This study aimed to present a novel dynamic navigation method to attain minimally invasive access cavity preparations and to evaluate its 3-dimensional (3D) accuracy in locating highly difficult simulated calcified canals among maxillary and mandibular teeth.
Three identical sets of maxillary and mandibular 3D-printed jaw models composed of 84 teeth in their anatomic locations with simulated calcified canals (N = 138 canals) were set up on dental manikins. The Navident dynamic navigation system (ClaroNav, Toronto, Ontario, Canada) was used to plan and execute access preparations randomly with high-speed drills by a board-certified Endodontist. Two-dimensional (2D) and 3D horizontal, vertical, and angulation discrepancies between the planned and placed access preparations were digitally measured using superimposed cone-beam computed tomographic scans. Analysis of covariance models were used to evaluate the associations and the interaction between tooth type and jaw, the canal orifice depth, and the discrepancies between planned and prepared access cavities. The significance level was set at .05.
The mean 2D horizontal deviation from the canal orifice was 0.9 mm, and it was significantly higher on maxillary compared with mandibular teeth (P < .05). The mean 3D deviation from the canal orifice was 1.3 mm, and it was marginally higher on maxillary teeth in comparison with mandibular teeth (P ≥ .05). The mean 3D angular deviation was 1.7 degrees, and it was significantly higher in molars compared with premolars (P < .05). The 3D and 2D discrepancies were independent of the canal orifice depths (P > .05). The average drilling time was 57.8 seconds with significant dependence on the canal orifice depth, tooth type, and jaw (P < .05).
This study shows the potential of applying dynamic 3D navigation technology with high-speed drills to preserve tooth structure and accurately locate root canals in teeth with pulp canal obliteration.
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- Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition.Endod Dent Traumatol. 1987; 3: 103-115
- Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision.Dent Traumatol. 2009; 25: 620-625
- Clinical outcomes for permanent incisor luxations in a pediatric population. III. Lateral luxations.Dent Traumatol. 2003; 19: 280-285
- Calcific metamorphosis of the pulp: its incidence and treatment.Oral Surg Oral Med Oral Pathol. 1967; 24: 825-830
- Pulp canal obliteration: an endodontic diagnosis and treatment challenge.Int Endod J. 2012; 45: 177-197
- Incidence of pulp necrosis subsequent to pulp canal obliteration from trauma of permanent incisors.J Endod. 1996; 22: 557-560
- Pulpal response after acute dental injury in the permanent dentition: clinical implications - a review.J Endod. 2015; 41: 299-308
- Human pulp changes of iatrogenic origin.Oral Surg Oral Med Oral Pathol. 1971; 32: 943-980
- Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up.Gerodontology. 2017; 34: 164-170
- Potential correlation between statins and pulp chamber calcification.J Endod. 2013; 39: 1119-1123
- Impact of endodontic treatments on the rigidity of the root.J Dent Res. 2006; 85: 364-368
- AAE endodontic case difficulty assessment form and guidelines.(Available at:)https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/10/2006casedifficultyassessmentformb_edited2010.pdf 2010(Accessed December 27, 2019)
- Periapical surgery using CAD/CAM guidance: preclinical results.J Endod. 2007; 33: 148-151
- Guided endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology.Dent Traumatol. 2016; 32: 240-246
- Microguided endodontics: accuracy of a miniaturized technique for apically extended access cavity preparation in anterior teeth.J Endod. 2017; 43: 787-790
- Microguided endodontics: a method to achieve minimally invasive access cavity preparation and root canal location in mandibular incisors using a novel computer-guided technique.Int Endod J. 2018; 51: 247-255
- Targeted endodontic microsurgery: a novel approach to anatomically challenging scenarios using 3-dimensional–printed guides and trephine burs—a report of 3 cases.J Endod. 2018; 44: 671-677
- A new approach for minimally invasive access to severely calcified anterior teeth using the guided endodontics technique.J Endod. 2018; 44: 1578-1582
- Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location.Int Endod J. 2016; 49: 966-972
- Accuracy of image-guided implantology.Clin Oral Implants Res. 2005; 16: 495-501
- Implant placement accuracy using dynamic navigation.Int J Oral Maxillofac Implants. 2017; 32: 92-99
- Guided endodontics versus conventional access cavity preparation: a comparative study on substance loss using 3-dimensional-printed teeth.J Endod. 2019; 45: 327-331
- Failures and healing in endodontically treated non-vital anterior teeth with posttraumatically reduced pulpal lumen.Acta Odontol Scand. 1982; 40: 223-228
- The prognosis for endodontic treatment of obliterated root canals.J Endod. 1988; 14: 565-567
- Stress-strain response in human dentine: rethinking fracture predilection in postcore restored teeth.Dent Traumatol. 2004; 20: 90-100
- Computer-aided dynamic navigation: a novel method for guided endodontics.Quintessence Int. 2019; 50: 196-202
- Comparison of different registration methods for surgical navigation in cranio-maxillofacial surgery.J Craniomaxillofac Surg. 2008; 36: 109-116
- The accuracy of static computer-aided implant surgery: a systematic review and meta-analysis.Clin Oral Implants Res. 2018; 29: 416-435
- Computer technology applications in surgical implant dentistry: a systematic review.Int J Oral Maxillofac Implants. 2009; 24: 92-109
- Navigation surgery for dental implants: assessment of accuracy of the image guided implantology system.J Oral Maxillofac Surg. 2004; 62: 116-119
- Residual dentin thickness in mandibular premolars prepared with gates glidden and ParaPost drills.J Prosthet Dent. 2000; 83: 617-623
- Exploiting the potential of free software to evaluate root canal biomechanical preparation outcomes through micro-CT images.Int Endod J. 2015; 48: 1033-1042
- The precision of the RoboDent system — an in vitro study.in: Lemke H.U. Inamura K. Doi K. CARS 2002 Computer Assisted Radiology Surgery. Springer Berlin Heidelberg, Berlin, Heidelberg2002: 947-952
- Simulated colonoscopy training leads to improved performance during patient-based assessment.Gastrointest Endosc. 2015; 81: 630-636
- Exploring training dental implant placement using computer-guided implant navigation system for predoctoral students: a pilot study.Eur J Dent Educ. 2019; 23: 415-423
Published online: April 24, 2020
Published by Elsevier Inc. on behalf of American Association of Endodontists.