The management of calcified teeth with iatrogenic errors with static-guided and freehand endodontic technique

The endodontic management of teeth with pulp canal calcification (PCC) is challenging and may result in iatrogenic errors in the form of excessive tooth structure loss and perforation. The present case reports aims to describe the management of calcified teeth with iatrogenic canal deviation using static-guided (SG) and conventional free hand endodontic technique.

A 23-year-old male patient referred to the clinic with the chief complaint of pain over the upper incisor teeth region. Periapical radiography and CBCT scan revealed pulp canal calcification (PCC) of maxillary central incisors (#11 and #21), and periapical radiolucency in relation to #21 and #22. The patient was informed about the treatment options including SG endodontic approach and the course of treatment was determined based on the patients' decisions. The endodontic treatment of teeth #21 and #22 was initiated with conventional free hand technique. After a perforation on the labial root wall, the patient opted for saving the tooth (#21) using SG endodontic technique. With the help of CBCT, intra-oral Scanner and a 3D printer, a guide was fabricated. The root canal was negotiated and the endodontic treatment was completed. Similarly, the endodontic treatment of a 21-year-old female patient with iatrogenic apical deviation was performed using the same endodontic protocol, except for the use of a static-guide. Follow-up examination revealed clinically asymptomatic patients with the radiographic signs of periapical healing in both the cases.

Tooth substance loss during access cavity preparation plays a vital role in determining the prognosis of the tooth. The teeth with PCC are categorized as cases with a high difficulty level which are often prone to iatrogenic errors. SG endodontic technique is a safe approach and provides predictable outcome in the management of cases with high difficulty level.