Guided endodontics in managing severely calcified teeth: A review

In our daily practice, we are confronted with calcified teeth which require special attention and care during endodontic treatment. Several etiologies have been incriminated in the presence of pulp calcifications, especially dental trauma and aging. Those calcifications can cause partial or complete pulp canal obliteration. Therefore, endodontic treatment of these teeth can be very risky and should be done by a specialist using ultrasonic tips and a microscope. This treatment requires more time and has a lower success rate compared to other cases. Lately, a technique combining the digital imaging and the cone-beam computed tomography (CBCT) is proposed to form an endodontic guide which allows any practitioner to access the canal more easily. The use of CBCT is important in the planning of the treatment of severely calcified teeth. The guided treatment has many advantages compared to the conventional approach. It is proved to be more precise, more conservative, and less time-consuming. It has a high success rate and reproducible results regardless of the experience of the practitioner. The purpose of this review is to gain a better understanding of the pulpal calcification process and its impact on the endodontic treatment and to give insight into the advantages of using the guided endodontic technique in comparison with the conventional treatment in treating severely calcified teeth.