Guided endodontics for calcified teeth: A case of improved precision and treatment efficiency

Traumatic dental injuries, such as concussion and subluxation, can lead to significant pathological changes in the dental pulp, including calcific metamorphosis (CM) and inflammatory external root resorption (IERR). CM, or pulp canal obliteration (PCO), results from increased odontoblastic activity following trauma and is often characterized by tooth discolworation and narrowing of the pulp canal. IERR, a common complication posttrauma, occurs due to disrupted pulpal blood supply and bacterial invasion, leading to osteoclastic activity on the root surface. This case report describes the nonsurgical management of a 38-year-old male patient with a history of trauma to tooth #21, resulting in CM and IERR. Clinical examination revealed tooth discoloration and pain, whereas radiographic findings confirmed PCO and root resorption. A guided access approach, aided by cone beam computed tomography imaging and three dimensional printing technology, was employed to successfully perform root canal therapy. Following a minimally invasive protocol, the canals were disinfected, treated with calcium hydroxide, and obturated using Biodentine and bioceramic sealer. A ceramic crown restoration was placed after the successful completion of the treatment. Follow-up radiograph after 3 and 8 months showed healing of pdl space.