An asymptomatic tooth shows a periapical radiolucency. On access the canal is found to be completely calcified and cannot be located. What is the most appropriate action?

Correct answer: A. Refer to an endodontist

• A. CORRECT. A calcified canal with periapical pathology needs the DENTAL OPERATING MICROSCOPE, ultrasonic tips and often CBCT to locate. Continuing blind is how furcation perforations and gouged pulpal floors happen. Referral protects both the tooth and the patient, and is a recognised standard-of-care decision rather than an admission of failure.
• B. Enlarging the access with round burs without magnification is precisely how the pulpal floor is perforated. The floor is thin and the anatomical landmarks are already obscured by calcification.
• C. Leaving a tooth with an established periapical lesion untreated allows the infection to progress.
• D. Extraction is premature — calcified canals are frequently negotiable under a microscope, and the tooth may well be salvageable.

Note: Useful landmarks when hunting a calcified orifice: the pulpal floor is always DARKER than the surrounding walls, orifices sit at the junction of floor and wall, and developmental grooves lead toward them.