International Journal of Dentistry and Oral Science (IJDOS) / IJDOS-2377-8075-08-8083

Number of Calcified Maxillary Anteriors Undergoing Root Canal Treatment Under 50 Years of Age - an Institutional Study

Jitesh S1, Adimulapu Hima Sandeep2*, Madhulaxmi M3

1 Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Senior Lecturer, Department Of Conservative dentistry and Endodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
3 Professor, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.

*Corresponding Author

Dr. Adimulapu Hima Sandeep,
Senior Lecturer, Department Of Conservative dentistry and Endodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
Tel: +91 90031 75288
E-mail: himas.sdc@saveetha.com

Received: July 30, 2021; Accepted: August 11, 2021; Published: August 18, 2021

Citation:Jitesh S, Adimulapu Hima Sandeep, Madhulaxmi M. Number of Calcified Maxillary Anteriors Undergoing Root Canal Treatment Under 50 Years of Age - an Institutional Study. Int J Dentistry Oral Sci. 2021;8(8):3981-3984. doi: dx.doi.org/10.19070/2377-8075-21000813

Copyright: Dr. Adimulapu Hima Sandeep�2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

Abstract

The main objective of this study is to find out the prevalence of calcified maxillary anteriors undergoing root canal treatment under 50 years of age group visiting Saveetha dental college and hospitals. This is an institutional based retrospective study conducted among 208 patients reported for root canal treatment of maxillary anteriors and the diagnosis of calcification was based on radiographic evidence. Patients reported to the OP other than maxillary anterior root canal treatment and medically compromised were excluded. From this current study, it was found that, out of 208 patients, 37 were reported with calcification and the prevalence rate was found to be 17%. The extent of calcification was evaluated in which 62% were completely calcified, 20 % of the teeth exhibited calcification till apical third and 18% was till middle third. Within the limits of the present study, prevalence of calcification in maxillary anteriors was found to be 17% under 50 years of age group. Comparing the extent of calcification, teeth with complete calcification (62%) was found to be the most prevalent when compared to calcification extending till apical and middle third and there was no significant association between gender and canal calcification.

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1.Keywords
2.Introduction
3.Conclusion
4.References

Keywords

Calcific Metamorphosis; Maxillary Anteriors; Pulp Calcification.

Introduction

Dental trauma is a common etiological factor to the primary and permanent dentition leading to several complications and management challenges for a dentist. Most common complications include the surface inflammation, internal resorption, pulpal necrosis, invasive cervical resorption and calcific metamorphosis [1, 2]. Calcific metamorphosis (CM) is defined as the pulpal response against the trauma resulting in rapid deposition of the hard tissues within the root canal space [3, 4]. Calcific metamorphosis complicates the access of the root canal system for dentists to do a successful root-canal treatment.

Calcific metamorphosis is one of the most common responses towards dental trauma. However, the degrees of response depend upon the severity of the trauma to the neurovascular tissues in the apical foramen [5, 6]. Treating canal calcification is a most taunting process for the endodontist [7, 8]. Calcific metamorphosis is more common in the anterior teeth and it is possible to identify it three months after an incidence of the injury and sometimes it might also occur even after a year. Even the vital pulp testing may give a negative response irrespective of the pulpal vitality, due to the increased dental thickness [9, 10]. Calcific metamorphosis occurs commonly following traumatic injuries like luxation, subluxation and concussion which leads to complete/partial obliteration of the root canal depending upon the severity of the injury or development stage of the tooth [11, 12]. It is mostly asymptomatic and most of the time is identified based on yellow discoloration of the affected crown tooth and is due to the thickness of dentin deposition. It is important to consider color change takes place uniformly across [9, 13]. The osteoid lesion with cellular inclusions adjacent to mineralised areas in the pulp could have been observed due to either an initial calcification of isolated pulp tissues/ epithelial mesenchymal extractions [14, 16]. Lundberg and Wek et al., showed that content of collagen increases in maxillary inclusion after trauma with decreased cell number [17-19].

Sihendh et al suggested root end resilient to be considered when a canal cannot be isolated. Previously our team has a rich experience in working on various research projects across multiple disciplines [20-34]. Now the growing trend in this area motivated us to pursue this project.

The purpose of this study was to describe the prevalence of canal calcification in the given sample and to report the extent of calcification of the same.

Materials and Methods

Study design and Study setting:

The present hospital based retrospective study was carried out with the use of a digital case record of 208 patients who underwent root canal treatment from lakhs of patients attending the dental college from june 2019 to march 2020.

Ethical clearance to conduct this study was obtained from the Scientific Review Board of the hospital (SDC/SIHEC/2020/DIASDATA/ 0619-0320) . An inclusion criterion was patients visiting the dental college in the specified period of time and patients undergoing RCT of maxillary anteriors. All the 208 patients who underwent RCT of maxillary anteriors were included in this study and cross verification of the data was done for errors. Each case was verified regarding general information of the patient; if anterior RCT was done then radiographic investigation was performed to assess the canal status. The exclusion criteria were missing or incomplete data. Exclusion criteria eliminated cases that were not approved by the concerned faculty in the hospital. Demographic details of cases went for RCTs and Radiographs were retrieved. Data was verified by one eternal examiner. Data was tabulated in Excel and imported to SPSS and variables were determined.

Result And Discussion

IBM SPSS version 20.0 was used for statistical analysis and descriptive analysis was used to describe age, gender and extent of calcification. Dependent variables were root canal treated teeth and independent variables were age, calcified root canal system. The gender distribution of the population who underwent for RCT for maxillary anteriors are males(66%) and females(34%) (figure 1and table 1) and from this current study, it was found to be that out of 208 patients, 37 patients had canal calcification and the prevalence was about 17% (figure 2 and table 2). The extent of Canal calcification was 62% were completely calcified, 20 % were till apical third, 18% were till middle third.(figure 3) and there was no significant association between gender and the canal morphology.(Pearson Chi-Square test - .368, p value was more than 0.05 ; statistically not significant)(figure 4).

In our present study, the prevalence of canal calcification of maxillary anterior was found to be 17.8% which is supported by the study done by Patterson and Micheal (1) where the incidence of Calcified canal ranges from 4% to 24%. In Calcified canal cases, typically the anterior teeth show a high dentin deposition rate of 3.5 �m /day as compared to the average normal rate of 2.8�m/ day for deciduous teeth and 1.5% �m/day for permanent teeth (35,36).The lamina dura remains intact without peripheral lesions and there is no widening of the PDL space. Radiographic diagnosis of Calcified canal requires a complete/partial obliteration of the pulp chamber and canal. A complete obliteration does not require a complete absence of pulp chamber and canal space. In contrast, a partial obliteration is when pulp chambers are not visible and the canal is markedly narrowed but still visible. For deciding root canal treatment, dentists must show sound knowledge towards canal anatomy and also possible variations. This greatly helps them prepare a better access to the cavity prior to planning the rubber dam. The access cavity was kept normal size and shape. It is recommended to use inductors like sodium hypochlorite for visualising location of the canal [37-39]. Usage of operating microscope required to localise the calcified canal [40, 41].

In our present study, the extent of calcification was found to be 62% completely calcified, 20% till the apical third, 18% was extending from apical to the middle third. Even though negotiating and managing the calcified canals is challenging, it can be accessed if a proper protocol is followed. Access cavity preparation is initiated with the rotary instrument directed towards the presumed location of the pulp chamber. Accurate radiographs are needed for preoperative assessment and periodic assessment of the bur penetration and orientation. Penetration proceeded with DG- 16 endodontic explorer. In case of deep excavation long shank round no.2 bur can be used.then the orifice can be enlarged using No. 8 or 10 K- files. Calcified canal management includes use of vital(external) bleaching with hydrogen peroxide to be considered as the first option [42, 43]. Operator's skill, patience, and a proper armamentarium are the requisites to overcome the difficulties posed by these unforgiving canals for their successful treatment. Our institution is passionate about high quality evidence based research and has excelled in various fields[44 -54]. We hope this study adds to this rich legacy.

The limitations of the study included geographic isolation, subjective error/bias, sample size, multi unleashed , larger sample size to be extensively done in this field of interest.

Table 1. Depicts the gender distribution of the present study. Gender distribution of the population out of 208; 138 males(66%) and 70 females(34%).

Table 2. Depicts the prevalence of the calcified canal of the present study. Out of 208 patients ; 37 calcified canal (17.8%) and 171 normal canal morphology(82.2%).

Figure 1. Bar chart depicting the gender distribution of the present study. X axis represents the gender and Y axis represents the percentage of the study population. Sample size n=208; 138 males (66%) and 70 females (34%).

Figure 2. Bar chart depicts the presence of calcification. X axis represents the status of the canal and Y axis represents the percentage of the study population. Out of 208 patients: 37 calcified canal (17.8%) and 171 normal canal morphology(82.2%).

Figure 3 - Pie chart shows the extent of calcification. In which completely calcified canal (green) 62%, calcification extending till the middle third(blue) 18% and the calcification extending only till the apical third(red) 20% of the cases.

Figure 4 - Bar graph depicting the association between the canal morphology among males and females. X axis represents the gender and Y axis represents the total count of the subjects. Association tested by Pearson Chi-Square test - .368, p value - 0.947(>0.05) ; statistically not significant though complete calcification of the canal (green) is more likely to occur in males than females.

Conclusion

Within the limits of the present study, prevalence of calcification in maxillary anteriors was found to be 17% under 50 years of age group. Comparing the extent of calcification, teeth with complete calcification (62%) was found to be the most prevalent when compared to calcification extending till apical and middle third. This study shows that complete calcification of the canal was more in males than females. Further investigation can be done on the etiological factors of calcification dividing the age groups. Operator's skill, patience, and a proper armamentarium are the requisites to overcome the difficulties posed by these unforgiving canals for their successful treatment.

References