Endodontic treatment features in geriatric patients with calcified root canals

Abstract

ACTUALITY. Endodontic treatment poses a significant clinical challenge, particularly in cases of calcified root canals (CRCs). Age-related changes in dentin structure, accompanied by partial or complete canal calcification, significantly complicate mechanical instrumentation, irrigation, and obturation of the root canal system. These factors increase the risk of iatrogenic complications and reduce the predictability of successful treatment outcomes. Given the increasing life expectancy and the growing need for geriatric patients to maintain their dentition, investigating effective approaches for managing CRCs in this population is of high relevance to clinical endodontics and geriatric dentistry.

OBJECTIVE. To determine the clinical features of endodontic treatment in geriatric patients with calcified root canals, evaluate the effectiveness of modern instrumental and pharmacological approaches, and identify key factors influencing treatment prognosis. MATERIALS AND METHODS. This clinical study was conducted at the Republican Dental Clinic and involved 72 patients aged 65–85 years diagnosed with calcified root canals based on cone-beam computed tomography (CBCT). The study included patients with vital and non-vital pulp, without significant root resorption or severe systemic diseases affecting bone tissue. Exclusion criteria included uncontrolled diabetes mellitus, severe cardiovascular diseases, and oncological pathology. Diagnostic methods comprised clinical examination, CBCT imaging, and endodontic microscopy. Treatment was performed using ultrasonic activation of irrigants and mechanical preparation with highly flexible nickel-titanium rotary instruments. A 17 % EDTA solution and 5.25 % sodium hypochlorite were used with ultrasonic activation to remove calcifications. The obturation technique involved vertical compaction of warm gutta-percha. Treatment effectiveness was assessed 12 months postoperatively using CBCT and clinical evaluation.

RESULTS. Full canal patency was achieved in 89% of cases (64 out of 72 teeth), while in 11 % (8 cases), calcifications impeded adequate instrumentation, necessitating treatment protocol modifications. The average time required to negotiate calcified root canals was (34.7 ± 5.2) minutes. The use of ultrasonic irrigation activation contributed to more effective calcification removal and a reduced incidence of instrument-related complications. After 12 months, treatment success — confirmed by clinical and radiographic criteria — was observed in 91.6 % of cases. Patients with complete canal patency had significantly better outcomes, whereas partial apical third calcification substantially reduced the likelihood of successful treatment. The primary predictors of treatment failure included significant apical third calcification (which increased failure risk by 4.3 times, p < 0.05), pronounced thinning of canal walls (which elevated the risk of perforation), and the presence of associated periapical lesions.

CONCLUSION. Endodontic treatment of calcified root canals in geriatric patients requires an individualized approach utilizing advanced imaging techniques, flexible instruments, and effective irrigation strategies. Ultrasonic activation of irrigants and the use of highly flexible nickel-titanium instruments enhance treatment success and reduce the risk of complications.