Endodontic management of severely calcified mandibular anterior teeth using guided endodontics: A report of a case and a review of the literature

Root canal calcification mainly occurs after physiologic dentin deposition throughout the aging process in elderlies or after traumatic injuries in young people, which can make endodontic treatment a challenge. The aim of this case report is to illustrate the successful endodontic treatment of severely calcified mandibular anterior teeth with the aid of “guided endodontics.” A 63-year-old Persian male patient was referred from the prosthetics department for root canal treatment of all six mandibular anterior teeth before his full-mouth reconstruction. Clinical examination showed severe attrition in all mandibular teeth with only the canines responding to sensitivity tests within the normal ranges. No tenderness to percussion and palpation or visible pocket depth was observed. Preoperative radiographs showed normal periodontal ligament spaces with no visible root canals within incisors, while the canines had moderately recessed pulpal spaces. A diagnosis of normal pulpoperiapical status was made. After precise clinical and radiographic examination, obtaining cone-beam computed tomographic images and digital intraoral scans, root canal treatments of the target teeth were performed using a custom-made three-dimensional model. A 4-month follow-up showed asymptomatic teeth, confirming that the endodontic guide is a useful tool to manage these cases safely. Previous case reports concerning “static guided endodontics” were also reviewed to identify the research gaps and the current limitations and benefits of the method.