Pulp calcifications, a nightmare for the endodontist
28/01/2025
Fellow
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Pulp calcifications are one of the main challenges faced by endodontic professionals. Pulp stones are defined as calcified foci that are observed in the coronal or, less frequently, radicular pulp cavity. They are found in the dental pulp of the teeth in primary and permanent dentition. These calcified structures can be detected in the pulp of healthy, infected, and even impacted teeth.
Calcifications can significantly complicate endodontic treatments. Removing these obstructions requires advanced techniques and specialized instruments to ensure a successful root canal therapy. Pulp stones may be embedded, attached to dentin walls or free within the pulp tissue. Calcifications within the pulp may lead to a poorer out come of a root canal procedure, as they can block access to the root canals, and hinder their subsequent cleaning and shaping.
Fig. 1
Pre op X-RAY
Fig. 2
First pulp chamber opening made by a colleague who sends me the case because he couldn't find the channels
In the video, an upper molar pulp chamber was initially opened by a colleague, but the procedure was not performed correctly. Due to the presence of calcifications, the canal orifices were not reached. The blockage, caused by the calcified tissue, made it difficult to navigate and access the canals properly. Using advanced tools, including an operating microscope and ultrasonic instruments, the calcification was carefully removed, allowing full access to the root canals, which were then prepared for treatment.
It continues by also removing an intracanal calcification of the palatal canal.
Then shaping, cleaning and obturation with guttapercha vertical warm condensation.
Fig. 3
Post op x-ray
Fig. 4
Inverse B/N X-ray show better the anatomy
Fig. 5
RX after coronal obturation.
The tooth is now awaiting treatment to be covered with an inlay.
Fig. 6
DR. Francinelli Jacopo
- Degree with honors in Brescia in 2018
- Numerous private courses in the field of endodontics
- 2020 2nd level post-graduate Master in Clinical and Microsurgical Endodontics at the University of Brescia with full marks and honors
- from 2019 he is clinical tutor in the 3rd year of Dentistry alongside Prof. Salgarello
- from 2021 he is tutor for the aforementioned university master
- He collaborates with the Spedali Civili of Brescia as a freelancer
- He has published articles in national and international journals
- Contract professor for the University of Brescia
- Member of the Italian Academy of Microscopic Dentistry
- Collaborate with colleagues in some private courses focused on endodontics
- He carries out his freelance activity in the province of Brescia dedicating himself mainly to micro-endodontics
Conclusions
Pulp calcifications often lead to treatment errors, especially by inexperienced practitioners, as seen in this case. These obstructions can prevent access to the root canals and complicate therapy. Proper knowledge and use of advanced tools are essential for overcoming these challenges and ensuring successful endodontic treatment.
Bibliography
Pietrzycka K, Pawlicka H. Clinical aspects of pulp stones: A case report series. Dent Med Probl. 2020 Apr-Jun;57(2):213-220. doi: 10.17219/dmp/117944. PMID: 32603035.
Chen G, Huang LG, Yeh PC. Detecting calcified pulp stones in patients with periodontal diseases using digital panoramic and periapical radiographies. J Dent Sci. 2022 Apr;17(2):965-972. doi: 10.1016/j.jds.2021.12.010. Epub 2022 Jan 11. PMID: 35756760; PMCID: PMC9201651.
