Non-surgical endodontic management of calcific metamorphosis with periapical lesion using bioactive glass: a case report

INTRODUCTION. Calcified root canals lead to various complications in endodontic treatment, as they complicate the locating of canal orifices, negotiating access, preparing the canals, and factoring in the time required for these procedures. Even with extensive precautions, the most serious problems can occur at any phase of the root canal treatment process. The pulpal chamber or root canal space is most frequently partially or completely obliterated in a tooth that has experienced a traumatic injury. A total or partial loss of pulp space is the most typical radiological representation of such a tooth. Pulp necrosis and radiographic signs of chronic periapical periodontitis are present in 7–27% of teeth with partial canal calcification. Small percentage of teeth (2–3%) may exhibit a complete occlusion of the pulp chamber and root canal system. AIM. To describe the clinical management of a calcified mandibular lateral incisor with a periapical lesion using a bioactive glass-based sealer. MATERIALS AND METHODS. A traumatized mandibular lateral incisor with radiographic evidence of canal calcification and a periapical lesion was identified. The root canal was located, negotiated, and prepared using standard endodontic techniques with special consideration for calcified anatomy. A recently developed bioactive glass-based sealer was selected for obturation. RESULTS. The calcified canal was successfully located and treated. Radiographic follow-up demonstrated proper canal obturation with resolution of the periapical lesion. CONCLUSIONS. Bioactive glass-based sealers show promising outcomes in the treatment of calcified root canals. Their bioactivity and sealing ability may enhance prognosis in complex endodontic cases involving traumatic canal calcification.