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.
A direct pulp capping was done on my tooth # 12 with Biodentine. The Dentist (2 of Entodontic specialist) states only if it hurts you can come back for RCT. However, looks like the symptoms are still like reversible pulpitis (Response only to stimulus and no linger pain with Hot/Cold food). Its been 2 months now.
On many websites I have seen there is an evaluation to check if there is a reparative dentin formation in a few months without which the next plan of action should be taken.
Please suggest which is true and how long should I wait so that I can save my tooth.
An X-ray is the best way to access whether the reparative dentin has formed and whether a Crown can be placed if necessary.
Hi Doc, my dentist said I have calcified tooth, my #9 due to multiple trauma. It’s been calcified for about 15 yrs maybe, no pain, but discolored. The first dentist that saw it yrs ago, said, let it be as long as there’s no pain. But now recently my other dentist saw apical radiolucency, it’s a forming abscess and there’s not much difference from my X-ray last March 2017 and still no pain. What to do?
Hi Doc, my #9 tooth is calcified, no pain just discoloration. 1st dentist, about 15 yrs ago said leave it alone. Recently, another dentist saw apical radiolucency but not much difference from X-ray last March 2017. Still no pain. Referred to an endodontist but I’m scared. Pls advice what’s the best thing to do?
If there is a radiolucency then it has to be treated, there are two options (to save it) with a Calcified Tooth – Root Canal Treatment (by an Endodontist) and Apicoectomy. If we leave the infection it might lead to an abscess or even a cyst. It is best to go to your Endodotist and get it done. As it is calcified there might not be any pain or in some cases no need for Local anesthesia as well.
I recently went to a Endodontist for a root canal on #14 tooth. It has 3 roots. One of the roots is calcified. The Dr. recommends a tooth extraction. I am so upset to have to loose another tooth. Should I ask him if he has heard of EDTA? I know he performs stem cell treatment on children. He seems to be an excellent Endodontist and did not charge me despite working on my for 45-60 minutes.
If he is an Endodontist, he must be knowing and using EDTA on a regular basis. If an Endodontist says that it cannot be saved maybe it needs Extraction itself.
If the calcification is present in One Root only, there is a procedure called “Apicoectomy or Root End Ressection” where you remove or cut off the tip of the Root which is infected to completely remove the infection which was not possible via RCT. – https://www.juniordentist.com/apicoectomy.html
This is an option which we consider if there is no possibility of a Root Canal Treatment to be successful.
Hello doc.. need Ur help to bcum master in RCT. Can you please help me to improve my treatment strategies… What steps or precautions should I follow!!
For a Root Canal treatment to be successful, the first and foremost aspect is to have a good diagnostic X-ray. This helps us in identifying the number of canals, any irregularities or abnormalities in the shape and number of canals. If there is any calcification of canals or a pulp stone involved. Identifying all these before hand can help us in deciding the treatment plan which we want to follow and makes it a lot faster and easier.
The next important aspect is irrigation – this helps in achieving a clear and sterile environment in the pulp canals for a successful root canal treatment.
The latest but most important point is to attain a perfect coronal seal. This is of utmost importance as this prevents any leakage which might lead to failure of a Root canal and also helps in placing a successful Crown.
Dear Doctor,
I had a calcified front tooth (top front tooth). The endodontist tried negotiating the canal until the level of the skin (4mm below CEJ) and then gave up saying trying more is not advisable. He later filled it up with MTA and gave me a crown. I am however worried if the procedure was correct. Please note that this was a very reputed multi speciality dental hospital and hence I thought they must be true. It is said that you must trust your doctor, and I did, but however i sometimes wake up with dreams that i have infection under the crown and need reassurance from time to time. Was this correct? are some calcified tooth really not negotiable? or did the endodontist not try hard enough?
There is nothing to worry about until there is no infection in the Periapical region. Placing an MTA plug is the right thing to do. You need to worry only when there is any pain or swelling in the tooth. In most cases the calcified tooth is asymptomatic life long.
a quick question: When does a doctor decide to stop negotiation? I thought it is always possible to find the canal using a microscope and other digital techniques?
I had no pain but the color of the tooth was changing which was the main reason for me to go for an RCT. The endodontist told me that there is no infection and there will be no infection in future too because the MTA will mimic the tooth and since the tooth is calcified there is no chance bacteria to reach the pulp and cause infection.
Do I need to get half yearly or yearly checkups of this crowned tooth? what do you suggest to “save” this tooth.
Thanks again!
Hi
Last Wednesday I had a root treatment done at the dentist due to decay. My dentist managed to find two roots but said the third was calcified as he was unable to find it.
He finished the filling and said that as the tooth had not given me any problems (the decay was picked up on a routine visit) he would leave it as it was.
If this tooth gives me no further problems is it ok to leave it .
Yes, in some cases if the Calcified Root canal is asymptomatic and difficult to locate it can be left. The only thing which we look for is the presence of any Peri-apical radiolucency in the calcified root.
Thank you for your very prompt and informative answer.
I do now have a follow up question re the same tooth.
Two days after the aforementioned filling I developed a heavy feeling in my cheek and also a headache in my left temple. This did ease but over the last week my left side still feels slightly pressured and on a recent doctor appointment I mentioned it thinking it was a sinus problem.
My GP feels it is a dental problem and thinks because it was quite an intensive filling it may be inflamed. Her advice was to wait two weeks and if it still is no better to visit my dentist.
My question is..is that sound advice and if there is a slight infection is it possible it will clear up on its own
Is has improved and I have no pain in the tooth or the gum area.
Were you give given a local anesthesia injection? From what you have mentioned it appears to be inflammation of the muscle which is seen in some cases of Local anesthesia where the muscle is injured while giving the injection. It will subside on its own over a period of time.
Yes, I was given an anaesthetic injection.Although it did seem to be a bit better, last night I had about 3 hours sleep.It wasn’t hugely painful but just felt a constant awreness in that area.I’m wondering if there is an infection there.
Hi doc! I had a root canal on my upper molar. Endodontist was able to clean and fill the 2 canals but the 3rd canal is calcified even after putting EDTA so it was not filled. We decided to observe in 2 months before putting a crown. After a month I feel a very little pain (about 1 in 1-10 rating) spontaneously with the tooth. Since this tooth is a part of a 2-teeth bridge, i do not know if i should risk putting back the bridge. But if i dont, i will have 2 missing teeth. Question: in your opinion, do u think my tooth as described can still last for long even if the calcified canal was not filled?
I had broken the crown on #3 tooth. I let it go for a year and a half. I grind my teeth at night, and I believe the trauma has caused this tooth to flare. I woke up to a swollen jaw and red pockets of fluid at the top of the gumline. I went to a clinic where I was given an antibiotic. I was told that my tooth had abscessed. As soon as my dentist office was open, I went to him. They X-rayed my tooth and told me that one of the 3 prong canals had calcified and referred me to an endodontist for a root canal. What can I expect?
Hi Doctor,
I went to a root canal expert office today, re/tooth #2. It is extremely
sensitive to cold, a little with warm.
The dr will do a root canal, but says that the tooth is calcified, so after 1st
hr/half appt, I come back for 2nd appt 4-6 wks later. Isnt that a bit long
for the 2nd step appt?
Ive had root canals before and always done within one appt, plus the dr
wants to give me Nitrous oxide sedation along with a relaxing pill the nite
before. I dont want the office girl I didnt want it, but the dr insisted that I have it?
Is this abnormal for a root canal?
My last endontist didnt give me either drugs, just local novacaine.
Can I go to a dentist and get the root canal done or is mine considered too
complicated. It almost seems like major surgery to me.
Your opinion is very appreciate. Thanks
Novacaine should do the trick to your even if it is calcified, but I cannot comment on the complication of the case without seeing it personally. As for the appointments in case of any peri apical infection we give it a bit of time to let it heal before the second appointment. Calcified Root Canal Treatment usually requires anywhere between 2-3 appointments and takes a lot of time for each appointment.
If only one of the canals is calcified it might not be much of an issue, you need to be ready for multiple appointments for your Root canal Treatment and each appointment can range between 1 hour to 2 hours.
An IOPA or X-ray can help in determining the prognosis of the tooth, In case there is no infection is calcified root it can be left, but if there is peri apical infection then it needs to be addressed mostly through Apicoectomy (https://www.juniordentist.com/apicoectomy.html) which is surgically removing the apical infection and back filling the root canal.
Respected Sir,
I opened an RCT in 46. The tooth is florosed. I was able to negotiate MB and ML canals but not to entire working length. And distal canal is totally unexcavated. What to do? There was no bleeding on opening the pulp chamber.
How is the IOPA ? Can you find the full working length of the canals in it?
If you are not able to locate the Distal canal, try using a Interdetal Scaler tip with Ultrasonic Scaler to slightly run around the portion of the floor of the mouth where you think the canal might be located.
Using a Endodontic Probe is also helpful in such cases.
For the MB and ML canals, time and patience is the only thing which you need to have, use lots of EDTA, take 06 number file and try to negotiate slowly to the working length, make sure you remove all legdges from the coronal portion to have a straight line access.
Hi Doctor,
I went in for my regular checkup and was told I have some calcification in some root canals. They said they would just keep an eye on it….but they won’t see it again in another 6 months! Can I do anything to prevent it from getting worse? I am beyond scared! I take good care of my teeth! Should I be worried! If it gets worse, what will happen to my teeth? I am in my mid-30’s, isn’t this too young to be worried about this?
Hi doc. I recently got 6 x front veneers on my front social 6. I had previous had composite bonding that was staining. However following the treatment I got a pain in my gum under my nose. I went to see a specialist you recommended rct however she could not find the root as it was calcified and referred me to have a cone beam ct of same tooth. When she examines the X-ray it looks like external tooth resorption . This calcified front tooth had trauma as a child. I have 2 options I’ve been told first get specialist gum surgery to open gum and seal resorption however the rct must be first done or secondly extract the tooth get get an implant. The endodontist recommend extraction as option 1 might fail and it would wasted money then only have to do option 2. What would you advise thank you
Hi doc,
I’ve just been diagnosed with generalised pulp calcification/obliteration in all my teeth. My history is chronic sclerodermatous gvhd following stem cell transplant to treat acute myeloid leukaemia. My teeth look normal and there is no pain. I’m a 37 yo woman, now 13 years post transplant. What does this mean for me? Sounds pretty devastating…
Hello, its nothing to worry about. Calcification dosent mean the teeth are affected in a negative way. It just means that the soft tissue (Pulp) has been replaced partially with calcified tissue as a Response from your own body to any trauma or stem cell treatment in your case.
As you are not facing any problems like pain or sensitivity in any of you teeth you can just make sure that you maintain good oral hygiene and do not let caries affect your teeth.
Calcifications only become a problem while performing Root canal Treatment, as they make it difficult to access pulp chamber.
I had my ortho treatment 7yrs back… Now when I took IOPA i saw i have calcified root canal of 21..I planned for another ortho management for my relapse and spacing… Is it possible for another treatment??
I have no pain, no radiolucency over the apical region..
Wat would be the possible things for I have to fear!?
You can go ahead with the Ortho treatment, calcified root canal does not affect anyway in Ortho treatment. Only when there is Ankylosis of the root to the bone it becomes a problem with re-treatment.
My teeth have been capped for 17 years with no problems. My front cap recently broke off. A root canal
couldn’t be completed because it was calcified. The endodontist drilled a hole in the root so that my dentist could put on a post and glue the cap on temporarily. They want to pull the tooth and recap 6 teeth to form a bridge for my front tooth. I’m heart broken to loose my front tooth. Do you know of another option?
In case of an infected tooth, a Root Canal is a must and if the Root is strong enough we can plan for a “Post and Core” technique to get support from the underlying root to put a cap on your tooth.
Why are they planning a 6 unit bridge if only one tooth is lost ? Are the other teeth weak periodontally ?
I’ve been advised that I have a calcified root and need a root canal procedure. It is on a molar that has been badly chipped for years. It also has an old filling. There is no pain. But I’ve advised to have a root canal and crown. I’ve had pain trauma in the past from a dental procedure and I’m very, very anxious and nervous. If I’m not feeling pain why would I need the procedure? I am concerned that it is a difficult procedure to perform successfully.
Having a Calcified tooth treated will not be painful but will only be a little time taking. Treating an infected tooth will be painful sometimes. So to make sure that the tooth is saved from any further damage of being chipped off and fractured, the procedure might have been suggested.
Hello, I have a discolored front tooth, my local dentist said the tooth is dead and needs a root canal. The dentist attempted to do a root canal but couldn’t go through with it because she discovered my canal is calcified. I didn’t have pain in that tooth until a cold test was done a few weeks ago and that’s when I was advised I needed a root canal. However I’m now having pain in that tooth. Should I see an endodontist? I don’t know if it’s infected due to the pain, I don’t want it to get worse. What do you recommend?
Hi Candace,
I most likely appears to be a Calcified canal from what you have described. The discoloration of the tooth happens when there is a past history of trauma to the tooth, as the tooth becomes dead or non vital it starts to change color to brown kr black. This is when the Calcification of Root canal starts as a defence mechanism of the tooth.
If your Dentist is confident enough to negotiate it then you can continue with them or visiting an Endodontist will be the best option.
Hi Dr, thanks for responding, so yes my front tooth is calcified my dentist found that out only when she drilled in my tooth as she was attempting to perform a root canal and couldn’t due to the calcification. Does calcification mean my tooth is dead? My tooth discoloration is more of a yellowish tint that is noticeable. Will dental bonding help with the discoloration? What do you recommend? Also I’m still having intermittent pain in the same calcified tooth.