Advertisement

Real-Time Guided Endodontics with a Miniaturized Dynamic Navigation System Versus Conventional Freehand Endodontic Access Cavity Preparation: Substance Loss and Procedure Time

      Abstract

      Introduction

      This study aimed to evaluate substance loss and the time required for access cavity preparation (ACP) using the conventional freehand method (CONV) versus a miniaturized dynamic navigation system of real-time guided endodontics (RTGE) in an in vitro model using 3-dimensional–printed teeth.

      Methods

      Nine human anterior maxillary teeth were selected and micro–computed tomographic scanned. Root canals were virtually reduced to 2 mm below the cementoenamel junction. The teeth were digitally duplicated and mirrored to yield 6 different models with 6 single-rooted teeth each. The models were 3-dimensionally printed using radiopaque resin and consecutively mounted on a dental mannequin for ACP. Two operators with 12 and 2 years of clinical experience, respectively, received 6 models (36 teeth) each and performed ACP on half of the models using RTGE (after digital planning) and CONV on the other half 2 weeks later. The time was recorded. Postoperative substance loss was measured by cone-beam computed tomographic imaging. The differences in time and substance loss between the methods and operators were evaluated by the t test.

      Results

      Overall, substance loss was significantly lower with RTGE than CONV (mean = 10.5 mm3 vs 29.7 mm3), but both procedures took a similar time per tooth (mean = 195 vs 193 seconds). Operator 1 (more experienced) achieved significantly less substance loss than operator 2 with CONV (mean = 19.9 vs 39.4 mm3) but not with RTGE (mean = 10.3 vs 10.6 mm3).

      Conclusions

      RTGE is a practicable, substance-sparing method performed in comparable time as CONV. Moreover, RTGE seems to be independent of operator experience.

      Key Words:

      To read this article in full you will need to make a payment

      References

        • Kiefner P.
        • Connert T.
        • ElAyouti A.
        • et al.
        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
        • Cvek M.
        • Granath L.
        • Lundberg M.
        Failures and healing in endodontically treated non-vital anterior teeth with posttraumatically reduced pulpal lumen.
        Acta Odontol Scand. 1982; 40: 223-228
        • Zehnder M.S.
        • Connert T.
        • Weiger R.
        • et al.
        Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location.
        Int Endod J. 2016; 49: 966-972
        • Krastl G.
        • Zehnder M.S.
        • Connert T.
        • et al.
        Guided endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology.
        Dent Traumatol. 2016; 32: 240-246
        • Connert T.
        • Zehnder M.S.
        • Amato M.
        • et al.
        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
        • Connert T.
        • Zehnder M.S.
        • Weiger R.
        • et al.
        Microguided endodontics: accuracy of a miniaturized technique for apically extended access cavity preparation in anterior teeth.
        J Endod. 2017; 43: 787-790
        • Buchgreitz J.
        • Buchgreitz M.
        • Bjorndal L.
        Guided root canal preparation using cone beam computed tomography and optical surface scans - an observational study of pulp space obliteration and drill path depth in 50 patients.
        Int Endod J. 2019; 52: 559-568
        • Buchgreitz J.
        • Buchgreitz M.
        • Mortensen D.
        • et al.
        Guided access cavity preparation using cone-beam computed tomography and optical surface scans - an ex vivo study.
        Int Endod J. 2016; 49: 790-795
        • Connert T.
        • Krug R.
        • Eggmann F.
        • et al.
        Guided endodontics versus conventional access cavity preparation: a comparative study on substance loss using 3-dimensional-printed teeth.
        J Endod. 2019; 45: 327-331
        • Moreno-Rabie C.
        • Torres A.
        • Lambrechts P.
        • et al.
        Clinical applications, accuracy and limitations of guided endodontics: a systematic review.
        Int Endod J. 2020; 53: 214-231
        • Zubizarreta-Macho Á.
        • Muñoz A.P.
        • Deglow E.R.
        • et al.
        Accuracy of computer-aided dynamic navigation compared to computer-aided static procedure for endodontic access cavities: an in vitro study.
        J Clin Med. 2020; 9: 129
        • Jain S.D.
        • Saunders M.W.
        • Carrico C.K.
        • et al.
        Dynamically navigated versus freehand access cavity preparation: a comparative study on substance loss using simulated calcified canals.
        J Endod. 2020; 46: 1745-1751
        • Jain S.D.
        • Carrico C.K.
        • Bermanis I.
        3-Dimensional accuracy of dynamic navigation technology in locating calcified canals.
        J Endod. 2020; 46: 839-845
        • Gambarini G.
        • Galli M.
        • Morese A.
        • et al.
        Precision of dynamic navigation to perform endodontic ultraconservative access cavities: a preliminary in vitro analysis.
        J Endod. 2020; 46: 1286-1290
        • Dianat O.
        • Nosrat A.
        • Tordik P.A.
        • et al.
        Accuracy and efficiency of a dynamic navigation system for locating calcified canals.
        J Endod. 2020; 46: 1719-1725
        • Dianat O.
        • Gupta S.
        • Price J.B.
        • et al.
        Guided endodontic access in a maxillary molar using a dynamic navigation system.
        J Endod. 2021; 47: 658-662
        • Chong B.S.
        • Dhesi M.
        • Makdissi J.
        Computer-aided dynamic navigation: a novel method for guided endodontics.
        Quintessence Int. 2019; 50: 196-202
        • van der Meer W.J.
        • Vissink A.
        • Ng Y.L.
        • et al.
        3D Computer aided treatment planning in endodontics.
        J Dent. 2016; 45: 67-72
        • Tavares W.L.
        • Viana A.C.
        • de Carvalho Machado V.
        • et al.
        Guided endodontic access of calcified anterior teeth.
        J Endod. 2018; 44: 1195-1199
        • Torres A.
        • Shaheen E.
        • Lambrechts P.
        • et al.
        Microguided endodontics: a case report of a maxillary lateral incisor with pulp canal obliteration and apical periodontitis.
        Int Endod J. 2019; 52: 540-549
        • D'Haese J.
        • Ackhurst J.
        • Wismeijer D.
        • et al.
        Current state of the art of computer-guided implant surgery.
        Periodontol 2000. 2017; 73: 121-133
        • Gambarini G.
        • Galli M.
        • Stefanelli L.V.
        • et al.
        Endodontic microsurgery using dynamic navigation system: a case report.
        J Endod. 2019; 45: 1397-1402
        • Dianat O.
        • Nosrat A.
        • Mostoufi B.
        • et al.
        Accuracy and efficiency of guided root-end resection using a dynamic navigation system: a human cadaver study.
        Int Endod J. 2021; 54: 793-801
        • Krishan R.
        • Paque F.
        • Ossareh A.
        • et al.
        Impacts of conservative endodontic cavity on root canal instrumentation efficacy and resistance to fracture assessed in incisors, premolars, and molars.
        J Endod. 2014; 40: 1160-1166
        • Plotino G.
        • Grande N.M.
        • Isufi A.
        • et al.
        Fracture strength of endodontically treated teeth with different access cavity designs.
        J Endod. 2017; 43: 995-1000
        • Reymus M.
        • Stawarczyk B.
        • Winkler A.
        • et al.
        A critical evaluation of the material properties and clinical suitability of in-house printed and commercial tooth replicas for endodontic training.
        Int Endod J. 2020; 53: 1446-1454