Observational analysis of endodontic treatment in calcified canals under the influence of patient clinical profile and tooth characteristics according to the root third
DOI:
https://doi.org/10.33448/rsd-v14i11.49890Keywords:
Pulp cavity , Endodontics, Root canal preparation.Abstract
Pulpal calcification is generally defined as partial or total obliteration of the pulp cavity by mineralized tissue, often associated with physiological aspects and the patient’s dental history. This condition leads to alterations in tooth anatomy that may hinder the performance of endodontic treatment, since such cases do not allow the adoption of conventional protocols. The present study aimed to identify, in an observational, cross-sectional, and retrospective manner, the main difficulties associated with the diagnosis and treatment of teeth with calcified canals. For this purpose, dental records, digital radiographs, and, when available, cone beam computed tomography scans related to endodontic treatments performed by the same endodontist over a 10-year period (May 2014 to May 2024) were analyzed. Data were collected at the private clinic EndoMais, located in Uberlândia, Minas Gerais, Brazil. A total of 54 teeth were evaluated, showing a higher prevalence of calcified elements in women between 40 and 69 years of age. It was observed that single-rooted teeth exhibited calcifications distributed along all three root thirds, whereas bi-rooted molars showed a greater tendency toward apical calcification. The main clinical difficulties were related to coronal access, canal location, and debridement, challenges mitigated by the use of an operating microscope, ultrasound, and cone beam computed tomography. Working length determination proved more accurate when complemented with electronic apex locators and radiographs. Obturation, even in altered anatomies, achieved satisfactory results using the thermoplasticized technique, reinforcing the importance of combining technological resources in the management of calcified canals.
References
Abbott, P., & Yu, C. (2007). A clinical classification of the status of the pulp and the root canal system. Australian Dental Journal Supplement, 52(1), 17–31.https://doi.org/10.1111/j.1834-7819.2007.tb00522.x
Agrawal, V. S., & Kapoor, S. (2020). Management of root canal stenosis and external inflammatory resorption by surgical root reconstruction using biodentine. Journal of Conservative Dentistry and Endodontics, 23(1), 102–106. https://doi.org/10.4103/JCD.JCD_128_20
Albuquerque Oliveira, A. L., Lima, L. S., Pereira, B. S., Ferreira, I. L., & Martins, G. B. (2024). Manejo clinico de calcificação pulpar em molar inferior. Brazilian Journal of Implantology and Health Sciences, 6(1), 1347–1357. https://doi.org/10.36557/2674-8169.2024v6n1p1347-1357
American Association of Endodontics. (2016). AAE glossary of endodontic terms. https://www.aae.org/specialty/clinical-resources/glossary-endodontic-terms/
Araújo, A. C. A., Silva, M. C. F., Lima, G. M., Santos, L. V. M., Vasconcelos, M. M. V. B., & Vasconcelos, R. G. (2024). Estudo retrospectivo observacional do tratamento endodôntico de dentes com dens invaginatus. Research, Society and Development, 13(11), e71131147421. https://doi.org/10.33448/rsd-v13i11.47421
Bao, P., Shen, Y., Lin, J., & Haapasalo, M. (2017). In vitro efficacy of XP-endo Finisher with 2 different protocols on biofilm removal from apical root canals. Journal of Endodontics, 43(2), 321–325.https://doi.org/10.1016/j.joen.2016.09.021
Buchanan, L. S. (1991). Paradigm shifts in cleaning and shaping. Journal of the California Dental Association, 19(5), 23–33.
Buchgreitz, J., Buchgreitz, M., & Bjørndal, L. (2019). 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. International Endodontic Journal, 52(5), 559–568. https://doi.org/10.1111/iej.13038
Carvalho, M. C., Zuolo, M. L., Arruda-Vasconcelos, R., Marinho, A. C. S., Loureiro, M. R. Z., & Pelegrine, R. A. (2019). Effectiveness of XP-endo Finisher in the reduction of bacterial load in oval-shaped root canals. Brazilian Oral Research, 33, e021. https://doi.org/10.1590/1807-3107bor-2019.vol33.0021
Chaniotis, A., & Ordinola-Zapata, R. (2022). Present status and future directions: Management of curved and calcified root canals. International Endodontic Journal, 55(S3), 656–684. https://doi.org/10.1111/iej.13685
Chaniotis, A., Sousa Dias, H., & Chanioti, A. (2024). Negotiation of calcified canals. Journal of Clinical Medicine, 13(9), 2703. https://doi.org/10.3390/jcm13092703
Chaves, H. G. S., Silva, L. L. C. F., Lima, M. V. A., & Alencar, C. R. B. (2022). Calcificação pulpar em dentes traumatizados – uma revisão da literatura. Research, Society and Development, 11(7), e36011729293. https://doi.org/10.33448/rsd-v11i7.29293
Chu, T., Ni, X., & Zhu, Y. (2022). [Retracted] EDTA combined with c‐pilot files and microultrasound for root canal calcification: Dredging effect and safety analysis. Computational and Mathematical Methods in Medicine, 2022, 1911448. https://doi.org/10.1155/2022/1911448
Consolaro, A., & Bernardini, V. R. (2007). Metamorfose cálcica da polpa e necrose pulpar asséptica no planejamento ortodôntico. Revista Dental Press de Ortodontia e Ortopedia Facial, 12(6), 21–23. https://doi.org/10.1590/S1415-54192007000600003
Elshenawy, H., El-Anwar, M. I., El-Ghafour, M. A., & Mostafa, M. (2019). Influence of small, midi, medium and large fields of view on accuracy of linear measurements in CBCT imaging: Diagnostic accuracy study. Open Access Macedonian Journal of Medical Sciences, 7(6), 1037–1042. https://doi.org/10.3889/oamjms.2019.232
Fleig, S., Attin, T., & Jungbluth, H. (2017). Narrowing of the radicular pulp space in coronally restored teeth. Clinical Oral Investigations, 21(4), 1251–1257. https://doi.org/10.1007/s00784-016-1899-8
Gonçalves, P. S., de Oliveira, J. B., Neto, J. J. S. M., de-Azevedo-Vaz, S. L., & Baratto-Filho, F. (2024). Identification and classification of pulp calcifications in posterior teeth according to dental condition using digital panoramic radiography and cone beam CT. Dentomaxillofacial Radiology, 53(5), 20230509. https://doi.org/10.1093/dmfr/twae015
Gulabivala, K., & Ng, Y. L. (2023). Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles. International Endodontic Journal, 56(S1), 82–115. https://doi.org/10.1111/iej.13897
Hülsmann, M., Heckendorff, M., & Lennon, A. (2003). Chelating agents in root canal treatment: Mode of action and indications for their use—A review. International Endodontic Journal, 36(12), 810–830. https://doi.org/10.1111/j.1365-2591.2003.00754.x
Imura, N., Pinheiro, S. L., Gomes, B. P. F. A., Zaia, A. A., Ferraz, C. C. R., & Souza-Filho, F. J. (2007). The outcome of endodontic treatment: A retrospective study of 2000 cases performed by a specialist. Journal of Endodontics, 33(11), 1278–1282. https://doi.org/10.1016/j.joen.2007.07.018
Ivanauskaitė, D., Juškevičiūtė, E., & Tamošiūnas, M. (2021). Prevalence of pulp stones in molars based on bitewing and periapical radiographs. Stomatologija, 23(1), 9–15.
Kaur, G., Gibreel, M., Nagra, G., Alghofaily, M., & El-Bialy, T. (2024). Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination-a systematic review and meta-analysis. BMC Oral Health, 24(1), 532. https://doi.org/10.1186/s12903-024-04259-w
Kumar, S., Chandra, S., & Jaiswal, J. N. (1990). Pulp calcifications in primary teeth. Journal of Endodontics, 16(5), 218–220. https://doi.org/10.1016/S0099-2399(06)81673-0
Kuyk, J. K., & Walton, R. E. (1990). Comparison of the radiographic appearance of root canal size to its actual diameter. Journal of Endodontics, 16(11), 528–533. https://doi.org/10.1016/S0099-2399(07)80215-9
Lago, I. R. F. do, Clementino, M. G., & Melo, M. (2023). O uso do ultrassom em endodontia: uma revisão de literatura. Research, Society and Development, 12(10), e149121043410. https://doi.org/10.33448/rsd-v12i10.43410
Leonardi, D. P., Baratto Filho, F., & Haragushiku, G. A. (2011). Alterações pulpares e periapicais . RSBO (Online), 8(4), 47–61.
Llaquet, M., Vidal, C., Mercadé, M., Muñoz, M., & Ortolani-Seltenerich, P. S. (2020). Guided endodontics for managing severely calcified canals. Journal of Endodontics, 46(3), 428-433. https://doi.org/10.1016/j.joen.2020.11.026
McCabe, P. S., & Dummer, P. M. H. (2012). Pulp canal obliteration: An endodontic diagnosis and treatment challenge. International Endodontic Journal, 45(2), 177–197. https://doi.org/10.1111/j.1365-2591.2011.01963.x
Medeiros, F. B. G. (2017). Calcificações pulpares-características clínicas, imagenológicas e morfológicas: revisão sistemática [Trabalho de Conclusão de Curso, Universidade Federal do Rio Grande do Norte]. Repositório Institucional da UFRN.
Menezes, C. N., Carneiro, V. F., & do Vale, M. S. (2019). Removal of filling material in endodontic retreatment: A literature review. RSBO, 16(2), 109–116. https://doi.org/10.21726/rsbo.v16i2.934
Miot, H. A. (2011). Tamanho da amostra em estudos clínicos e experimentais. Jornal Vascular Brasileiro, 10(4), 275–278. https://doi.org/10.1590/S1677-54492011000400001
Miranda, L. G. de, & Milhomem, C. N. R. (2021). Uso do ultrassom no acesso endodôntico de dentes com calcificação pulpar: revisão de literatura. Facit Business and Technology Journal, 1(27).
Monteiro, J. F., Gomes, F. A., Costa, G. L., da Rosa, R. A., Só, M. V. R., & Barletta, F. B. (2024). Análise da taxa de sucesso e insucesso no retratamento endodôntico não cirúrgico de molares em uma população brasileira. Research, Society and Development, 13(9), e6913946849. https://doi.org/10.33448/rsd-v13i9.46849
Neelakantan, P., Subbarao, C., & Grotra, D. (2010). Cone-beam computed tomography study of root and canal morphology of maxillary first and second molars in an Indian population. Journal of Endodontics, 36(10), 1622–1627. https://doi.org/10.1016/j.joen.2010.07.006
O'Connor, R. P., Demayo, T. J., & Roahen, J. O. (1994). The lateral radiograph: An aid to labiolingual position during treatment of calcified anterior teeth. Journal of Endodontics, 20(4), 183–184. https://doi.org/10.1016/S0099-2399(06)80332-8
Oliveira, D. H., Guerim, P. H. F., Bello, M. C., Buligon, M. P., Marin, J. A., Marquezan, P. K., & Marquezan, F. K. (2023). Endodontia guiada: tecnologia aplicada na resolução de tratamentos de canais calcificados. Arquivos de Ciências da Saúde da UNIPAR, 27(1), 447–459. https://doi.org/10.25110/arqsaude.v27i1.2023.9105
Paradiso, D., Tullio, A., & Bensi, C. (2023). Working length determination in primary teeth pulpectomy: A systematic review and meta‐analysis. Australian Endodontic Journal, 49(2), 444–454. https://doi.org/10.1111/aej.12652
Patel, B. (2015). Endodontic radiology. In S. Patel & J. L. Gutmann (Eds.), Endodontic diagnosis, pathology, and treatment planning: Mastering clinical practice (pp. 161–177). Springer International Publishing.https://doi.org/10.1007/978-3-319-15591-3_12
Patterson, S. S., & Mitchell, D. F. (1965). Calcific metamorphosis of the dental pulp. Oral Surgery, Oral Medicine, Oral Pathology, 20(1), 94–101. https://doi.org/10.1016/0030-4220(65)90272-0
Pereira, A. S. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria. Editora da UFSM.
Pisano, M., Tripi, T. R., Gagliano, V., Di Dio, M., Fiorillo, L., & Cicciù, M. (2024). Evaluation of the accuracy of electronic apex locators in modern endodontics: An umbrella review. Medicina, 60(10), 1709. https://doi.org/10.3390/medicina60101709
Quaresma, S. A., da Costa, R. P., Petean, I. B. F., Sousa, A. C. S., Mazzi-Chaves, J. F., Ginjeira, A., & Sousa-Neto, M. D. (2022). Root canal treatment of severely calcified teeth with use of cone-beam computed tomography as an intraoperative resource. Iranian Endodontic Journal, 17(1), 39–47. https://doi.org/10.22037/iej.v17i1.36153
Ravanshad, S., Khayat, S., & Freidonpour, N. (2015). The prevalence of pulp stones in adult patients of Shiraz Dental School, a radiographic assessment. Journal of Dentistry, 16(4), 356–361.
Rodrigues, C. T., Duarte, M. A. H., Vivan, R. R., & Bernardineli, N. (2013). Avaliação do EDTA, vinagre de maçã e SmearClear, com e sem ativação ultrassônica, na remoção da smear layer em diferentes níveis do canal radicular. Dental Press Endodontics, 3(2), 43–48.
Santos, G. R. A., & de Almeida Coelho, J. (2022). O uso do Easy Clean na ativação das soluções irrigantes. Revista Científica Unilago, 1(1).
Sharma, M. C., & Arora, V. (2010). Determination of working length of root canal. Medical Journal Armed Forces India, 66(3), 231–234. https://doi.org/10.1016/S0377-1237(10)80044-9
Shi, X., Zhang, C., Liu, S., Lu, Y., & Yang, Y. (2018). Novel navigation technique for the endodontic treatment of a molar with pulp canal calcification and apical pathology. Australian Endodontic Journal, 44(1), 66–70. https://doi.org/10.1111/aej.12207
Shitsuka, R. et al. (2014). Matemática fundamental para tecnologia. (2ed.). Editora Érica.
Silva, A. J. C., & Fernandes, S. L. (2022). Tratamento endodôntico em canais calcificados. Revista Ibero-Americana de Humanidades, Ciências e Educação, 8(4), 1460–1473. https://doi.org/10.51891/rease.v8i4.5152
Silva, E. J. N. L., Queiroz, P. M., Estrela, C., & De-Deus, G. (2017). Assessing pulp stones by cone-beam computed tomography. Clinical Oral Investigations, 21(7), 2327–2333. https://doi.org/10.1007/s00784-016-2027-5
Silva, M. R. R. R., Arruda, J. A. A., Yamasaki, E. M., & Silva, E. M. (2020). Microscópio operatório na endodontia. Research, Society and Development, 9(8), e981986858. https://doi.org/10.33448/rsd-v9i8.6858
Silva, F. V. D., Oliveira, A. C., Pires, J. V. L., & Lucena, E. H. G. (2021). Avaliação de tratamentos endodônticos realizados por acadêmicos de odontologia de uma instituição de ensino superior da paraíba, Brasil. Archives of Health Investigation, 10(4), 522–529. https://doi.org/10.21270/archi.v10i4.5312
Siqueira, J. F., Jr., Rôças, I. N., & Hu, Y. (2022). Dens invaginatus: Clinical implications and antimicrobial endodontic treatment considerations. Journal of Endodontics, 48(2), 161–170. https://doi.org/10.1016/j.joen.2021.11.014
Só, G. B., Rosa, R. A., Duarte, M. A. H., Só, M. V. R., & Vivan, R. R. (2024). Effect of obturation techniques on the quality of root canal fillings: A systematic review and meta-analysis of in vitro studies. Iranian Endodontic Journal, 19(2), 61–72. https://doi.org/10.22037/iej.v19i2.40210
Sousa, P., Viana, D., Araújo, A., Caram, C., Galvão, A., & Oliveira, M. (2025). Estudo observacional da prevalência de canais calcificados em casos de tratamentos endodônticos numa população brasileira. Research, Society and Development, 14(10), e148141049782. http://dx.doi.org/10.33448/rsd-v14i10.49782
Stewart, G. G. (1995). Gaining access to calcified canals. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 79(6), 764–768. https://doi.org/10.1016/S1079-2104(05)80314-2
Tassoker, M. (2018). Evaluation of the relationship between sleep bruxism and pulpal calcifications in young women: A clinico-radiological study. Imaging Science in Dentistry, 48(4), 277–281. https://doi.org/10.5624/isd.2018.48.4.277
Toubes, K. M. P. S., de Oliveira, P. A. D., de-Jesus-Soares, A., de Moura, M. R., & de Carvalho, M. C. (2012). Comparative analysis of accessory mesial canal identification in mandibular first molars by using four different diagnostic methods. Journal of Endodontics, 38(4), 436–441. https://doi.org/10.1016/j.joen.2011.12.035
Van der Meer, W. J., Vissink, A., Ng, Y. L., & Gulabivala, K. (2016). 3D computer aided treatment planning in endodontics. Journal of Dentistry, 45, 67–72. https://doi.org/10.1016/j.jdent.2015.11.007
Veloso, A. C. R. (2017). Abordagem clínica a canais radiculares calcificados e/ou atresiados. Repositório Institucional da UFP.
Vieira, M., & Aguiar, P. F. (2021). Tratamento endodôntico de canais calcificados com auxílio da endodontia guiada. Revista Ibero-Americana de Humanidades, Ciências e Educação, 7(10), 3334–3355. https://doi.org/10.51891/rease.v7i10.3050
Wu, D., Shi, W., Wu, J., Wu, Y., Liu, W., & Zhu, Q. (2011). The clinical treatment of complicated root canal therapy with the aid of a dental operating microscope. International Dental Journal, 61(5), 261–266. https://doi.org/10.1111/j.1875-595X.2011.00070.x
Yang, Y. M., Guo, B., Guo, L. Y., Yang, Y., Su, Y., & Wang, Y. (2016). CBCT-aided microscopic and ultrasonic treatment for upper or middle thirds calcified root canals. BioMed Research International, 2016, 4793146. https://doi.org/10.1155/2016/4793146
Zahran, S. S., & Alamoudi, R. A. (2024). Radiographic evaluation of teeth with pulp stones and pulp canal obliteration: Characteristics, and associations with dental parameters. Libyan Journal of Medicine, 19(1), 2306768. https://doi.org/10.1080/19932820.2024.2306768
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Deivid Daniel Cardoso Viana, Pedro Henrique do Espirito Santo Sousa, Ana Clara Alves Araújo, Alexia da Mata Galvão, Cristiane Melo Caram, Marcelo Tavares, Maria Antonieta Veloso Carvalho de Oliveira

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
