There are some frustrating experiences that every dental professional faces during root canals. For instance, ever run into surprise apical calcification and curvatures? These unexpected finds can really complicate your access. Within teeth, some curves are drastic and obvious, while others are more subtle. Unfortunately, it’s the subtle ones you have to watch out for! They’ll make you feel like you’re doing something wrong, so you have to know what to do when you get stuck.
Recently, a dentist reached out to me asking about a case. She was doing a root canal on tooth #13. On the radiograph, the tooth looked pretty straightforward, but she discovered it wasn’t at all! She sent me this image, a working length radiograph of tooth #13.
One of the canals was close to patency, but I wasn’t convinced it was patent yet. The other canal was short, and therein lay her frustration.
This kind of working length issue happens to me every day, and it’s important to know how to troubleshoot it because it never stops occurring.
When you can’t get to length, here are the 8 tricks for apical calcification and curvatures in root canals that I shared with her. Now I’m sharing them with you:
1. Use smaller files. Not having any luck with your 10 file? It’s time to think smaller so you can get down to that apex. I use 6 and 8 files all the time. If something’s really calcified, then I’ll use a 21mm hand file over a 25mm one; the shorter files tend to work better for these situations.
2. Toss the K files and get C ones. That’s “C” for “cutting,” which is exactly what you need for getting through that apical calcification to 0.0. Rather than the “quarter turn pull,” this file needs to be used in a pecking motions. (More on my Top 10 Tools for Endo here.)
3. If the tip of the file gets bent, then cut the tip off and keep using the file as-is. This will keep your tip more active and help it cut more efficiently. Don’t forget that you just shortened your file, though! This is also a great way to get more life out of your file instead of reaching for a new one.
4. When your hands get tired, use the M4 Handpiece! It’s freakin’ awesome! It basically turns your hand into a rotary file, so that it can bust through those calcified canals and get you down to apex. (You’ll want to make sure you keep that pecking motion when you use it.) Here’s one one put out by Kerr, but you can obviously reach out to your dental supplier for more options.
5. Curve your files beforehand. Straight files can get stuck, especially if you’re dealing with a curvature issue. Try precurving the file and see if that helps.
6. Start with a coronal opening. Want your hand file to glide to the apex with ease? Things will become a lot more simple if you’ll remove the coronal interferences. While you may have to go back and forth some between your rotary and your hand files for this process to work, don’t go too quickly and stress your files (or cause separation). It will take time and patience, but it could be the key to get you to that apex.
7. Use some EDTA. Let it soak in the canals for a few minutes, then work your files in while it’s still there. It certainly won’t hurt, and it just might make all the difference.
8. Put it aside for another day. Sometimes, when you’ve been working on a tooth for a long time, you just need some time away from it. If none of these tactics work, then place some calcium hydroxide and be done. At the next appointment, you’ll have fresh perspective (and a fresh set of eyes) to help you conquer crazy apical calcification and curvatures!
Hopefully, these tips and tricks for dealing with constricted canals will be helpful and get you unstuck. Don’t give up! Remember, your goal is to save teeth! Working length and patency are so important to root canal success.
You can do this!
-Sonia
These are great suggestions! Thanks for sharing your knowledge.
Thanks for all your support Meena!
-Sonia
Very usefula me helpful practical tips ma’am..
Thank you so much 💕
I’m glad it’s useful for you!
-Sonia
Thanq. Ma’m very helpful ma’m i hve one question. Ma’m can B.D.S practice in Abroad if yes then how?
I am sorry, I am not aware of the admissions process and that is not the intention of this blog. Best of luck to you.
-Sonia
UR SMALL SMALL TIPS REALLY R A BOOST FOR ME TO PERFORM ROOTCANALS WHICH R TOUGH. THANK U SO MUCH MA’AM N KEEP SHARING.
I’m grateful this was helpful for you!
-Sonia
Excellent and efficient tips! Thank you
Thank you! So glad you got something from this!
-Sonia
Really helpful..
yep, always good to call it a day when things aren’t going your way. fresh eyes always so helpful to both you and the patient. <3
Agreed! And thanks for reading!
-Sonia
What do you use to cut a slightly bent tip of an instrument off with? Thanks for the blog and information.
Terri – Any dental scissors you have should work.Thank you for following!
-Sonia
So useful tips mam. Thanks a ton for guiding with these useful tips . Hope to see much more tips in future.
I’ll definitely keep the tips coming!
-Sonia
These are such a simple but practical tips. Thank you so much Sonia for inspiration!!!
Thank you for reading – so happy to help!
-Sonia
Great tips. A question about using C files. Does your “pecking” motion include watchwinding the file at all, or is it purely in and out motion? Also, my understanding is C files are end cutting. Do we need to be concerned with ledging/perforating with these? How do we know we are still following a calcificed canal vs. ledging?
I just found your website and love the tips you are sharing. Thanks again!
Typically when it’s calcified I use a pecking motion because the calcification won’t allow me to watchwind. But I guess you could say there’s a slight bit of a watchwind when I use ANY file. But keeping the file straight in a blocked situation really helps. And there’s always a risk of transportation and ledging with any file, but with smaller C files there is less risk.
There is a very typical feeling I call a “stick” with my hand file that lets me know I’m still in the canal. Small files, plus EDTA, will help you stay in the canal.
Hope this helps!
– Sonia
That helps, thanks again!
Thanku for the tips Mam!! I’m sure these will be of great help.
You’re so welcome. Thanks for reading!
-Sonia
Hello, recently I’ve received some advice to leave EDTA gel inside calcified canal.. have you ever tried that? And will it do any harm leaving it inside the canal for 5 days?
Hi!! I don’t like to leave EDTA in the canals for two long because it will corrode your dentinal tubules. EDTA is something that I always wash out. Hope this helps.
-Sonia
I have tried everything during a RetreAtment of 46 3 canal
With 3 mesial roots and distal
When viewing the x ray one of the mesial roots was filled about 4 mm short from the radiographic apex
And the distal root was filled completely
But the failure was due to the missed second mesial canal which was found by me and instrumented
Is it okay to fill the first mesial only 16 mm insted of 20 mm due to the impossibility of reaching the radiographic apex due to calfication i wasn’t able to overcome ?
The missed canal had a apical leaion
Hi there!! There are studies that show that if you are short in a necrotic case or there are percussion symptoms, for every mm that you are short, your success rate drops by 14% per millimeter. So, never finish short and always be patent. So, if you are 4mm short, then your success rate just dropped by 56%. I have a rule, if there is a lesion, then there is a canal. Endo is tricky and you have to learn how to work those calcifications without giving up. If you can’t get to the end, then refer it to a specialist. It may be that at this time, the patient may need an apico too. Hope this helps.
-Sonia
I love all the tips!
Thanks Rebekkah!
-Sonia
thanks ma’am for sharing ur simple tips.. i look forward to ur advices n tips evry time u put up.
Thank you – I’m so glad you’re following!
-Sonia
Thanks ma’am it’s really helpful for me, really had trouble with blocked canals,thanks a lot
Yes, they can be tricky! Glad to be of help! – Sonia
Absolutely great tips!!! Thank you!!!
You’re so welcome! – Sonia
Thanks for this case and your great tips. I will definitely try the C-files because I do use #6 and #8 files regularly ,however they are so thin I have a hard time feeling pressure with them and they bend easily.
Glad you liked the tips! Let me know how it goes when you put them into action! – Sonia
Thank you mam..thanks for these tips…it will sure help me in calcified canals…thank you very much
You’re very welcome – glad to be of service! – Sonia
Mam…please some input on cracked teeth…how to identify theses..
Vikas,
That is a great question and is something that I dive deep into in Eschool since it is such a special topic and requires more attention.
-Sonia
Thanks Sonia for your suggestions and useful tips. Really appreciate it.
You’re welcome – it really is my pleasure. – Sonia
Thank u mam
You’re very welcome. – Sonia
Hello ma’am,
Your trics are benificial..
Thanx:)
That’s great to hear!
-Sonia
Your tricks and tips are really helpful. I love reading your blogs. Thank you very much Dr. Chopra for sharing your knowledge and experience.
Thank you so much for the feedback! I’m glad it’s useful for you.
-Sonia
Thank you ma’am very useful for we beginner dentist
I’m grateful to hear it, Dr. Rukhsar!
-Sonia