Management of calcified canals during root canal treatment. A systematic review of case reports

Calcified canals pose substantial challenges in endodontic treatment because of narrowing of pulp chambers and canal lumens, reducing accessibility and biomechanical preparation. Nevertheless, with advanced techniques and well-devised strategies, successful management of calcified canals is achievable. This comprehensive analysis aims to rigorously assess extant literature concerning the clinical management of teeth affected by pulp canal obliteration that necessitates root canal therapy and to formulate a comprehensive, updated algorithm for clinical decision-making strategies.

The study adhered to the PRISMA 2020 guidelines, the Cochrane Handbook (version 5.1.0), and Fourth Edition of the JBI Reviewer's Manual, and was registered with PROSPERO (CRD42023460967). Electronic data sources consulted included Central, Medline, Embase, PsycINFO, Scopus, ERIC, and ScienceDirect, using standardized keywords and open-text phrases. The JBI checklist was used to evaluate the quality of case reports and case series.

Thirty-four case reports involving 41 patients were selected. For calcified canals, non-surgical endodontic treatment utilizing chelating agents and flexible rotary instruments has proven highly effective. Furthermore, the employment of a dental operating microscope in conjunction with ultrasonic tips has been reported to improve clinical outcomes in several cases. Also, the use of cone beam computed tomography (CBCT) along with 3D print guides considerably increased success rates in managing these cases.

This review highlights techniques like ultrasonic instruments, flexible nickel-titanium (Ni-Ti) files, and newer methods such as advanced imaging (CBCT) and 3D printed guides. Many case reports show that these approaches lead to higher success rates. Dentists should get familiar with these methods to improve patient outcomes and monitor for any complications. Future research should focus on creating standard protocols and exploring new tools and imaging to advance endodontics.