Calcified Root canals have always been a nightmare for Dentists and Endodontists alike, they are difficult to locate and are very time taking to locate and prepare. As the name suggests, Calcified Root Canals are calcium deposited in the root canals which are usually hollow or with the pulp tissue in it. The cause of Calcification varies, might be due to prolonged infection, trauma etc. Let us have a look at how to treat calcified root canals and know why they are caused in the first case.
Why and When are Root Canals Calcified ?
Root canals are calcified in both anterior and posterior teeth alike without many variations in ratios; there are many reasons why Root canals can become calcified:
- Can be a result of Natural Process of Aging
- Prolonged Trauma
- Prolonged infection
- Non Vital tooth without Endodontic treatment for many years
- Dental Decay
- Dental Fillings or Crowns which are exerting constant force on tooth and root canal over a long period of time
- Gingival Recession that occurs in Coronal part of the tooth
How does the Calcification Progress in the Root Canal ?
- Calcification process often starts from the Coronal Portion of the Root canal, the coronal portion of the root canal is the first to calcify due to the many reasons mentioned above which are often seen mainly on the coronal part of the root canal.
- Hence the coronal portion is more calcified compared the Apical portion in a Calcified Root Canal, if you can go through the Corol 1/3 rd portion of the Calcified Root then it becomes very easy to reach the apex with the help of Files, Reamers (start with 06, 08 and 10 numbers) and some help from RC-Help (EDTA Paste with Carbamide peroxide) or any EDTA solution used alternatively with NaOCl irrigation to soften the Dentin in the Root canal.
How to Locate Calcified Root Canals:
- Locating Calcified canals in Anteriors is a rather easy process as we know the location and even the size of the root canal is rather large. But the trouble begins in case of Posteriors or teeth with multiple root canals where locating the Root canal openings becomes rather difficult and over cutting of the Dentin will often lead to Perforations in furcation as we have seen in many cases.
- While locating Calcified canals having Patience is of utmost importance
- Using the Radiograph get a mental picture of the supposed location of the calcified canal and start removing the Dentin covering.
- When you reach the location which you think was the canal opening earlier, isolate the cavity properly
- Now you can see the difference between the Primary and secondary Dentin which is slightly whiter
- And in the middle of the Secondary Dentin you can find a White Spot which is the remnant of the Root canal
- This is where you need to start exploring using either a “Micro canal Opener” or “Ultrasonic Tips” to slowly make way for the Files to be used.
- Once the Coronal part of Calcification is dealt with it is very easy to reach the apex without much difficulty taking help of files and Reamers starting from 06 n.o and progressing towards bigger numbers.
- There are many lubricants or De Calcifiers which are available in the market like RC-Help or any EDTA solution or gel which help in softening the calcified portion of the root canal to ease the way for doing BMP. While using EDTA the canal should be irrigated constantly with NaOCl.
Instruments used to Locate Calcified Root Canals:
- 6 n.o to 10 n.o K files – (Numerous until you achieve patency)
- Endodontic Probe – Very useful in locating the Pulp chamber
- Ultrasonic Scaler with Interdental Scaler Tip – This helps in removing any calcified tissue on top of the pulp chambers and achieve initial entry into the canal without damaging floor of the Pulp chamber.
- EDTA and and Sodium Hypochlorite Irrigants
- Lots of patience and time
Calcified Roots are an enigma in Dentistry for the Endodontist, treating such cases is a challenge but it sure brings in a lot of satisfaction after completing the case successfully. Main sutra of treating Calcified canals is to be patient and keep trying.
Honestly speaking root canal treatment this word first time i heard from dentist. I not even know is type of treatment is there… From last 2 weeks I was suffering from toothache and some resist body pain as well, my dentist suggest me do root canal treatment. I am very scared to do that, I don’t know it will be going to be painful or not…What should i do is there any alternate option for root canal treatment ?
Hi Varun,
I recently saw a patient who had trauma in upper central incisor many years ago, tooth is non vital with some radiolucency at apex about 5*5 mm. Radiograph comparison showed no changes in apical radiolucency . Other dentist told the pt that canal is calcified and tooth should be leave it like that. Tooth color is dark compare to others. What would you recommend doing? RCT is nearly impossible. apicoectomy? Thanks.
Hi Harsh,
Having a Calcified canal does not make it impossible to do RCT on, it is just that we need a lot of patience and use decalcifying agents to get access to the canal as it is 11 or 12 we can easily know where the aceess would have been so with the use of Ultrasonic Tips you can get access, keep in mind that the calcified canal is softer than the surrounding tooth structure and do RCT on it before going for a Crown. I have done many cases like this it is just that we need to give time for the BMP part which can be divided into 2 appointments.
Try to go for it, once you do it the next time it becomes much easier.
i want to know about calcified root canals,how to treat,and want to show images of calcified canals
I have had approximately 8 root canal treatments over 24 years and every one has been successful except one which was done by a general dentist. That one failed after 4 years and when I demanded to be referred to my endodontist Dr David Barnard his xrays revealed that the dentist had only cleared one third of the way along the canals. He then redid the whole job and the tooth now crowned is fine. My experience with general dentists is that they do not immediately refer you to an endodontist when they experience difficulty with canals. One even said to me that an endodontist would not do anything that he wasn’t doing and wanted to extract the tooth.
My urgent advice to anyone requiring root canal treatment is to ask to be referred to an endodontic specialist who will charge approximately $2,250.00 in total. If I may say so the two endodontists that I have been referred to over the 24 years are Dr Barnard as above and Dr Barry Sandler.
For those fearful of the procedure let me reassure you that it is not painful simply because the nerve is now dead as opposed to a general drilling of a tooth where the nerve is still alive. Indeed once the canals are drained the relief is immediate.
Done properly by a skilled endodontist results in great success.
Hi. I have a case 37. the mesiobuccal canal seems calcified at the middle. the file progresses to 16mm and then i feel like i am hitting a wall. i have used files 6,8,10. i have precurved them, bent them but so improvement. even in the radiograph the outline of the canal disappears after 16mm.. the remaining part is radio opaque… what do i do?
Did you try using lots and lots of RC Help? In some cases if the particular root is not having any radiolucency and cannot reach till the apex can be left out and filled in.
Just heard about calcified tooth canal at my dentist ? wondered what it is ? top part of my tooth and now also side leaving roots ? my dentist recommended a partial with a tooth on it and removal of my tooth roots ! would this be best or any other solution ? should I see another dentist maybe ?? worried its my lower 3rd from centre ?
I had a case 16 with crown, access opening done via it..Mesiobuuccal canal i found hinderance not going beyond 18mm and tried to gather info from iopa but wasnt very sure if the canal is calcified or no.. i cleaned MD and P canals till 21 mm..used lot of irrigation Hypo and EDTA and decided not to try further and planned second appointment.whole half an hour of 2nd appointment i invested in MB and finally managed to open it and den obturated the tooth in the same visit..was really glad and satisfied with the amount of effort i put and with the beautiful resulti could see in the xray.
“Being Patient” is one of the most important points in case of Calcified Roots.
Plz, what is the difference between blocked canal and calcified canal?
A Calcified canal is one where the pulp tissue is degraded and in the pulp chamber, calcium deposition takes place blocking the canal as a long or chronic defense mechanism by our body to keep out infection.
There can be many scenarios which lead to a Blocked canal – It can be due to calcification of the canal, blocked canal due to Pulp Stones, Ledge formation during Root canal procedure can lead to blockage of canal.
I have a discoloured tooth with not much sensation of heat. But there is no pain in any way and no symptoms other than the discolouration. My dentist started a root canal treatment and has discovered a calcified canal. Should the root canal be continued or is it better to stop, and if later on there are any symptoms try to restart.
It can be continued, if the canals are completely calcified the tooth can be left as it is and go ahead with restoration of it.
I was recently told that the cabals were calcified or obliterated and endodontist recommended proceeding with crown. When I remarked that there was some pain (not constant maybe 3-4 at worst on a 10 scale) he remarked that the pain would be way worse if the canal was not calcified. They’ve completed the restoration and crown with a post. Am I stuck with this pain for the rest of my life? It’s worse after hot or cold foods.
If you are having sensitivity / pain on taking hot and cold foods, it should be addressed as it can be problem with the restoration or the crown. After any restoration or crown there should be no pain or sensitivity on the treated tooth.
As for the calcified canals, it depends on the extent of calcification to decide whether to fill the canals or just to give it a crown or restoration. It is better you get it checked once again as there should not be any pain or sensitivity in the tooth.
I have a patient in whom i have intended to do RCT in 36 and started to do access opening ..and took a preoperative xray but i could only get distal canal and not Mesiobuccal and Mesiolingual canals.I tried t hard to find the orifice but in vain..then i did bmp in distal canal only and kept intracanal medicament and closed with temporary filling and sent the patient. What should i do next ..should i just do obturation in the distal canal and restore the tooth or go for extraction?
Did you use the Ultrasonic Scaler in the pulpal floor ? It helps in some cases of Calcified canals where the dentin can be removed with the scaler and can prevent any perforation.
I have a patient in whom I have opened 46 with great difficulty negotiated mesial canals and in distal canal went half way through and then the canal is not negotiable…I have tried from from 6 file using EDTA…wat to do
According to my dentist no way to treat that tooth which have calcified except removing the tooth. Wht i do ??
Hi Varun,
I am Sukanya from India. I am staying in USA.. I have cavities. I had a chirped teeth and it pains from 2 days so I went to my dentist today. It’s no 2 teeth( right upper) He said I need root canal . So he started the procedure after spending 2hours in the procedure chair he said he found the 2 nerves but not able to find the 3rd nerve . Then he gave 2 options
1. He referred me to endodontics for root canal
2. I can go for tooth extraction
Going to specialist is expensive and I have one more root canal to be done on lower right
Can you please suggest which is the better option.
Thanku
Sukanya
It is better to go to a specialist if you want to save the tooth, If you get the tooth extracted it will be even more costlier to replace the tooth extracted by either a Bridge or an Implant. The two options given by the Dentist are the only ones which are best suited for your situation. If you are going to come to India anytime in the near future it will be better to plan the treatment plan here which is much cheaper and same procedure and material are used at a much much lower price point.
If the tooth is asymptomatic it can be left as it is, in case there is infection it is better to take a second opinion from a Specialist – Endodontist who will be the best option to make sure whether the tooth is treatable or not.
Is there any periapical inflammation in the said canal? If there is not infection in the canal then it can be left as it is and go ahead with the obturation. If there is any inflammation then it is a difficult scenario, the option arises whether to extract the tooth.
Hi Dr. varun
Today I had my last stage for RCT, stage 3 .The Dentist told me that the tooth”46″ has sclerosis. The pain is on off. He requested me to see a Specialist.
What are the complications of the sclerosis? And is the tooth going to heal?
Sclerosis is nothing but an abnormal hardening of body tissue like bone or pulpal tissue in case of the tooth. This does affect the time taken and mode of treatment in case of a Root Canal. Your tooth can be cured, it is best that you see a specialist.
Hi so I’ve just come back from an emergency appointment with my dentist because I have been experiencing extreme pains inside my tooth.it has always been sensitive to hot/cold foods but over the past few days the pain has increased by 10. Initially she suggested booking me in for a root canal but then when she looked she said to me that one of the roots has calcified. So she changed my appointment for a much longer one as she said it’s a very tricky procedure. I’m not really sure what that means and I’m really scared of the dentist! Will I experience any pain/ what will happen if she doesn’t manage to fix the problem.
Dear Varun, RC Cal is an calcium hydroxide radio opaque paste, while RC Help is an EDTA lubricating paste i think by error you have mentioned RC Cal instead of RC Help. Dr. Paresh Thakkar of Prime Dental Products Pvt Ltd
Thank you for pointing it out Dr. Paresh Thakkar, it has been corrected.
Hi Louise,
Treatment for Calcified Root canal is often painless but is surely time taking. Let me give you an example – When you are watering your garden, if the water pipe or hose is clear without any blockage you just take the hose and water the plants and leave. In case there is something stuck in the water pipe, you take some time to clear the blockage before watering the plants. The same is in this case, the canal which is usually open is now calcified or blocked so it takes time to clear the block. Hence the extended period of time is required to treat a Calcified Root in comparison to Normal Root.
hi Dr. Varun , i have a patient in whom i have started rct in 11 and tried access opening. I tried hard to find the orifice but ended with perforation. I closed the tooth with temporary filling and patient is not having any pain or sensitivity but radiolucency at apex. Pateint’s chief complaint is discolouration of tooth only. What to do next?? patient has already visited three times for the same tooth.
Hello Dr. Sia,
If there is a perforation, better to seal it with MTA and in case you are not able to find the canal, you can go for Apicoectomy to treat the Peri apical radiolucency. After that you go for a crown to help covering up the discolored tooth.
can i give him crown without doing apicoectomy? as patient is not ready for any surgical process.what if i give him crown like that as he is not having pain.
If there was no periapical radiolucency you can give a crown without any worry. As you mentioned that there is periapical pathology, on giving a crown it will flare up and the patient might start having pain.
You can give a crown and take your chances with it, hoping that it might not flare up. Whatever you do, make sure that you explain to the patient in detail what the condition is and what might happen, sometimes the patient tend to blame it on us stating that we did not mention them this option. So Write it down in their prescription and also in your OP card after explaining about the alternatives to the patient.
thanks doc..
Hi varun I hv a que …I’m doing rct of max ist premolar. .opening of both canals is visible but file is not going inside palatal canal ..wt does it mean ?? Canal Is calcified? ?
Have you taken the xray with the buccal file inserted ? How does it look ?
Hello doctor,
I have my front upper tooth 1 got fractured under the gum (middle third of the tooth) but no color change nothing but sometimes pain comes and some pus pimple forms and breaks off when took xray few years back the fracture line was clear but now it got reduced is there possiblity of broken tooths rejoin inside?insaw a endodontist he said for RCT and other doctor says to extract and put tooth bridge im 28 yeas old pls advice
At your Age it is best to go for RCT or Root Canal treatment and then get a Zirconia Cap or Crown as it is the front tooth. If you are getting a Pus Pimple it is due tooth fact that there is infection under the bone at the tip of the Root of the tooth which needs to be treated first.
Extraction should always be the last resort as the natural tooth is the best and if it is possible to save the natural tooth it has to be done at any cost.
Thanks for the swift reply doctor i checked with my dentist and few other dentist for opinion majority of them advice to go for extraction because there of the fracture,and they advice for titanium which cost upto 40k and zirconium root 1.5 lakhs,meanwhile on internet i can see there are some reasearch on stemcell tooth regeneration how far are we from that becoming a realty and how much would it cost?will that be safe?
After what age one can opt for implant what role age plays here doctor?
Hello doctor how they treat the infection under the bone?
Can a root canal be done with a calcified tooth?
Yes, it can be done but takes multiple appointments and a lot of time.
I did #12 RCT. Palatal canal could not be negotiated completely with size 10 file, not even through coronal 1/3. Buccal canal was negotiated to apex by apex locator. Sealed buccal and took PA, apical 1/3 is not sealed with GP. Pt returned 3 days later with pain. I adjusted the temporary crown as she was hitting there first. How would you proceed if the pt continues with pain?
Have your Tried using Ultrasonic tips to open up the palatal canal, have found that ultrasonic tips are very useful in getting a clear Palatal canal opening which can be useful when there is calcification or Pulp stone blocking the Coronal portion of the canal.
You need lots of time to negotiate the canal, as for the pain we can only tell after seeing an IOPA what might be the problem.
Hi. Dr. Varun,
I was seeing by two dentists whom were not able to do the root canal on my #29- They said its calcified- That was about a year ago – I let it go because I did not have any pain- Few days ago all of the sudden I started to have pain and next day my face was all swollen -still it is- The took looks almost black :( I am currently taking antibiotics – I went today to be seen and I was referred to an specialist – I don’t now where to go- I don’t want to loose my tooth- I am wondering if I could send you the x-ray it was taken today for you to see and if you are able to tell me if they should be able to actually do a root canal- Thank you-
hello doc.. i have started rct in 16 17.on first siiting everything was fine. I have used dvitaliser in both teeth after opening. From next sitting patient is feeling pain badly. TOP is positive bot on filing canals are cleaned. Like this i am stuck in one other case also. What to do? what medicine should i fill in canals to remove pain. patient already visited 3-4 times for this teeth.
Did you take an IOPA ? Have you reached the complete working length ? Are you over extending the canals ? Did you miss any accessory or extra canal ?
There are multiple reasons for the pain to appear, so try to eliminate one after the other by following the X-Ray and also clinically. Make sure you irrigate properly with Sodium Hypochlorite (using Warm Hypo and activating it inside the canals can help in devitalising the accessory canals which are hard to clean.
If you have an IOPA and can forward it to my mail – juniordentist@gmail.com it can be helpful in identifying the problem.
Sure, if you can send me and X-ray we can get a clear idea about the calcified root canal. My mail i.d is juniordentist@gmail.com.