GUIDED ENDODONTICS IN THE MANAGEMENT OF CALCIFIED CANALS: CURRENT EVIDENCE AND CASE REPORT

Abstract

INTRODUCTION: Calcified root canals can manifest as pulp nodules or pulp obstruction, resulting in narrow canals that are difficult to access and visualize. Guided endodontics is an approach that represents a minimally invasive alternative for the endodontic treatment of teeth with calcification. Objective: This study aims to conduct an integrative literature review and report a clinical case on the use of guided endodontics as a safe and effective alternative for treating calcified teeth. MATERIALS AND METHODS: The literature search was conducted in the PUBMED database using the descriptors: (Cone-beam computed tomography) AND (dental pulp calcification) AND (root canal therapy) in English, covering the period from 2015 to 2025. Thirty-eight articles were found. Full-text articles were included, and after a critical reading of titles and abstracts, case reports and studies unrelated to the topic were excluded, resulting in 8 selected articles. A 26-year-old patient reported tooth discoloration and a history of trauma over 10 years ago. Radiographs showed total obliteration of the canal in tooth 21 and periapical bone rarefaction. Cone-beam computed tomography (CBCT) was performed for planning, and guided endodontics was chosen. Tomographic images and intraoral scanning enabled the fabrication of a surgical guide. Conservative access was performed without perforations, and the canal was successfully instrumented and filled. After six months, the patient remained asymptomatic. RESULTS: The guided technique showed high accuracy in locating calcified root canals, with a 93% success rate. It was effective for both endodontists and general practitioners, reducing treatment time and tooth substance loss. The technique prevented complications such as perforations and deviations, being safer than the conventional approach. Dynamic navigation allowed for a faster and more predictable procedure, especially for less experienced professionals. However, it requires training and may not be suitable for professionals with visualization or control difficulties. Despite its high accuracy, it requires additional radiographs and careful planning. CONCLUSION: Guided endodontics is an effective technique for treating calcified canals, offering greater precision, less damage to dental structure, and predictability, and can be used regardless of the operator's experience.