Pulp canal obliteration: an endodontic diagnosis and treatment challenge

Aim: To review the literature on pulp chamber and root canal obliteration in anterior teeth and to establish a clear protocol for managing teeth with fine, tortuous canal systems.

Summary: Pulp canal obliteration (PCO) occurs commonly following traumatic injuries to teeth. Approximately 4-24% of traumatized teeth develop varying degrees of pulpal obliteration that is characterized by the apparent loss of the pulp space radiographically and a yellow discoloration of the clinical crown. These teeth provide an endodontic treatment challenge; the critical management decision being whether to treat these teeth endodontically immediately upon detection of the pulpal obliteration or to wait until symptoms or signs of pulp and or periapical disease occur. The inevitable lack of responses to normal sensibility tests and the crown discoloration add uncertainty to the management; however, only approximately 7-27% of teeth with PCO will develop pulp necrosis with radiographic signs of periapical disease. Root canal treatment of teeth with pulpal obliteration is often challenging. This article discusses the various management approaches and highlights treatment strategies for overcoming potential complications.

Key learning points: Up to 25% of traumatized anterior teeth can develop pulp canal obliteration; Discolouration is a common clinical finding in teeth with pulp canal obliteration; Up to 75% of teeth with pulp canal obliterations are symptom-free and require no treatment other than radiographic monitoring; Routine pulp sensibility tests are unreliable in the presence of pulp canal obliteration; Teeth with pulp canal obliteration in need of root canal treatment pose particular diagnostic and treatment challenges.