Clinical Effectiveness of Magnification in Managing Calcified Canals and Immediate Definitive Restoration: A Case Report

Abstract

Pulp canal calcification represents a significant challenge in endodontics, marked by progressive obliteration of the canal lumen that complicates localization, negotiation, and effective disinfection. This case report presents a clinical protocol applied to a maxillary molar with severe calcification in the orifice portion of the mesiobuccal canal. Using high-magnification operating microscopy and ultrasonic instrumentation, the canal orifice was successfully located and instrumented. An immediate definitive restoration was performed to optimize the coronal seal and reduce the risk of microleakage and reinfection. The treatment followed a structured, stepwise approach incorporating current technological resources and evidence-based procedures, including selective dentin removal, glide path creation, and adhesive restorative techniques. Treatment involved three clinical sessions, with initial preparation of the distobuccal and palatal canals using manual and rotary instruments, followed by location and negotiation of the calcified mesiobuccal canal using ultrasonic tips and C-Pilot files under magnification, intracanal medication with calcium hydroxide, and final obturation by lateral condensation. Restoration included hybrid adhesive protocols and cusp reconstruction to ensure long-term seal and mechanical stability. This approach allowed for preservation of tooth structure and favorable prognosis in a complex anatomical scenario. The case emphasizes the importance of clinician expertise, customized access design, and timely restoration to reduce the risk of procedural complications. It highlights the need for adaptable, case-specific strategies in managing calcified canals to support predictable outcomes and long-term clinical success.