Pulp calcification: a receded pulp chamber (and calcified canals) vs pulp stones An important part in knowing how to approach an endo case and to assess its difficulty is to evaluate for calcification of the pulp and the type of calcification that is present.
The left image shows a case where the entire system is moderately calcified. The height of the pulp chamber (distance between the chamber roof and floor) is reduced, and the canals are thinner. This means that when accessing, it is important to continuously check the depth of access and angulation, because it may be more difficult to recognize when you've accessed into the chamber, and there may not be the obvious "drop" into the chamber that you might normally look for. It is also then sometimes more difficult to find all the canals, and it is more difficult to manage a calcified canal (higher risk of instrument separation and canal transportation, etc)
The right image shows a case with pulp stones. There, the chamber height is not reduced but there are the calcifications within the chamber, which as I explained in my previous post on stones, can be hiding tissue and canals, and make it more difficult to get into a canal. They may also be covering the pulp chamber floor and trick you into thinking you've finished accessing. However the presence of stones does not necessarily mean the canals themselves are calcified. The stones should be gently removed during access.
In each of these cases, there is calcification of the pulp and canal system, but in different ways. This can affect how a case is managed.
Both calcified pulp systems and pulp stones come with their own difficulties in management!
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