Dr. Shatakshi B. Bartere, Dr. Anant A. Heda, Dr. Narendra U. Manwar, Dr. Yogesh Tandil, Dr. Neelam Rahul, Dr. Deepashri Tekam


The successful endodontic treatment of depends on ability to negotiate the canal to its apical terminus, thorough debridement or disinfection and obturation of the prepared canal space. In situations such as Calcific Metamorphosis, calcific deposits block the access to the canal, and falls under difficult category cases. One should have the thorough knowledge about such anatomical and pathological variations so that the complications can be avoided. Present case reports endodontic management of maxillary right central incisor with calcific metamorphosis with previously failed endodontic treatment having separated root canal instrument and canal perforation. Even though there was separated instrument and perforation site, the proper management increases the prognosis of the tooth.


Calcific metamorphosis, instrument retrieval, perforation repair, MTA

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Siddiqui SH. Management of pulp canal obliteration using the Modified-Tip instrument technique. International journal of health sciences. 2014 Oct; 8(4):426-428.

Patterson SS, Mitchell DF. Calcific metamorphosis of the dental pulp. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 1965 Jul 1;20(1):94-101.

Reis LC, Nascimento VD, Lenzi AR. Operative microscopy–indispensable resource for the treatment of pulp canal obliteration: a case report. Braz J Dent Traumatol. 2009;1(1):23-26.

Soames JV, Southam JC. Oral Pathology. 4th ed Oxford: Oxford University Press; 1998: 41.

Cohen S, Hargreaves KM. Pathways of the Pulp. 10th Ed. St. Louis, Mo: Elsevier Mosby; 2011.

Fonseca GM, Fonseca MM. Calcific Metamorphosis with Pathological Root Resorption in Permanent Teeth: Morphohistometric Evaluation of Two Cases. International Journal of Morphology. 2015 Jun 1;33(2):712–718.

Munley, P. J. & Goodell, G. G. Calcific metamorphosis. Clinical Update. 2005:27(4).

Torneck CD. The clinical significance and management of calcific pulp obliteration. The Alpha omegan. 1990;83(4):50-54.

McGuigan MB, Louca C, Duncan HF. Endodontic instrument fracture: causes and prevention. British dental journal. 2013 Apr;214(7):341-348.

Souter NJ, Messer HH. Complications associated with fractured file removal using an ultrasonic technique. J Endod 2005;31:450-452.

Hulsmann M, Sehinkel I. Influence of several factors on the success or failure of removal of fractured instruments from the root canal. Endod Dent Traumatol, 1999,15:252-258.

Ward JR, Parashos P, Messer HH. Evaluation of an ultrasonic technique to remove fractured rotary nickel titanium instruments from root canals: clinical cases. J Endod 2003;29:764-767.

Suter B, Lussi A, Sequeira P. Probability of removing fractured instruments from root canals. Int Endo J 2005: 38;112-123.

Roda RS. Root perforation repair: Surgical and non-surgical management. Pract Proced Aesthet Dent. 2001; 13: 467-72.

Tsesis I, Fuss Z. Diagnosis and treatment of an accidental root perforation. Endodontic Topics. 2006; 13: 95-107.

Fuss Z., Trope M. Root perforations: classification and treatment choices based on prognostic factors. Endod. Dent. Traumatol. 1996;12(6):255–264.

Saha SG, Shrivastava R., Neema H., Saha M. Furcal perforation repair with MTA: A report of two cases. JPFA. 2011;25:196–199.

Amaral G, Kattenbach R, Fidel R, Fidel S. MTA as a filling material in internal root resorption. Braz J Dent Traumatol. 2009;1(2):40-44.


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