Endodontic guides and ultrasonic tips for management of calcifications

Aim: To describe the role of guided endodontics with ultrasonic tips in management of calcified canals.  Summary Case 1: A 23-year old female presented with esthetic complaint related to the maxillary left central incisor with a history of trauma.  Radiographic examination revealed internal resorption and apical calcification.  A silicone impression of the maxillary jaw was obtained and scanned to plan for access of the calcified canal by means of implant planning software. Guides were fabricated through rapid prototyping and allowed for the correct orientation of an ultrasonic tip to provide access through the calcifications. An access cavity was done, the calcified canal was accessed by the help of the fabricated guide, and the root canal was prepared and obturated using warm vertical technique apical to the resorptive defect. The rest of the canal was filled with mineral trioxide aggregate (MTA). One-year follow-up revealed no symptoms and evidence of radiographic healing. Case 2: A 43-year old male was referred for endodontic treatment of the maxillary right first molar. The mesiobuccal and palatal canals were prepared by the referring dentist who failed to locate the distobuccal canal.  Radiographic examination revealed a previously initiated root canal therapy, widening of the periodontal membrane space and coronal calcification of the distobuccal canal.  A silicone impression of the maxillary jaw was obtained and scanned similar to the first case. The distobuccal canal was located using the ultrasonic tip through the guide, prepared, and obturated using warm vertical technique.  One-year follow-up revealed no symptoms and evidence of radiographic healing. Key Learning Points Endodontics guides with ultrasonic tips are reliable in management of root canal calcifications. Three-dimensional imaging using CBCT and CAD/CAM provides accurate 3D guides.