Root canals can be frustrating at times, even for a seasoned veteran like me. If you run into a canal blockage, it can be so annoying. So can the curvature of those canals. Today, I want to talk about how to treat calcified root canals, so that you can reduce your headache and improve your outcomes.

These unexpected finds can really complicate your access and impact your chair time. Within teeth, some blockages and curves are drastic and obvious, while others are more subtle. Unfortunately, it’s the subtle ones you realllllly have to watch out for! They’ll make you feel like you’re doing something wrong—so it’s super important that you stay on the right path by knowing what to do when you run into one of these. That way, you can empower yourself to get unstuck and rock your root canal.

Calcified root canals: How to treat the unexpected

Recently, a dentist reached out to me asking about a specific case that was pretty dang tricky. 

She was doing a root canal on tooth #13. On the radiograph, the tooth looked pretty straightforward, but—you guessed it—she discovered that it wasn’t so simple after all! She sent me this image, a working length radiograph of tooth #13.

And before you freak out, the dentist promised me that the rubber dam IS there! She let me know that the clamp is just on a different tooth, so we can’t see it in the image.

You better believe my FIRST question to her was, “Where the hell is your rubber dam??” But don’t worry—she’s a pro. To reiterate, the clamp was on a different tooth out of sight in this image. At least, that’s what she reassured me!

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 dang day, and it’s important to know how to troubleshoot it because if you’re doing endo, it’s just something you’re going to come up against.

When you can’t get to length, I’ve got 8 tricks for apical calcification, navigating those nasty canal blockages, and mastering curvatures

I shared all of this with her, and I want to share it with you, too.

Eight Tips for How to Treat Calcified Root Canals, Blockages, and Curvatures

1. Use smaller files. Not having any luck with your 10mm file? It’s time to think smaller so you can get down to that apex. I use 6 and 8 files all the time. In endo, if a canal is blocked then I’ll use a 21mm hand file over a 25mm one; the shorter files tend to work better for these situations. Check out my favorite files here.

2. Toss the K files and get C files. That’s “C” for “cutting,” which is exactly what you need for getting through that nasty apical calcification to 0.0. Rather than the “quarter turn pull,” this file needs to be used in a pecking motion. Read about my top 10 tools for endo here.

3. If the tip of the file gets bent, then cut it 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. Easy peasy.

4. When your hands get tired, use the M4 Handpiece! It’s freakin’ awesome! It basically turns your hand into a rotary file for busting through calcification and canal blockages when you’re doing endo and helping you get down to the apex.

You’ll want to make sure you keep that pecking motion when you use it. I use one by Kerr, but you can of course reach out to your dental supplier for more options.

5. Try curving your files beforehand. Straight files can get stuck, especially if you’re dealing with a curvature issue. Try precurving the file and seeing if that helps.

6. Start with some coronal shaping. Want your hand file to glide to the apex with ease? It will become a lot simpler if you remove the coronal interferences, so start to do some coronal shaping with your rotary files. While you may have to go back and forth between your rotary and your hand files for this process to work, take your time. If you go too quickly and stress your files (or cause separation, which absolutely no one wants), you can end up in a worse state than you started. 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. As a last resort, put it aside for another day. Dealing with canal blockages in endo or navigating tricky curvature is time-consuming. And when you’ve been working on a tooth for a long time, you might need some time away. Especially if you’ve tried all these tactics and you’re still not having success, you might feel frustrated. If that’s the case, place some calcium hydroxide and take a break. At the next appointment, you’ll have a fresh perspective and a fresh set of eyes to help you conquer that crazy canal constriction!

Perseverance and belief are my top tips for how to treat calcified root canals, blockages, and curvatures

I will say it over and over again. If you don’t believe that you can save the tooth, then it doesn’t matter how many tips and tricks you’ve learned; you won’t go all in to save it. Instead, we must believe in the amazing healing power of root canals to get that tooth in good shape again, and do everything we can to save it.

Hopefully, this guidance for dealing with calcified root canals, blockages, and curvatures will help you problem-solve the next tricky tooth you run into.

Don’t give up! Remember, your goal is to save teeth! Working length and patency are so important to root canal success. I believe in you. Do you believe in yourself?

If you truly want to become confident with endodontics, I recommend enrolling in E-School, my award-winning, online endodontic CE curriculum. It is designed to help dentists of all types become endo rockstars. We start with the basics and then discuss tweaks, workflows, and mindset shifts that truly make all of the difference in your outcomes, efficiency, and profitability. Enroll in E-School today!

– Sonia