Management of Calcified Lower Premolar with Canal Obliteration

Calcified root canals, whether totally or partially obliterated, present one of the greatest challenges in endodontics. They carry a high risk of procedural errors such as instrument fracture, ledge formation, or perforation. Successful management requires patience, the right technique, and advanced tools like ultrasonic tips, magnification, and proper illumination. In this case, a lower premolar presented with complete canal obliteration. The initial treatment attempt involved an incorrect access direction, which resulted in significant gouging of the pulp chamber floor while searching for the canals. Pre-operative radiographs showed disappearance of canal shadows in the apical region, confirming severe calcification. After correcting the access cavity to align with the actual canal orifices, ultrasonic tips were used under magnification to incrementally remove calcifications,…