Endodontic Management of Calcific Metamorphosis in Maxillary Central Incisor: A Case Report

Abstract

Calcific metamorphosis is a pulpal reaction to dental trauma where the root canal gets obliterated by the deposition of hard tissue within the root canal space. Calcified root canal possesses a great challenge to the endodontist as negotiating such canal is very much difficult and tiring job along with risk of iatrogenic root perforation. Negotiation of root canal during endodontic treatment is very much crucial for its success as it could affect the cleaning, shaping, disinfection and finally 3 dimensional obturation of the root canal. This case report demonstrates the clinical management of maxillary central incisor with calcified canal in a 28 years old female patient with a history of trauma 2 years back. The preoperative radiograph shows complete obliteration of the canal up to coronal 2/3rd of the root canal along with widening of the periodontal ligament space. The only way to locate and negotiate such calcified canal was to remove the calcified pulp tissue from the canal while staying centered within the root during negotiation. Control radiograph was taken to rule out any deviation from the root’s centre during negotiation. Once the calcified tissue from the coronal 3rd of the root was removed using fine ultrasonic instruments, a #08 C+ file in a watch winding motion along with alternate use of 5.25% sodium hypochlorite and 17% EDTA was then used to negotiate the remainder of the canal. After negotiation of the calcified canal of tooth #21, it was then successfully cleaned, shaped and obturated till the apical terminus.