systems importantly eliminate the bulky head of the conventional handpiece which notoriously blocks light and obstructs vision. Ultrasonic instruments are used with a light touch in a brush-cutting manner to progressively sand away precise amounts of dentin. Microscopes and ultrasonic instruments have led to microsonic techniques that have significantly improved vision, control and safety when searching for difficult to find canals.

Specifically, the abrasively coated SINE tips or the ENDO-2 or 3 are the ultrasonic instruments of choice for troughing along grooves such as between the MB1 and MB2 orifices. Traditionally, clinicians have searched for the MB2 system within the groove off the MB1 orifice when in fact the MB2 is mesial to this groove, under the shelf of overlying dentin. This lip of dentin can be safely sanded away and easily eliminated with ultrasonic energy. Ultrasonic instruments can also be used to chase calcified canals that are receded and have pulled down and away from the pulpal floor. Further, the tip of an ultrasonic instrument may be used to vibrate and disintegrate a pulpal stone and is safer and more efficient than drilling or trying to remove them with spoons or excavators. For additional information, I also refer you to the Ruddle on Shape•Clean•Pack DVD and/or the Ruddle on Retreatment DVD "Disassembly & Missed Canals" as each have sections that clearly show a number of methods for finding canals.

        

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