Digital radiographic exams were obtained with different angles and analyzed using different filters. These case reports aimed to describe the management of lateral perforation in the middle cervical third of the root in two maxillary incisors with pulp canal calcification using Bio-C Repair, with safe and viable clinical treatment strategies. Clinical approach of teeth with PCO should follow a decision-making algorithm incorporating clinical and radiographic signs and patient-reported symptoms. Symptomatic PCO teeth should follow regular endodontic treatment pathways. Conclusions: For discolored non-symptomatic PCO teeth, external bleaching is advocated and the RCT approach should not be implemented as a preventive intervention strategy. Guided endodontic technique was performed in six of those teeth. For teeth diagnosed with PN, non-surgical RCT was performed in 10 teeth and surgical RCT in one tooth. The prevalence of pulp necrosis (PN) was 36.4%. Discolored non-symptomatic PCO teeth were mostly managed with external bleaching. The “watchful waiting” approach was the most implemented clinical strategy. The number of traumatized teeth diagnosed with PCO was 33. Results: Twenty case reports were selected, resulting in a total of 27 patients. Quality assessment was performed using the JBI Critical Appraisal Tool for Case Reports. Regarding clinical approaches, only teeth managed with a “watchful waiting” approach, tooth bleaching or root canal treatment (RCT) were included. Only anterior permanent teeth with PCO due to dental trauma were included. Materials and Methods: An electronic search strategy was performed in Pubmed, EBSCOhost and LILACS from inception to March 2021. The present review follows the PRISMA guidelines and was registered on PROSPERO database (CRD42020200656). All rights reserved.īackground and Objectives: This systematic review aimed to assess the literature focusing on the clinical management of traumatized teeth with Pulp Canal Obliteration (PCO) and propose an updated clinical decision-making algorithm. © 2017, Iranian Association of Endodontics. It served as a guide for the direction of the ultrasonic tips to keep them within the pulp chamber safely, with a low risk of iatrogenic injury. If the canal was not identified, CBCT was mandatory in order to show more detailed view of the precise position of the canals, their directions, degrees of obstruction and dimensions. The clinical evaluation of the access cavity with the aid of MO was crucial. Complete root canal obliteration identified in radiography did not necessarily mean that pulp tissue was not visible clinically, either. In cases 2, 3 and 4, the canals were identified with DR, DOM, US tips and CBCT. In case 1, the canal was identified using DR, DOM and US tips. All four canals were successfully identified, with no complications. After identification of the canal, it was then negotiated and instrumented with the rotary instruments. Sagittal and axial slices guided the direction of the ultrasonic tips. If the canal was not identified, CBCT was requested. Subsequently, the access cavity was performed with the aid of DOM. DR was taken with different angulations and analyzed with different filters. Four anterior teeth with PCO were chosen. This article describes four cases with safe and feasible clinical treatment strategies for anterior teeth with pulp canal obliteration (PCO) using cone-beam computed tomography (CBCT), digital radiography (DR), dental operating microscopy (DOM) and ultrasonic tips (US).