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Fig. 17 Fig. 18 Fig. 16 Fig. 16 Decision flowchart. Tips for clinical management of pulp canal obliteration 1. It is essential to remember that the pulp chamber is always located in the center of the tooth at the level of the cemen- toenamel junction (CEJ; Fig. 13).5 2. The calcified pulp chamber is darker than and appears a different color to the axial wall root dentin.5 3. A much better solution is to prepare the access cavity close to or through the incisal edge. This approach facili- tates straight-line access and is a more predictable approach to locating the pulp chamber while avoiding unneces- sary damage (Fig. 14).5 4. The use of the dental operating micro- scope is recommended to identify col- or changes (Fig. 15).5 5. Using long shank burs in a slow hand- piece or preferably ultrasonic tips to penetrate deeply into the canal system is recommended.5 6. Sodium hypochlorite can also be used to aid in the identification of a calcified canal by visualizing the occurrence of bubbling (called a bubble or champagne test). 5 Take radiographs at multiple angles to maintain alignment and direction during the procedure. 7. 8. A CBCT scan is quite useful in the plan- ning and progression of treatment.1 9. Alternate between size 8 and 10 K-files with a gentle watch-winding motion with minimal vertical pressure with reg- ular replacement of the instruments before fatigue occurs.5 C ≈ 11 mm (distance from midpoint of a line connecting the two cusp tips and closest point to the furcation) E ≈ 2.5 mm (height of the pulp chamber) 10. Frequently irrigate and scrub with che- lating agents/sodium hypochlorite. Af- ter that, dry and observe. 11. A crown-down approach has been rec- ommended to improve tactile sensa- tion and better apical penetration.5 12. In single-rooted teeth, never forget the root canal centricity in the root, look for the color changes (sometimes, it is useful to use the fisheye view: de- liver irrigant to the pulp chamber) and search the root canal lingually in max- illary incisors. In multirooted teeth, look for white lines and white spots. 13. The calcification process as seen in pul- pal obliteration occurs in a corono- apical direction, so once the initial canal has been located an instrument tends to progress more easily as it advances toward the canal terminus.5 14. In premolars and molars, taking into consideration the following anatomical landmarks may be useful. Important anatomical landmarks16, 17 D ≈ 7 mm (distance from midpoint of a line connecting the two cusp tips to the pulp chamber ceiling) C ≈ 11 mm (distance from the buccal cusp tip to the closest point to the furcation) E ≈ 6 mm (distance from the buccal cusp to the pulp chamber ceiling) F ≈ 2 mm (height of the pulp chamber) The measurements were similar for both maxillary and mandibular molars. 15. The decision flowchart (Fig. 16) out- lines the various treatment options that can be considered depending on the presenting signs and symptoms. Conclusion In this article, I have provided several tips for approaching the endodontic challenge of pulp canal obliteration. However, in an era devoted to conservative dentistry, oth- er tools are emerging that may allow a more conservative, faster and more pre- dictable approach in a large number of clinical situations where root anatomy is favorable: “microguided endodontics”. Editorial note: A list of references is available from the publisher. 54 — issue 2018 Endodontics Article