Journal of Dental School

Vol. 44 No. 1 (2026)

Guided Endodontics with Minimally Invasive Preparation in a Tooth with Calcific Metamorphosis: A Case Report Minimally-invasive Guided Endodontics

Journal of Dental School, Vol. 44 No. 1 (2026), 29 December 2025 , Page e24
https://doi.org/10.22037/jds.v44i1.50075

Abstract

Calcific metamorphosis (CM), marked by the gradual deposition of calcified tissue within the pulp chamber and root canal system, presents significant challenges for endodontic treatment. A 45-year-old female patient was referred to treat a discolored left maxillary central incisor, which exhibited CM. The tooth showed no pain upon palpation or percussion. Parallel periapical radiograph revealed pulp canal obstruction and an apical radiolucent lesion, confirming necrotic pulp with asymptomatic chronic apical periodontitis. To manage this condition, a guided endodontic technique was implemented due to the obstruction in the root canal. Utilizing a 3D CBCT scan, a digital splint guide was created for precise canal access. Under anesthesia, the enamel was carefully removed, and specialized drills and irrigation methods were employed to maintain cleanliness and cooling. Following restoration with composite material, the patient was scheduled for follow-up appointments at 3, 6, and 12 months to monitor healing. The final follow-up indicated periapical lesion healing. This case highlights the effectiveness of guided endodontics in managing complex metamorphosis calcification, offering a promising approach for improved treatment outcomes.

Keywords:
  • Metamorphosis Calcificationm
  • Endodontic Treatment
  • Necrotic Pulp
  • Guided Endodontics
  • Bioceramic Sealer

How to Cite

Ashraf, H., Eslambol Nassaj, A., Rahmatian, S., & Rostami, M. (2026). Guided Endodontics with Minimally Invasive Preparation in a Tooth with Calcific Metamorphosis: A Case Report: Minimally-invasive Guided Endodontics. Journal of Dental School, 44(1), e24. https://doi.org/10.22037/jds.v44i1.50075

References

1. Chaniotis A, Sousa Dias H, Chanioti A. Negotiation of calcified canals. J Clin Med. 2024;13(9):2703. doi: 10.3390/jcm13092703.

2. McCabe PS, Dummer PM. Pulp canal obliteration: an endodontic diagnosis and treatment challenge. Int Endod J. 2012; 45(2):177-97. doi: 10.1111/j.1365-2591.2011.01963.x

3. Jacobsen I, Kerekes K. Long-term prognosis of traumatized permanent anterior teeth showing calcifying processes in the pulp cavity. Scand J Dent Res. 1977; 85(7):588-98. doi: 10.1111/j.1600-0722.1977.tb02119.x

4. Oginni AO, Adekoya-Sofowora CA, Kolawole KA.Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision. Dent Traumatol. 2009; 25(6):620-25. doi: 10.1111/j.1600-9657.2009.00819.x

5. Robertson A, Andreasen FM, Bergenholtz G, Andreasen JO, Norén JG.Incidence of pulp necrosis subsequent to pulp canal obliteration from trauma of permanent incisors. J Endod. 1996; 22(10):557-60. doi: 10.1016/s0099-2399(96)80018-5

6. Yang X, Zhang Y, Chen X, Huang L, Qiu X. Limitations and Management of Dynamic Navigation System for Locating Calcified Canals Failure. J Endod. 2024; 50(1):96-105. doi: 10.1016/j.joen.2023.10.010

7. Nabavi S, Navabi S, Mohammadi SM. Management of Pulp Canal Obliteration in Mandibular Incisors with Guided Endodontic Treatment: A Case Report. Iran Endod J. 2022; 17(4): 216-9. doi: 10.22037/iej.v17i4.38381

8. Braga Diniz JM, Diniz Oliveira HF, Pinto Coelho RC, Manzi F, Silva FE, Carvalho Machado V,, et al. Guided Endodontic Approach in Teeth with Pulp Canal Obliteration and Previous Iatrogenic Deviation: A Case Series. Iran Endod J. 2022; 17(2):78-84. doi: 10.22037/iej.v17i2.36830

9. Zehnder MS, Connert T, Weiger R, Krastl G, Kühl S. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. Int Endod J. 2016; 49(10):966-72. doi: 10.1111/iej.12544

10. Holcomb JB, Gregory WB Jr. Calcific metamorphosis of the pulp: its incidence and treatment. Oral Surg Oral Med Oral Pathol. 1967; 24(6):825-30. doi: 10.1016/0030-4220(67)90521-x

11. Mungekar-Markandey S, Mistry L, Jawdekar A. Clinical success of iatrogenic perforation repair using mineral trioxide aggregate and other materials in primary molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent. 2022; 15(5):610-6. doi: 10.5005/jp-journals-10005-2038

12. Cvek M, Granath L, Lundberg M. Failures and healing in endodontically treated non-vital anterior teeth with posttraumatically reduced pulpal lumen. Acta Odontol Scand. 1982; 40(4):223-8. doi: 10.3109/00016358209019816

13. Dąbrowski W, Puchalska W, Ziemlewski A, Ordyniec-Kwaśnica I. Guided Endodontics as a Personalized Tool for Complicated Clinical Cases. Int J Environ Res Public Health. 2022; 19(16):???. doi: 10.3390/ijerph19169958

14. Samiei M, Sabanik P, Tavakkoli Avval S. Guided Endodontics for Non-surgical Root Canal Retreatment: A Systematic Review.Iran Endod J. 2025;20(1):e3. doi: 10.22037/iej.v20i1.46903.

15. Krastl G, Zehnder MS, Connert T, Weiger R, Kühl S. Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology. Dent Traumatol. 2016; 32(3):240-6. doi: 10.1111/edt.12235

  • Abstract Viewed: 8 times

Download Statastics

Developed By

Open Journal Systems

Information

Make a Submission

Make a Submission