Dental trauma results in various complications and poses an enigma to the practitioner. Calcific metamorphosis is one of the sequelae of trauma. A female patient of 35 years visited the specialty clinic of endodontics for the management of a discolored tooth. Clinically, discolored 21 was observed with no pain on palpation and percussion. The pulp sensibility test revealed a negative response. Radiographic examination revealed pulp canal obliteration with an apical radiolucency of Peri Apical Index (PAI 4). The tooth was diagnosed as necrotic pulp with asymptomatic apical periodontitis. Attempt to negotiate the canal under a Dental Operating Microscope (LABOMED, Los Angeles, CA, USA) and ultrasonics (Satelec, Acteon, France) was futile. Cone-beam computed tomography image revealed a patent canal in the apical third. Using real-time guided endodontics with a dynamic navigation system (Navident, ClaroNav, Toronto, ON, Canada), the protocol of plan, trace, and place was followed, and successful canal negotiation was achieved. After radiographic confirmation, root canal treatment was completed.

The current case study evaluated the effect of vital pulp therapy on a human dental pulp after a long-term period using micro-computed tomography (MCT) for the first time. In the presented report, the successful outcomes of full pulpotomy using calcium-enriched mixture (CEM) cement on an irreversible pulpitis case were documented clinically/radiographically over 5 years. Due to an unrestorable crown fracture at the 5-year recall, the tooth was extracted and evaluated by MCT; the images showed that CEM pulpotomy allowed the dental pulp to create complete dentinal bridges without pulp canal obliteration (PCO). These MCT results showed that CEM pulpotomy, as a bio-regenerative treatment, caused no negative consequence of PCO or calcific metamorphosis on dental pulp over the long term.

A case of pulp canal obliteration (PCO) two years after the completion of orthodontic treatment is presented. Post orthodontic treatment PCO is a rare finding. A 23 years old female presented with the discoloration of clinical crown of maxillary right central incisor. Radiographic examination revealed the calcified canal and diffused periapical radiolucency. Vitality tests were negative. A decision was made to do root canal treatment followed by the walking bleaching. After the successful completion of the root canal treatment the internal bleaching was performed. The discolored tooth showed significant improvement in color. Internal bleaching is a viable conservative treatment for improving esthetics in single non vital discolored tooth.

Pulp canal calcification is 1 of the possible outcomes after certain types of dental trauma. This can make endodontic treatment more challenging should it become necessary. Because of the increased degree of difficulty, sometimes procedural incidents do occur during root canal treatment. This case report demonstrates an unusual clinical presentation of a root perforation and missed canal, which had undergone calcification as a result of trauma some years earlier. A contemporary approach to treatment involved a combination of treating the biological complication of the calcified canal combined with surgical repair of the iatrogenic complication of a perforation using modern imaging techniques and materials.

OBJECTIVE: To compare the accuracy and effort of digital workflow for guided endodontic access (GEA) procedures using two different software applications in 3D-printed teeth modeled to simulate pulp canal obliteration (PCO) in vitro.
METHODS: 32 3D-printed incisors with simulated PCO were fabricated and mounted, four each on maxillary and mandibular study arches. Cone beam computed tomography (CBCT) and 3D surface scans were matched and used to virtually plan and prepare GEA by one operator using two different methods: 1) CoDiagnostiX (CDX; Dental Wings) with 3D-printed templates, and 2) Sicat Endo (SE; Sicat) with subtractive CAD/CAM-manufactured templates. Postoperative CBCT and virtual planning data were superimposed for analysis. Accuracy was assessed by measuring the discrepancies between planned and prepared cavities at the tip of the bur (three spatial dimensions, 3D vector, angle). Virtual planning effort was defined as the time and number of computer clicks. A 95% confidence interval (CI) was computed for each sample.
RESULTS: SE successfully located root canals for GEA in 16/16 cases (100%) and CDX in 15/16 cases (94%). SE resulted in less mean deviation at the tip of the bur with regard to distance in the labial-oral direction (0.12 mm), 3D vector (0.35 mm), and angle (0.68 degrees) compared with CDX (0.54 mm, 0.74 mm, 1.57 degrees, respectively; P < 0.001). CDX required less mean planning time and effort for each four-tooth arch (10 min 50 s, 107 clicks) than SE (20 min 28 s, 341 clicks; P < 0.05).
CONCLUSIONS: Both methods enabled rapid drill path planning, a predictable GEA procedure, and the reliable location of root canals in teeth with PCO without perforation.

OBJECTIVE: The literature on the pathogenesis of extrusive dental luxation has been focused on periodontal tissue responses, with little attention given to the pulp. The aim of this study was to evaluate the response of dental pulp of teeth following extrusive luxation in a rat model.
METHODS: The maxillary right central incisors of 30 rats were extrusively luxated and repositioned after 5 minutes. The animals were euthanized after 7, 15, and 30 days to provide three groups: I, II, and III, respectively (n = 10). Histological sections were stained with H and E for histomorphometric analysis of the odontoblast layer, reparative dentin deposition, Hertwig\'s epithelial root sheath, pulp necrosis, and periapical inflammatory infiltrate.
RESULTS: In most cases, new vascular formation occured in association with reparative dentin deposition on the root walls and within the pulp. In some cases, dentin deposition occupied the entire pulp space over time, with no other types of non-odontogenic hard tissues being observed. Pulp necrosis with the presence of periapical inflammatory infiltrate was also observed in a few cases. No statistical differences were observed among the studied groups.
CONCLUSIONS: Following extrusive luxation, calcific metamorphosis of the pulp is very likely to occur.

Dental trauma to the permanent dentition can lead to clinical complications and its management may considerably challenge a practitioner. The incidence of pulp canal obliteration following dental trauma has been reported to be approximately 4 - 24%. Attempting to locate canals following calcific metamorphosis and negotiating it to full working length may lead to iatrogenic errors such as fractured instrument and perforation. This review article describes the possible etiology of Calcific Metamorphosis, its clinical and radiographic features as well as its management.

BACKGROUND: Avulsion of permanent teeth is one of the most serious dento-alveolar traumatic injuries. Pulp canal obliteration (PCO) is one of the consequences after replantation of avulsed immature teeth. The aim of this systematic review was to determine when calcification following replantation of an avulsed immature tooth begins and to evaluate the prevalence of PCO in these cases.
METHODS: Electronic database MEDLINE via Ovid, PubMed, Cochrane, and Web of science databases were searched. Hand searching was performed through reference lists of endodontic and trauma textbooks, endodontic and trauma-related journals, and relevant articles from electronic searching. Pooled data from the selected articles were analyzed for prevalence of healing and PCO as well as mean first evidence of PCO.
RESULTS: Pulp healing after replantation of immature teeth occurred in 32.9%, while pulpal necrosis occurred in 67.1% of teeth. PCO was the most frequent outcome of pulpal healing as it occurred in 96% of healed pulps. First evidence of obliteration was observed from 3 to 14 months with mean time of 9.5 months (95% CI = 4.5-14.5 months).
CONCLUSIONS: PCO is considered the mechanism by which the pulp heals after replantation of avulsed immature permanent teeth. PCO is very fast and can be recognized radiographically during the first year from the onset of the trauma.

The incidence of pulp canal obliteration following dental trauma has been reported to be approximately 4 - 24% and its management can be quite challenging for the practitioner. Locating the canal and negotiating it to full working length may lead to iatrogenic errors such as fractured instrument and perforation. This case report deals with such a case using the modified tip instrument technique to gain access and negotiate the canal to the apex followed by conventional root canal preparation and obturation.