Manual filing in calcification of the root canal in the middle third. Endodontic treatment with obliteration of the canal lumen accessed in the traditional way, with fine diamond tips and a lot of patience
Case study carried out in class III of the specialization in endodontics at HPG Brasília by student Alessandra.
Machado, Ricardo. Endodontics: Biological and Technical Principles. Available at: GEN Group, GEN Group, 2022:
Introduction
According to the American Association of Endodontists Glossary of Endodontic Terms (2012), root canal obliteration (RCO) or calcium metamorphosis, is the pulpal response to trauma, characterized by rapid deposition of mineralized tissue in the intracanal space. It is believed that trauma leads to impairment of the pulpal vasculonervous supply, generating ischemia, which induces the deposition of mineralized tissue. Besides trauma, factors such as caries, abfraction, abrasion, pulp capping, pulpotomy, occlusal problems, untimely orthodontic forces, harmful oral habits and physiological aging can also trigger RCO.
Teeth with RCO show yellowish or yellowish-brown coloration when compared to "normal" teeth. Such chromatic changes result from irreversible changes in the pulp, such as dentin deposition, degeneration or chronic inflammation and necrosis. The reduction in the coronal pulp space, associated with the gradual narrowing of the canal, gives the characteristic opacity observed in these cases.
In principle, teeth with OCR do not present sensitivity to palpation and percussion, unless they are also affected by pulpoperiradicular alterations. Responses to thermal tests are generally negative due to difficulties in stimulating the pulp, since the pulp chamber is obliterated. These responses are variable when electrical testing is performed.
Due to intense dentin deposition, the pulp space may appear completely obliterated on radiographic examination, although it can be identified by histological sections. Pulpal mineralizations are characterized radiographically as radiopaque areas anywhere in the chamber or root canal.
Teeth with RCO are commonly diagnosed due to the presence of suggestive signs and symptoms, such as chromatic alteration, radiographic manifestations and pain. Still, one should always consider in association the information obtained through subjective and objective semiology, and imaging exams (radiographic and tomographic).
Digital radiographs (RD) have provided greater dynamism in the acquisition process, as well as the use of effects (filters) and the possibility of image magnification, greatly assisting in the identification and resolution of OCR cases. On the other hand, conventional radiographs can make visualization difficult, even favoring the non-identification of channels, especially in more complex cases.
