Fig. 1

Once calcified canals are identified radiographically the clinician should keep in mind the following fundamental protocols pertaining to instrumentation: locating the canals with proper magnification; instrumenting with stiff, pre-curved stainless steel hand files, followed by narrow and flexible mechanized NiTi files; and, all the while, ensuring the canals are kept lubricated during the filing process. In turn, instrumenting calcified canals comes down to having the proper armamentaria and techniques

Fig. 2

Pre operative situation We notice a very bad amalgam restoration. That cause of fracture the walls  

Fig. 3

The presence of pulpotec in The cavity was seen clearly. First of all we have to put the rubber dam then complete removing  all the materials and inflamed tissue

Fig. 4

After isolation we can notice necrotic pulp  Tissue in the canals  Most studies show that the best way to treat necrotic cases to use calcium hydroxide in the  first appointment to reduce flare up. So we prepared coronal third then we use intracanal medication (calcium hydroxide )

Fig. 5

The next visit 

The canals were scouting with stanless still

Manual files 

Start with #6 #8 #10 #15

That manual glide path facilitate

 the preparation  With rotary files and reduce

 the possibility of files fracture 

Then E Flex files were used 

#19 2% 

#20 4%

 #25 4%

 #30 4%

Fig. 6

After cleaning and shaping 

And irrigation with 

Sodium hypochloride 5.25 %

Edta 17 %

Chlorohexiden 2%

And saline between each irrigant 

The canals were ready for obturation 

Fig. 7

Master cone radiography Is the most important image in  hole treatment because here we can make an adjustment before obturation

Fig. 8

Warm vertical compaction technique  Was used  Down pack with fast pack

Fig. 9

Post op clinical view  We have to clean the access cavity very well after obturation when we use resin sealer the using of alcohol and sandblasting.

Fig. 10

Post op radiograph

Fig. 11

About the Author:

Dr . Elias Abboud Damascus Syria 

2018 : B.D.S ( Damascus university )




During the retreatment procedure, regaining the anatomy and cleaning the entire endodontic system is necessary for a better long term prognosis of the tooth. This will suppose the removal of the entire material. A long and sharp explorer such as Explora will give us the possibility to detect the orifices


Cohen's Pathways of the Pulp Ha JH, Park SS. Influence of glide path on the screw-in effect and torque of nickel-titanium rotary files in simulated resin root canals, Restor Dent Endod 2012;37:4.

Jamileh Ghoddusi , Maryam Javidi , Mohammad Hasan Zarrabi ,  Hossein Bagheri Flare-ups Incidence and Severity after Using Calcium Hydroxide as an Intra Canal DressingIranian Endodontic Journal, Vol. 1 No. 1 (2006), 1 April 2006 , Page 7-13