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Alyahya A, Qudeimat MA. Optimal outcomes of pulpotomy in young patients: Long-term prospects for permanent molars with signs and symptoms indicative of irreversible pulpitis. J Dent 2024; 147:105132. [PMID: 38901324 DOI: 10.1016/j.jdent.2024.105132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES Limited literature addresses the long-term success of complete pulpotomy in permanent molars with signs of irreversible pulpitis in young patients. The aim of this observational study was to prospectively evaluate the long-term outcomes of complete pulpotomy using mineral trioxide aggregate (MTA) over an average period exceeding 11 years. METHODS Out of 27 molars displaying signs suggestive of irreversible pulpitis which underwent MTA pulpotomy, 24 molars were followed-up for a mean duration of 11.0 ± 2.2 years (range 8.2 to 14.8 years). Clinical and radiographic assessments were periodically conducted, tailored to each patient's specific circumstances. Treatment failure criteria included clinical signs and symptoms and radiographic evidence suggesting a lack of pulpal or periapical healing. RESULTS 83 % of molars had signs and symptoms of symptomatic irreversible pulpitis, with 83 % displaying apical periodontitis. Clinically and radiographically, all pulpotomies (100 %) were considered successful. A hard tissue barrier was observed in 71 % of teeth, and continued root maturation was evident in all molars with open apices. Complete pulp canal obliteration (PCO) was present in 21 % of the molars. All radiographic apical radiolucencies completely resolved. CONCLUSIONS This study demonstrates a 100 % success rate over an average 11-year follow-up for complete pulpotomy in managing permanent molars with signs and symptoms of irreversible pulpitis in young patients. It offers evidence for its long-term efficacy in promoting healing of pulp and periapical tissues. CLINICAL SIGNIFICANCE This study showed high long-term success for complete pulpotomy in young permanent molars with irreversible pulpitis, with clinical and radiographic success over 11 years. Despite initial symptoms of pulpitis and apical periodontitis, the treatment resulted in tissue healing, root maturation, and resolution of periapical radiolucencies, suggesting it as an alternative to root canal therapy.
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Affiliation(s)
- Asma Alyahya
- Discipline of Paediatric Dentistry, College of Dentistry, Kuwait University, Kuwait
| | - Muawia A Qudeimat
- Discipline of Paediatric Dentistry, College of Dentistry, Kuwait University, Kuwait.
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2
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Zhang T, Chen D, Zhang F, Xie S, Wu G, Hu Q, Yan F, Tang X. Comparison of selective laser melting and stereolithography etching templates for guided endodontics. PeerJ 2024; 12:e17646. [PMID: 39071130 PMCID: PMC11276761 DOI: 10.7717/peerj.17646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/06/2024] [Indexed: 07/30/2024] Open
Abstract
Background With the increasing application of guided endodontics to treat complex root canal treatment, the entire process of root canal treatment has become more precise, reducing damage to tooth structure and improving success rates. However, due to the limitations of the operating space, the use of guided endodontic templates in posterior root canal treatment is less common. This study aims to compare the accuracy and reliability of selective laser melting (SLM) and traditional stereolithography etching (SLA) guided endodontic templates for posterior root canals, providing better treatment strategies for posterior root canal treatment. Methods The teeth were randomly assigned to either SLM or SLA group. Preoperative cone-beam computed tomography (CBCT) and a three-dimensional (3D) scanner were used to establish the 3D root canal system and the accurate occlusal models of the teeth. The virtual access to the canal access was designed using Mimics 19.0 and 3-Matic 11.0. The endodontic access was performed based on either SLM or SLA templates. The accuracy of endodontic preparation was measured in three-dimensions by calculating deviations from planned accesses. The template height and tooth substance loss rates in each group were measured. Results SLM-guided templates have a low average deviation at the entry point and apical portion of the bur of total posterior teeth (including premolars and molars) and individual molars (P < 0.05). Moreover, there was a significant difference in angular deviations and height of template in total posterior teeth and individual molars (P < 0.05). The mean substance loss rate of the SLA group was slightly greater than that of the SLM group, but the difference was not statistically (P > 0.05). Conclusions SLM-guided endodontics provides a more predictable and precise location of root canal orifice for the treatment of posterior teeth.
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Affiliation(s)
- Ting Zhang
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, China
| | - Du Chen
- The Affiliated Stomatological Hospital of Nanjing Medical University, Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Fei Zhang
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, China
| | - Sijing Xie
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, China
| | - Guofeng Wu
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, China
| | - Qingang Hu
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, China
| | - Fuhua Yan
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, China
| | - Xuna Tang
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, China
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3
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Fornara R, Pisano M, Salvati G, Malvicini G, Iandolo A, Gaeta C. Management of Calcified Canals with a New Type of Endodontic Static Guide: A Case Report. Dent J (Basel) 2024; 12:166. [PMID: 38920867 PMCID: PMC11202512 DOI: 10.3390/dj12060166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/03/2024] [Accepted: 04/19/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Background: Pulp canal obliteration (PCO) is a common condition characterized by an abnormal dentinal apposition within the canal wall, which often rises as a consequence of dental trauma. In recent years, "guided endodontics" has offered a reliable and safer procedure for endodontic access in case of PCO. The present case report aims to introduce a new endodontic guided system with a sleeveless, open-frame titanium guide designed to reduce costs compared to traditional templates. (2) Methods: The patient is a 19-year-old female who was referred to a private clinic to treat a calcified and symptomatic tooth (3.3) with apical periodontitis. Following the first unsuccessful treatment attempt using the operating microscope, a three-dimensional cone beam computed tomography (CBCT) examination and an optical impression were performed in agreement with the patient. The Digital Imaging and Communications in Medicine (DICOM) and Standard Tessellation Language (STL) files were sent to the lab for the template packaging, and the patient was scheduled for a second appointment. The endodontic guide was accurately positioned, and shaping and filling were concluded with success. The canal was sealed with the single-cone technique and bioceramic sealer. (3) Results: The patient reported no significant post-operative symptoms. Notably, the treatment achieved total symptom resolution, as evidenced by radiographic assessments conducted 3 and 24 months post-treatment, confirming the procedure's success. (4) Conclusions: This innovative sleeveless, open-frame static titanium guide presents a promising advancement in guided endodontics for PCO treatment. The advantages include preserving healthy dental tissue, reduced chairside operating time, and cost savings compared to conventional templates. This approach holds promise for enhancing the quality and efficiency of endodontic procedures in cases of PCO. While the static guide holds promise, larger prospective studies are necessary to validate its efficacy, safety, and broader applicability in routine endodontic procedures.
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Affiliation(s)
| | - Massimo Pisano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy (A.I.)
| | - Giovanni Salvati
- Unit of Endodontics and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.S.); (C.G.)
| | - Giulia Malvicini
- Unit of Endodontics and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.S.); (C.G.)
| | - Alfredo Iandolo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy (A.I.)
| | - Carlo Gaeta
- Unit of Endodontics and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.S.); (C.G.)
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Chaniotis A, Sousa Dias H, Chanioti A. Negotiation of Calcified Canals. J Clin Med 2024; 13:2703. [PMID: 38731233 PMCID: PMC11084956 DOI: 10.3390/jcm13092703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/02/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
The gradual formation of hard tissue along the root canal walls is a natural process associated with aging, typically progressing slowly over time. In reaction to tooth wear, operative procedures, vital pulp treatments, or regenerative endodontic procedures, hard tissue may also accumulate within the pulp canal space at a slow rate. In certain cases, such as dental trauma, autotransplantation, or orthodontic treatment, this deposition of hard tissue can accelerate unexpectedly, resulting in rapid narrowing or complete closure of the root canal space. This situation is called calcific metamorphosis (CM), root canal calcification, or pulp canal obliteration (PCO). Performing conventional endodontic therapy on severely calcified canals presents significant challenges and increases the risk of procedural accidents. Calcified canals introduce such complexity that dedicated negotiation concepts and specially designed instruments have been developed to deal with the challenge. This article seeks to review the existing methods for effectively navigating calcified canals and to introduce the buckling resistance activation test (BRAT) technique.
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Affiliation(s)
| | - Hugo Sousa Dias
- Private Practice, Dentistry Department, CESPU-IUCS University, 4585-116 Gandra, Portugal;
| | - Anastasia Chanioti
- School of Dentistry, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece;
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5
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Dianat O, Naseri M, Safi Y, Modaberi A, Zargar N, Peters OA, Farajollahi M. Accuracy comparison of single- and double-sleeve endodontic guides for fiber post removal. BMC Oral Health 2024; 24:497. [PMID: 38678244 PMCID: PMC11055251 DOI: 10.1186/s12903-024-04283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND This study aimed to assess the accuracy of two different endodontic guides for fiber post removal. METHODS In this in vitro study, 54 maxillary canine fiber posts were mounted on 36 maxillary stone casts; 18 teeth were mounted unilaterally, and 36 teeth were mounted bilaterally. Static endodontic guides were fabricated according to baseline cone-beam computed tomography (CBCT) and intraoral optical scans using Blue Sky software. In the single-sleeve endodontic guides group (SSG), two anterior and two posterior teeth were included in a 5-unit guide. In the double-sleeve endodontic guides group (DSG) group, the guide was passed through the midline to include both canine teeth and extended by 2 teeth posterior to the canine teeth bilaterally (a 10-unit guide). After drilling, postoperative CBCT scans were taken and superimposed on the virtually designed path, and the maximum coronal deviation (MCD) at the marginal entry point of the tooth, maximum apical deviation (MAD) at 10 mm apical to the tooth margin, and maximum angular deflection (MAnD) of the drill were calculated. RESULTS The mean MCD, MAD, and MAnD were 0.34 mm, 0.6 mm, and 2.32 degrees, respectively, in the SSG and 0.31 mm, 0.7 mm, and 2.37 degrees, respectively, in the DSG. The two groups were not significantly different from each other in terms of MCD (P = 0.573), MAD (P = 0.290), or MAnD (P = 0.896). CONCLUSIONS The accuracies of the two techniques, the extended double sleeve guide and the single sleeve guide, were comparable and thus DSG may be used for removal of fiber posts in adjacent or distant teeth.
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Affiliation(s)
- Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Mandana Naseri
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yaser Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Modaberi
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Zargar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ove A Peters
- School of Dentistry, The University of Queensland, Herston, QLD, Australia
| | - Mehran Farajollahi
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Huang D, Wang X, Liang J, Ling J, Bian Z, Yu Q, Hou B, Chen X, Li J, Ye L, Cheng L, Xu X, Hu T, Wu H, Guo B, Su Q, Chen Z, Qiu L, Chen W, Wei X, Huang Z, Yu J, Lin Z, Zhang Q, Yang D, Zhao J, Pan S, Yang J, Wu J, Pan Y, Xie X, Deng S, Huang X, Zhang L, Yue L, Zhou X. Expert consensus on difficulty assessment of endodontic therapy. Int J Oral Sci 2024; 16:22. [PMID: 38429281 PMCID: PMC10907570 DOI: 10.1038/s41368-024-00285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/19/2024] [Indexed: 03/03/2024] Open
Abstract
Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.
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Affiliation(s)
- Dingming Huang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Jingping Liang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Junqi Ling
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Zhuan Bian
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qing Yu
- Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Benxiang Hou
- Department of Endodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Xinmei Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ling Ye
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tao Hu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hongkun Wu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Geriatric dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bin Guo
- Department of Stomatology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qin Su
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhi Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lihong Qiu
- Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Wenxia Chen
- College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Xi Wei
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Zhengwei Huang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jinhua Yu
- Department of Endodontics, School and Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Zhengmei Lin
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Qi Zhang
- Department of Endodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Deqin Yang
- Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Zhao
- Department of Endodontics, First Affiliated Hospital of Xinjiang Medical University, and College of Stomatology of Xinjiang Medical University, Urumqi, China
| | - Shuang Pan
- Department of Endodontics, Schoolof Stomatology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jian Yang
- Department of Endodontics, The Affiliated Stomatological Hospital of Nanchang University, Nanchang, China
| | - Jiayuan Wu
- Key Laboratory of Oral Disease Research, School of Stomatology, Zunyi Medical University, Zunyi, China
| | - Yihuai Pan
- Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Xiaoli Xie
- Department of Cariology and Endodontics, Xiangya Stomatological School, Central South University, Changsha, China
| | - Shuli Deng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xiaojing Huang
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Lan Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Yue
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China.
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Liu H, Hieawy A, Shen Y. Endodontic Treatment of Two Calcified Mandibular Central Incisors: A Case Report. Cureus 2024; 16:e53066. [PMID: 38410353 PMCID: PMC10896276 DOI: 10.7759/cureus.53066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Treating calcified root canals presents significant challenges, as incorrect approaches can result in treatment failure or lead to complications. The necessity for advanced diagnostic and therapeutic tools is often paramount in these situations. This case report demonstrates the successful treatment of two calcified mandibular central incisors, followed up for a period of up to six years. It emphasizes the effectiveness of integrating cone-beam computed tomography, dental operating microscopes, and ultrasonic instruments in the treatment of such challenging cases.
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Affiliation(s)
- He Liu
- Division of Endodontics, Department of Oral Biological & Medical Sciences, University of British Columbia, Vancouver, CAN
| | - Ahmed Hieawy
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, CAN
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, CAN
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8
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Elhakim A, Hwang J, Kim S, Kim E, Kang S. Three-dimensional accuracy of endodontic access preparations using novel nonrestrictive static guides: A laboratory study. AUST ENDOD J 2023; 49:631-640. [PMID: 37697890 DOI: 10.1111/aej.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/22/2023] [Accepted: 08/13/2023] [Indexed: 09/13/2023]
Abstract
This study compared the accuracy of traditional endodontic access to conservative access cavities prepared with or without novel nonrestrictive endodontic access guides by operators with different levels of clinical experience without visual aids, using a three-dimensional volumetric accuracy analysis method. The accuracy of the preparations was analysed using a novel 3D volumetric analysis by calculating the intersection and volume of the actual cavities to the planned model cavities. The experienced operator significantly outperformed the inexperienced operator in the free hand groups, while accuracy of conservative access cavities prepared using the novel guides were comparable and significantly higher than the other groups (p < 0.05). The results demonstrated clinical experience enhanced endodontic preparations accuracy and that nonrestrictive guides achieve accurate conservative access cavities which are independent of the operator skill level. Additionally, the three-dimensional volumetric analysis is a consistent and objective method to judge the accuracy of guided endodontic techniques.
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Affiliation(s)
- Ahmed Elhakim
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Junghwan Hwang
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sunil Kim
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Euiseong Kim
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sumi Kang
- Department of Dental Education, College of Dentistry, Yonsei University, Seoul, Korea
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9
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Farajollahi M, Dianat O, Gholami S, Saber Tahan S. Application of an Endodontic Static Guide in Fiber Post Removal from a Compromised Tooth. Case Rep Dent 2023; 2023:7982368. [PMID: 37745692 PMCID: PMC10516697 DOI: 10.1155/2023/7982368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Removing a fiber post from a root canal that requires endodontic retreatment is often very challenging. Conventional freehand techniques for removing fiber posts are time-consuming, sometimes result in iatrogenic errors, and heavily rely on the practitioner's experience. The endodontic static guide can be an alternative method. While the use of an endodontic 3D-printed static guide for fiber post removal has been reported as highly successful, it can also cause complications. Skipping any critical steps during the guide construction or its clinical application can lead to errors. This case report presents the saving of a compromised tooth with a fractured fiber post and a periapical lesion around the apex through the use of an endodontic static guide for fiber post removal. This study describes possible sources of error that may happen during construction and clinical use of the guide.
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Affiliation(s)
- Mehran Farajollahi
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Samaneh Gholami
- Department of Restorative Dentistry, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Saber Tahan
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Mekhdieva E, Del Fabbro M, Alovisi M, Scotti N, Comba A, Berutti E, Pasqualini D. Dynamic Navigation System vs. Free-Hand Approach in Microsurgical and Non-Surgical Endodontics: A Systematic Review and Meta-Analysis of Experimental Studies. J Clin Med 2023; 12:5845. [PMID: 37762786 PMCID: PMC10531643 DOI: 10.3390/jcm12185845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and limitations of this approach, there is no evidence-based information about its efficiency in comparison with that of the traditional method in endodontics. (2) Objectives: We aimed to explore any beneficial effects of the DNS and compare the outcomes of DNS vs. free-hand (FH) approaches for non-surgical and microsurgical endodontics. (3) Methods: A literature search was conducted in August 2023 to identify randomized, experimental, non-surgical, and microsurgical endodontic studies that compared the DNS with FH approaches. The procedural time (ΔT, s), substance loss (ΔV, mm3), angular deviation (ΔAD, °), coronal/platform linear deviation (ΔLD_C, mm), and apical linear deviation (ΔLD_A, mm) were recorded and analyzed. Quality and risk of bias assessments were conducted according to the Quality Assessment Tool For In Vitro Studies. A meta-analysis was performed using mean difference and standard deviation for each outcome, and heterogeneity (I2) was estimated. p < 0.05 was considered significant. (4) Results: One-hundred and forty-six studies were identified following duplicate removal, and nine were included in the systematic review and meta-analysis. The overall risk of bias was classified as low. The DNS was found to be more accurate and efficient than the FH approach was, resulting in a significantly shorter operation time (p < 0.00001) and less angular (p ≤ 0.0001) and linear deviation (p ≤ 0.01). For substance loss, the advantage of the DNS was significant only for microsurgery (p = 0.65, and p < 0.005, for non-surgical and microsurgical procedures, respectively). A reduced risk of iatrogenic failure using the DNS was observed for both expert and novice operators. (5) Conclusions: The DNS appears beneficial for non-surgical and microsurgical endodontics, regardless of the operator's experience. However, appropriate training and experience are necessary to access the full advantages offered by the DNS.
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Affiliation(s)
- Elina Mekhdieva
- Department of Surgical Sciences, Dental School, Endodontics and Operative Dentistry, University of Turin, 10124 Torino, Italy; (M.A.); (N.S.); (A.C.); (E.B.); (D.P.)
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20133 Milan, Italy;
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mario Alovisi
- Department of Surgical Sciences, Dental School, Endodontics and Operative Dentistry, University of Turin, 10124 Torino, Italy; (M.A.); (N.S.); (A.C.); (E.B.); (D.P.)
| | - Nicola Scotti
- Department of Surgical Sciences, Dental School, Endodontics and Operative Dentistry, University of Turin, 10124 Torino, Italy; (M.A.); (N.S.); (A.C.); (E.B.); (D.P.)
| | - Allegra Comba
- Department of Surgical Sciences, Dental School, Endodontics and Operative Dentistry, University of Turin, 10124 Torino, Italy; (M.A.); (N.S.); (A.C.); (E.B.); (D.P.)
| | - Elio Berutti
- Department of Surgical Sciences, Dental School, Endodontics and Operative Dentistry, University of Turin, 10124 Torino, Italy; (M.A.); (N.S.); (A.C.); (E.B.); (D.P.)
| | - Damiano Pasqualini
- Department of Surgical Sciences, Dental School, Endodontics and Operative Dentistry, University of Turin, 10124 Torino, Italy; (M.A.); (N.S.); (A.C.); (E.B.); (D.P.)
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Pires CRF, Souza-Gabriel AE, Pelozo LL, Cruz-Filho AM, Sousa-Neto MD, Silva RG. Guided endodontics of calcified canals: The drilling path of rotary systems and intracanal dentin wear. AUST ENDOD J 2023; 49 Suppl 1:64-70. [PMID: 36106713 DOI: 10.1111/aej.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/03/2022] [Indexed: 11/26/2022]
Abstract
This study evaluated the drilling path (mm) and the dentin wear (mm3 ) of two instruments used during guided endodontic access. Twenty mandibular incisors with calcified canals were selected using cone-beam computed tomography (CBCT) and fixed in articulated models. Preoperative CBCT scans were performed in combination with intraoral scanning, and the images were reconstructed in the Blue Sky Bio software for access planning and printing the guides. The access cavity was drilled with 1.0-mm-diameter bur (DSP) and 0.8-mm-diameter bur (Munce). Postoperative CBCT was performed, and the images obtained preoperative and postoperative were superimposed for the analyses. Data were analysed by a t-test and linear regression (α = 0.05). No difference was found in the drilling path (p = 0.422). However, the Munce bur had higher dentin wear than the DSP bur (p = 0.011). A positive linear correlation (R2 = 0.859) was found between the factors.
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Affiliation(s)
| | | | - Laís Lima Pelozo
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Antônio Miranda Cruz-Filho
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ricardo Gariba Silva
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Celik HK, Koc S, Kustarci A, Caglayan N, Rennie AE. The state of additive manufacturing in dental research - A systematic scoping review of 2012-2022. Heliyon 2023; 9:e17462. [PMID: 37484349 PMCID: PMC10361388 DOI: 10.1016/j.heliyon.2023.e17462] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background/purpose Additive manufacturing (AM), also known as 3D printing, has the potential to transform the industry. While there have been advancements in using AM for dental restorations, there is still a need for further research to develop functional biomedical and dental materials. It's crucial to understand the current status of AM technology and research trends to advance dental research in this field. The aim of this study is to reveal the current status of international scientific publications in the field of dental research related to AM technologies. Materials and methods In this study, a systematic scoping review was conducted using appropriate keywords within the scope of international scientific publishing databases (PubMed and Web of Science). The review included related clinical and laboratory research, including both human and animal studies, case reports, review articles, and questionnaire studies. A total of 187 research studies were evaluated for quantitative synthesis in this review. Results The findings highlighted a rising trend in research numbers over the years (From 2012 to 2022). The most publications were produced in 2020 and 2021, with annual percentage increases of 25.7% and 26.2%, respectively. The majority of AM-related publications in dentistry research originate from Korea. The pioneer dental sub-fields with the ost publications in its category are prosthodontics and implantology, respectively. Conclusion The final review result clearly stated an expectation for the future that the research in dentistry would concentrate on AM technologies in order to increase the new product and process development in dental materials, tools, implants and new generation modelling strategy related to AM. The results of this work can be used as indicators of trends related to AM research in dentistry and/or as prospects for future publication expectations in this field.
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Affiliation(s)
- H. Kursat Celik
- Dept. of Agr. Machinery and Technology Engineering, Akdeniz University, Antalya, 07070, Turkey
| | - Simay Koc
- Dept. of Endodontics, Fac. of Dentistry, Akdeniz University, Antalya, Turkey
| | - Alper Kustarci
- Dept. of Endodontics, Fac. of Dentistry, Akdeniz University, Antalya, Turkey
| | - Nuri Caglayan
- Dept. of Mechatronics, Fac. of Engineering, Akdeniz University, Antalya, Turkey
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Vasudevan A, Sundar S, Surendran S, Natanasabapathy V. Tooth substance loss after incisal endodontic access and novel single-tooth template-guided endodontic access in three-dimensional printed resin incisors with simulated pulp canal calcification: A comparative in vitro study. J Conserv Dent 2023; 26:258-264. [PMID: 37398863 PMCID: PMC10309124 DOI: 10.4103/jcd.jcd_3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 07/04/2023] Open
Abstract
Context Background Guided endodontics has various applications, one of which is for calcified canal negotiation. Recently, a new single-tooth template has been fabricated to overcome the drawbacks of bulky guides, which are difficult to use with rubber dam isolation. Aim This study aimed to assess the efficacy of the novel single-tooth template for negotiation of pulp canal calcification (PCC) in three-dimensional (3D)-printed resin incisors by comparing substance loss and time taken between incisal endodontic access (IEA) and single-tooth template-guided endodontic access (SGEA). Methods Forty-two resin incisor teeth having patent canal in the apical third were used (N = 21/group). They were subcategorized based on operator's experience into senior endodontist (SE), postgraduate (PG), and undergraduate (UG) (n = 7/operator). Canals were negotiated conventionally for IEA and using the single-tooth template for SGEA. Substance loss was calculated from the volume difference between pre- and postoperative cone-beam computed tomography scans. The time taken was also recorded. Statistical Analysis Used Statistical analysis was performed using unpaired t-test and one-way analysis of variance test. Results Canals were successfully negotiated in 100% and 95% of teeth in the SGEA and IEA groups, respectively. Overall substance loss and time taken were significantly lesser for SGEA for all operators (P < 0.001). In the IEA group, post hoc test showed statistical significance between SE and UG for substance loss (P < 0.05) and SE-UG and PG-UG for time taken (P < 0.05). No significant difference among operators was noted for both parameters in SGEA. Conclusions SGEA resulted in significantly lesser substance loss and time taken for canal negotiation in 3D-printed resin incisors with simulated PCC. This was independent of the experience levels of the operator.
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Affiliation(s)
- Aishwarya Vasudevan
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Sathish Sundar
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Smita Surendran
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
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Gómez Meda R, Abella Sans F, Esquivel J, Zufía J. Autotransplantation of Maxillary Third Molar with Its Attached Buccal Cortical Plate Combined with a Connective Tissue Graft. J Endod 2023; 49:313-320. [PMID: 36623751 DOI: 10.1016/j.joen.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Tooth replacement often leads to insufficient vertical volume in the recipient socket bone. The aim of this novel report is to present a successful fully guided autotransplantation of a maxillary right third molar (tooth #1) with its attached buccal plate. The procedure was combined with a palatal connective tissue graft to reconstruct a buccal hard and soft tissue defect of an irreparable maxillary right first molar (tooth #3). METHODS A 45-year-old man complaining of pain in tooth #3 came to the clinic. Tooth #3 was non-restorable due to an extensive caries and a vertical root fracture of the mesiobuccal root, leading to a total loss of the buccal cortical plate. Guided autotransplantation of tooth #1 was completed by using 3-dimensional surgical templates for implant burs and a 3-dimensional-printed replica. After positioning the donor tooth, the cortical plate was fixed to the recipient socket with osteosynthesis screws. A connective tissue graft was also harvested to increase the band of keratinized gingiva and the thickness of the buccal soft tissue. At 6-month follow-up, the screws were removed, showing excellent regeneration throughout the buccal area. RESULTS At 3-year follow-up, the transplanted tooth was asymptomatic, with a natural bone level and no signs of replacement or inflammatory root resorption. CONCLUSIONS The use of a donor tooth and its attached bone cortical plate combined simultaneously with a connective tissue graft appears to improve hard and soft tissues in a single procedure.
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Affiliation(s)
| | - Francesc Abella Sans
- Department of Endodontics, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
| | - Jonathan Esquivel
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Al-Helou N, Zaki AA, Al Agha M, Moawad E, Jarad F. Which endodontic access cavity is best? A literature review. Br Dent J 2023; 234:335-339. [PMID: 36899249 DOI: 10.1038/s41415-023-5581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/19/2022] [Accepted: 11/01/2022] [Indexed: 03/12/2023]
Abstract
The preparation of an access cavity is the first part of endodontic treatment and is a key stage in the healing of both periapical and pulpal infections. It should allow endodontists to remove obstructions in the pulp chamber, locate all canal orifices and clean the entire root canal system with minimum coronal tooth structure removed. This has been done traditionally through establishing straight line access. The development of minimally invasive endodontics aimed to preserve as much of the natural tooth structure as possible, particularly dentine, while undertaking root canal treatment, resulting in the development of other access cavity preparations. This includes conservative, ultra conservative (ninja), truss, guided access, caries-orientated and restorative access cavities. These access cavity preparations also gained popularity due to increased magnification and enhanced lighting, allowing practitioners to visualise the pulpal space in greater detail throughout treatment.Our current recommendation is to conduct access cavities traditionally rather than conservatively. Ideally, conservative access cavities need magnification, which might not be available for all clinicians. With traditional access cavity, the procedure takes less time and it is more predictable to locate the canal orifices, deliver irrigation effectively, avoid iatrogenic damage with biomechanical preparation and achieve better obturation.
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Affiliation(s)
- Noor Al-Helou
- Dental Core Trainee in Restorative Dentistry, The Royal London Dental Hospital, London, UK.
| | - Ammar Ahmed Zaki
- Academic Clinical Fellow in Prosthodontics, The Royal London Dental Hospital, London, UK
| | - Mustafa Al Agha
- Clinical Lecturer in Endodontics, Liverpool University Dental Hospital, Liverpool, UK
| | - Emad Moawad
- Specialist in Endodontics and Senior Clinical Lecturer, Liverpool University Dental Hospital, Liverpool, UK
| | - Fadi Jarad
- Professor of Restorative Dentistry, Liverpool University Dental Hospital, Liverpool, UK
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Effectiveness of guided endodontics in locating calcified root canals: a systematic review. Clin Oral Investig 2023; 27:2359-2374. [PMID: 36640178 DOI: 10.1007/s00784-023-04863-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this study is to answer the question: "Is guided endodontics an effective technique for locating calcified canals?". METHODS A systematic search was carried out by two independent authors in PubMed, Web of Science, Scopus, and Scielo databases. According to the PIOS criteria, observational studies, ex vivo studies, clinical case reports, and case series were included. The quality of evidence of observational studies, case reports, and case series were assessed using the respective Joanna Briggs Institute critical appraisal tool, and a previous personalized tool was used to assess the quality of the ex vivo studies. RESULTS Forty-five studies were included. Of them, 21 were clinical case reports, 11 case series, 12 ex vivo studies, and 1 cohort study. Of the 45 studies analyzed, 43 reported that guided endodontics is an effective and precise technique to access the permeable portion of calcified canals. Only 2 studies report accidents or failures related to the use of endodontic guides. CONCLUSIONS Guided endodontics allows conservative access, minimizes accidents, and is effective in locating calcified canals; however, it is a technique that still presents limitations. CLINICAL RELEVANCE Guided endodontics has been proposed as a simple and effective technique for the treatment of calcified canals. The expansion of this technique requires knowing its benefits and limitations to ensure success and avoid accidents.
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Wu J, Heng M, Bai Y. A novel dice-inspired multifunctional 3D printing guided splint for minimally invasive access cavity preparation and canal orifice identification. Technol Health Care 2023; 31:2381-2387. [PMID: 37302052 DOI: 10.3233/thc-230002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The minimally invasive endodontics could retain more peri-cervical dentin (PCD) and other important dental structures, thus realizing the minimal loss of teeth structures and preserving the strength and function of the endodontically treated tooth (ETT). The search for abnormal root canals or calcified root canals could be quite time-consuming and increase the risk of perforation. OBJECTIVE This study introduced a novel multifunctional 3D printing guided splint inspired by the dice, which can achieve the minimally invasive access cavity preparation and canal orifice identification. METHOD Data were collected from an outpatient with dens invaginatus. Cone-beam Computed Tomography (CBCT) revealed a type III invagination. The CBCT data of the patient were imported into a computer-aided design (CAD) software (Exocad 3.0; Exocad GmbH) for the 3D reconstruction of jaw bones and teeth. The dice-inspired 3D printing guided splint consists of the sleeve and guided splint. The sleeve with minimal invasive opening channel and orifice locating channel were designed with a reverse-engineering software (Geomagic Wrap 2021). The reconstructed models in the Standard Template Library (STL) format were imported into a CAD software. The design of the template was aided by the dental CAD software in Splint Design Mode. The sleeve and splint were exported into the STL files separately. A 3D printer (ProJet® 3600 3D Systems) was used to separately generate the sleeve and guided splint, and was made by stereolithography and processed in a medical resin (VisiJet M3 StonePlast). RESULTS The novel multifunctional 3D printing guided splint could be set in position. The opening side in the sleeve was selected and the sleeve was inserted in place. The minimal invasive opening was made in the crown of the tooth to access the pulp. The sleeve was draw out and turned to the orifice location side, and then inserted in place. The target orifice was located rapidly. CONCLUSION This novel dice-inspired multifunctional 3D printing guided splint allow dental practitioners to gain accurate, conservative, and safe cavity access from teeth with anatomical malformations. Complex operations might be carried out with less reliance on the operator's experience than with conventional access preparations. This novel dice-inspired multifunctional 3D printing guided splint would have a broad application in the dental field.
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Affiliation(s)
- Jiaqi Wu
- First Clinical Division, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Modi Heng
- Dental Laboratory Center, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Yunyang Bai
- Department of Geriatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing, China
- National Center for Stomatology, School and Hospital of Stomatology, Peking University, Beijing, China
- National Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Peking University, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, School and Hospital of Stomatology, Peking University, Beijing, China
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Kulinkovych-Levchuk K, Pecci-Lloret MP, Castelo-Baz P, Pecci-Lloret MR, Oñate-Sánchez RE. Guided Endodontics: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13900. [PMID: 36360780 PMCID: PMC9657991 DOI: 10.3390/ijerph192113900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
The main objective of this paper is to perform an updated literature review of guided endodontics based on the available up-to-date scientific literature to identify and describe the technique, its benefits, and its limitations. Four electronic databases (PubMed, Scopus, Science Direct, and Web of Science) were used to perform a literature search from 1 January 2017 to 13 May 2022. After discarding duplicates, out of 1047 results, a total of 29 articles were eligible for review. Guided endodontics is a novel technique that is currently evolving. It is applied in multiple treatments, especially in accessing and locating root canals in teeth with pulp canal obliteration, microsurgical endodontics, and removing glass fiber posts in endodontic retreatments. In addition, it is independent of an operator's experience, requires less treatment time for the patient, and is more accurate and safer than conventional endodontics.
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Affiliation(s)
- Kateryna Kulinkovych-Levchuk
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, 30008 Murcia, Spain
| | - María Pilar Pecci-Lloret
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, 30008 Murcia, Spain
| | - Pablo Castelo-Baz
- Unit of Dental Pathology and Therapeutics II, School of Medicine and Dentistry, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain
| | - Miguel Ramón Pecci-Lloret
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, 30008 Murcia, Spain
| | - Ricardo E Oñate-Sánchez
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, 30008 Murcia, Spain
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Connert T, Weiger R, Krastl G. Present status and future directions - Guided endodontics. Int Endod J 2022; 55 Suppl 4:995-1002. [PMID: 35075661 PMCID: PMC9790195 DOI: 10.1111/iej.13687] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/18/2022] [Indexed: 12/30/2022]
Abstract
Luxation injuries and other stimuli may lead to a pulp canal obliteration (PCO). Even though the apposition of tertiary dentine is a sign of a vital pulp, in some cases root canal treatment is indicated in the long term due to apical periodontitis or pulpitis. Depending on the extent of PCO, root canal treatment may be challenging even for experienced and well-equipped endodontic specialists. The 'guided endodontics' (GE) technique was introduced 6 years ago as an alternative to conventional access cavity preparation for teeth with PCO and apical pathosis or irreversible pulpitis. Using three-dimensional radiological imaging such as cone-beam computed tomography and a digital surface scan, an optimal access to the orifice of the calcified root canal can be planned virtually with appropriate software. GE is implemented either with the help of templates analogous to guided implantology (= static navigation) or by means of dynamic navigation based on a camera-marker system. GE has emerged as a field of research in the last 6 years with very promising laboratory-based results regarding the accuracy of guided endodontic access cavities for both static and dynamic navigation. Clinical implementation seems to provide favourable results, but the evidence is mainly based on numerous case reports and a few case series. This narrative review aims to provide an update on the present status of GE and to identify relevant research areas that could contribute to further improvements of this technique.
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Affiliation(s)
- Thomas Connert
- Department of Periodontology, Endodontology and CariologyUniversity Center for Dental Medicine Basel UZBUniversity of BaselBaselSwitzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and CariologyUniversity Center for Dental Medicine Basel UZBUniversity of BaselBaselSwitzerland
| | - Gabriel Krastl
- Department of Conservative Dentistry and PeriodontologyUniversity Hospital of WürzburgWürzburgGermany
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Ribeiro D, Reis E, Marques JA, Falacho RI, Palma PJ. Guided Endodontics: Static vs. Dynamic Computer-Aided Techniques—A Literature Review. J Pers Med 2022; 12:jpm12091516. [PMID: 36143301 PMCID: PMC9501573 DOI: 10.3390/jpm12091516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 11/26/2022] Open
Abstract
(1) Background: access cavity preparation is the first stage of non-surgical endodontic treatment. The inaccuracy of this step may lead to numerous intraoperative complications, which impair the root canal treatment’s prognosis and therefore the tooth’s survival. Guided endodontics, meaning computer-aided static (SN) and dynamic navigation (DN) techniques, has recently emerged as a new approach for root canal location in complex cases. This review aims to compare SN and DN guided endodontics’ techniques in non-surgical endodontic treatment. (2) Methods: an electronic search was performed on PubMed, Scopus, and Cochrane Library databases until October 2021. Studies were restricted by language (English, Spanish and Portuguese) and year of publication (from 2011 to 2021). (3) Results: a total of 449, 168 and 32 articles were identified in PubMed, Scopus, and Cochrane Library databases, respectively, after the initial search. Of the 649 articles, 134 duplicates were discarded. In this case, 67 articles were selected after title and abstract screening, of which 60 were assessed for eligibility through full-text analysis, with one article being excluded. Four cross-references were added. Thus, 63 studies were included. (4) Conclusions: guided endodontics procedures present minimally invasive and accurate techniques which allow for highly predictable root canal location, greater tooth structure preservation and lower risk of iatrogenic damage, mainly when performed by less experienced operators. Both SN and DN approaches exhibit different advantages and disadvantages that make them useful in distinct clinical scenarios.
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Affiliation(s)
- Diana Ribeiro
- Dentistry Department, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Eva Reis
- Dentistry Department, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Joana A. Marques
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Rui I. Falacho
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Institute of Oral Implantology and Prosthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Paulo J. Palma
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Correspondence: ; Tel.: +351-239-249-151
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Jiandong B, Yunxiao Z, Zuhua W, Yan H, Shuangshuang G, Junke L, Hongwei W, Hua X. Generalized pulp canal obliteration in a patient on long-term glucocorticoids: a case report and literature review. BMC Oral Health 2022; 22:352. [PMID: 35971099 PMCID: PMC9380356 DOI: 10.1186/s12903-022-02387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The calcification of the tooth pulp is a pathological condition that occurs in response to various factors. A uncommon haematological condition known as paroxysmal nocturnal haemoglobinuria (PNH) is characterized by bouts of haemolysis, and it requires long-term use of glucocorticoids (GCs). CASE PRESENTATION A female patient who was diagnosed with PNH and had a history of long-term use of GCs came to our department for root canal therapy (RCT) for teeth 25, 26, and 27. The radiographs showed generalized pulp canal obliteration (PCO) in most of the patients. None of these teeth (25, 26, or 27) were sensitive to percussion, and they did not respond to thermal or electrical sensitivity tests. A diagnose of pulp necrosis was made for these teeth. RCT was carried out with the help of an oral microscope, and then a prosthodontic procedure was created for the teeth. CONCLUSIONS Based on the patient's long history use of GCs and a series of related studies, we conclude that the long-term usage of GCs contributes significantly to the onset of PCO.
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Affiliation(s)
- Ban Jiandong
- Department of Stomatology, Hebei Eye Hospital, Xingtai, 054000, China
| | - Zhang Yunxiao
- Department of Haematology, The First Affiliated Hospital of Xingtai Medical College, Xingtai, 054000, China
| | - Wang Zuhua
- Department of Endodontics, Stomatological Hospital of Peking University, Beijing, 100010, China
| | - Hou Yan
- Department of Stomatology, Hebei Eye Hospital, Xingtai, 054000, China
| | - Geng Shuangshuang
- Department of Stomatology, Hebei Eye Hospital, Xingtai, 054000, China
| | - Li Junke
- Department of Stomatology, Hebei Eye Hospital, Xingtai, 054000, China
| | - Wang Hongwei
- Department of Stomatology, Hebei Eye Hospital, Xingtai, 054000, China
| | - Xu Hua
- Department of Stomatology, Hebei Eye Hospital, Xingtai, 054000, China.
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Main Applications and Recent Research Progresses of Additive Manufacturing in Dentistry. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5530188. [PMID: 35252451 PMCID: PMC8894006 DOI: 10.1155/2022/5530188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 12/16/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022]
Abstract
In recent ten years, with the fast development of digital and engineering manufacturing technology, additive manufacturing has already been more and more widely used in the field of dentistry, from the first personalized surgical guides to the latest personalized restoration crowns and root implants. In particular, the bioprinting of teeth and tissue is of great potential to realize organ regeneration and finally improve the life quality. In this review paper, we firstly presented the workflow of additive manufacturing technology. Then, we summarized the main applications and recent research progresses of additive manufacturing in dentistry. Lastly, we sketched out some challenges and future directions of additive manufacturing technology in dentistry.
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Santiago MC, Altoe MM, de Azevedo Mohamed CP, de Oliveira LA, Salles LP. Guided endodontic treatment in a region of limited mouth opening: a case report of mandibular molar mesial root canals with dystrophic calcification. BMC Oral Health 2022; 22:37. [PMID: 35148745 PMCID: PMC8832717 DOI: 10.1186/s12903-022-02067-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The endodontic treatment of calcified root canals in molars is a challenging and time-consuming procedure. Even with the aid of a surgical microscope, the risk of root perforation is high, especially in the furcation area. The purpose of this study is to report the Computer-Aided-Design and Manufacturing (CAD-CAM) workflow, the innovative strategies for the template ideation, and the guided endodontic treatment of a mandibular molar with dystrophic calcification in the mesial root canals. CASE PRESENTATION A 58-year-old female patient, ASA I, was referred to endodontic treatment in the right first mandibular molar for prosthetic reasons. The mesiobuccal and mesiolingual canals appeared obliterated in the radiographic images. The absence of dental crown, tooth inclination, and the limited mouth opening of the region contributed to a poor visual reference of the tooth in the dental arch and the direction of the remaining lumens of the canals. Despite using surgical microscopy, the conventional technique led to the deviation of the mesiobuccal canal towards the furcation area. The obliteration of both mesial root canals was confirmed using the Cone Beam Computer Tomography. The clinical history associated with the tomography diagnosis was compatible with dystrophic calcifications in the pulp canals. The patient was submitted to an intra-oral scanning as well. The Digital Imaging and Communications in Medicine data (DICOM) were segmented. The Standard Tessellation Language (STL) files were processed following the CAD-CAM workflow, aiming to create two different endodontic templates with a new open design concept. The templates with open design allowed direct visualization of the operative field, irrigation, and dentin debris removal. The strategy of the guidance sleeves niche as half-cylinders allowed the drill insertion in a limited mouth opening region. CONCLUSIONS The digital planning and guided access permitted to overcome the case limitations and then re-establish the glide path following the original anatomy of the root canals. The guided endodontic represents a personalized technique that provides security, reduced risks of root perforation, and a significant decrease of the working time to access obliterated root canals even in the mesial root canal of mandibular molars, a region of limited mouth opening.
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Affiliation(s)
- Marcos Coelho Santiago
- Post-Graduation Program in Dentistry, Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Michel Mattar Altoe
- Post-Graduation Program in Dentistry, Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Caroline Piske de Azevedo Mohamed
- Post-Graduation Program in Dentistry, Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Laudimar Alves de Oliveira
- Department of Dentistry, Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Loise Pedrosa Salles
- Department of Dentistry, Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil.
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Gonçalves WF, Garcia LDFR, Vieira-Schuldt DP, Bortoluzzi EA, Dias-Júnior LCDL, Teixeira CDS. Guided Endodontics in Root Canals with Complex Access: Two Case Reports. Braz Dent J 2022; 32:115-123. [PMID: 35019015 DOI: 10.1590/0103-6440202104537] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/05/2021] [Indexed: 01/17/2023] Open
Abstract
This article reported two clinical cases in which the guided endodontics was used to perform the access to the root canals. The first case presents a 40-year-old female with a history of pain related to the left maxillary canine. After radiographic examination, the presence of severe calcification up to the apical third of the root canal, associated with a periapical radiolucency, was noted. In the second case, an 85-year-old male was referred to our service with pain upon palpation, at the right mandibular first molar. The radiographic images revealed the presence of endodontic treatment and a fiberglass post in the distal root canal, which was associated with extrusion of the filling material and a periapical lesion. The 3D-guides were planned based on cone beam computed tomography and intraoral digital scanning, which were aligned using a specific software. Therefore, implant drills could be guided up to the root canal length required for each case. In the first case, a surgical root canal was created and the patient was free of signs and symptoms after the treatment was completed. In the second case, it was observed that the fiber post was worn by the drill, allowing free access to the filling material. It was possible to perform the endodontic reintervention in a more predictable way and in less time. In both cases, the use of the guided endodontics allowed the preservation of a large part of the dental structure. The procedures were performed faster, without the occurrence of fractures and perforations.
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Affiliation(s)
- Wesley Fernandes Gonçalves
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daniela Peressoni Vieira-Schuldt
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Eduardo Antunes Bortoluzzi
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Luiz Carlos de Lima Dias-Júnior
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Cleonice da Silveira Teixeira
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Su Y, Chen C, Lin C, Lee H, Chen K, Lin Y, Chuang F. Guided endodontics: accuracy of access cavity preparation and discrimination of angular and linear deviation on canal accessing ability-an ex vivo study. BMC Oral Health 2021; 21:606. [PMID: 34814892 PMCID: PMC8609758 DOI: 10.1186/s12903-021-01936-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Guided endodontics technique has been introduced for years, but the accuracy in different types of teeth has yet to be assessed. The aim of this study is to evaluate the accuracy of three dimensional (3D)-printed endodontic guides for access cavity preparation in different types of teeth, and to evaluate the predictive ability of angular and linear deviation on canal accessibility ex vivo. METHOD Eighty-four extracted human teeth were mounted into six jaw models and categorised into three groups: anterior teeth (AT), premolar (P), and molar (M). Preoperative cone beam computed tomography (CBCT) and surface scans were taken and matched using implant planning software. Virtual access cavity planning was performed, and templates were produced using a 3D printer. After access cavities were performed, the canal accessibility was recorded. Postoperative CBCT scans were superimposed in software. Coronal and apical linear deviations and angular deviations were measured and evaluated with nonparametric statistics. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of angular and linear deviation for canal accessibility in SPSS v20. RESULTS A total of 117 guided access cavities were created and 23 of them were record as canal inaccessibility, but all canals were accessible after canal negotiation. The average linear deviation for all groups was 0.13 ± 0.21 mm at coronal position, 0.46 ± 0.4 mm at apical position, and 2.8 ± 2.6° in angular deviation. At the coronal position, the linear deviations of the AT and P groups were significantly lower than M group deviation (P < 0.05), but no statistically significant difference between AT group and P group. The same results were found in linear deviation at the apical position and in angular deviation. The area under the ROC curve was 0.975 in angular deviation, 0.562 in linear deviation at the coronal position, and 0.786 at the apical position. Statistical significance was noted in linear deviation at the apical position and in angular deviation (P < 0.001). CONCLUSIONS In conclusion, this study demonstrated that the accuracy of access cavity preparation with 3D-printed endodontic guides was acceptable. The linear and angular deviations in the M group were significantly higher than those in the other groups, which might be caused by the interference of the opposite teeth. Angular deviation best discriminated the canal access ability of guided access cavity preparation.
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Affiliation(s)
- Yinghui Su
- Division of Endodontics and Operative Dentistry, Dental Department, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
- Dental Department, Kaohsiung Municipal Cijin Hospital, Kaohsiung, 805, Taiwan
| | - Chenghui Chen
- Division of Endodontics and Operative Dentistry, Dental Department, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Kaohsiung, 80708, Taiwan
| | - Chiahua Lin
- Division of Endodontics and Operative Dentistry, Dental Department, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Huina Lee
- Division of Endodontics and Operative Dentistry, Dental Department, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Kerkong Chen
- Division of Endodontics and Operative Dentistry, Dental Department, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Kaohsiung, 80708, Taiwan
| | - Yenkun Lin
- Research Center for Precision Molding, National Chung Cheng University, Chiayi, 62102, Taiwan
| | - Fuhsiung Chuang
- Division of Endodontics and Operative Dentistry, Dental Department, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Kaohsiung, 80708, Taiwan.
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26
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Fonseca Tavares WL, de Oliveira Murta Pedrosa N, Moreira RA, Braga T, de Carvalho Machado V, Ribeiro Sobrinho AP, Amaral RR. Limitations and Management of Static-guided Endodontics Failure. J Endod 2021; 48:273-279. [PMID: 34801590 DOI: 10.1016/j.joen.2021.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/21/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022]
Abstract
Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided endodontics has become an alternative approach for pulp canal calcification, facilitating the location of root canals more predictably through the combined use of cone-beam computed tomographic imaging, oral scanning, and endodontic access guides. Although several reports have shown that guided endodontics is safer, faster and can be performed without an operating microscope and by less experienced operators, the technique has limitations, and iatrogenesis may occur. This article describes the limitations of static-guided endodontics and possible causes of failures. In the present case, not fixing the guide to the bone and inaccuracies generated by manually performing mesh merger software led to root perforation. Endodontic microsurgery was effective in resolving this case and should be considered the treatment of choice when guided endodontics cannot be used safely or when it fails.
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Affiliation(s)
- Warley Luciano Fonseca Tavares
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Natália de Oliveira Murta Pedrosa
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Raphael Alves Moreira
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tiago Braga
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Vinícius de Carvalho Machado
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Antônio Paulino Ribeiro Sobrinho
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Vinagre A, Castanheira C, Messias A, Palma PJ, Ramos JC. Management of Pulp Canal Obliteration-Systematic Review of Case Reports. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111237. [PMID: 34833455 PMCID: PMC8625069 DOI: 10.3390/medicina57111237] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/29/2022]
Abstract
Background 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. The present review follows the PRISMA guidelines and was registered on PROSPERO database (CRD42020200656). Materials and Methods: An electronic search strategy was performed in Pubmed, EBSCOhost and LILACS from inception to March 2021. Only anterior permanent teeth with PCO due to dental trauma were included. Regarding clinical approaches, only teeth managed with a “watchful waiting” approach, tooth bleaching or root canal treatment (RCT) were included. Quality assessment was performed using the JBI Critical Appraisal Tool for Case Reports. Results: Twenty case reports were selected, resulting in a total of 27 patients. The number of traumatized teeth diagnosed with PCO was 33. The “watchful waiting” approach was the most implemented clinical strategy. Discolored non-symptomatic PCO teeth were mostly managed with external bleaching. The prevalence of pulp necrosis (PN) was 36.4%. For teeth diagnosed with PN, non-surgical RCT was performed in 10 teeth and surgical RCT in one tooth. Guided endodontic technique was performed in six of those teeth. Conclusions: For discolored non-symptomatic PCO teeth, external bleaching is advocated and the RCT approach should not be implemented as a preventive intervention strategy. Symptomatic PCO teeth should follow regular endodontic treatment pathways. Clinical approach of teeth with PCO should follow a decision-making algorithm incorporating clinical and radiographic signs and patient-reported symptoms.
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Affiliation(s)
- Alexandra Vinagre
- Institute of Operative Dentistry, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (A.V.); (C.C.); (J.C.R.)
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Catarina Castanheira
- Institute of Operative Dentistry, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (A.V.); (C.C.); (J.C.R.)
| | - Ana Messias
- Institute of Oral Implantology and Prosthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal;
- CEMMPRE—Center for Mechanical Engineering, Materials and Processes, University of Coimbra, 3030-788 Coimbra, Portugal
| | - Paulo J. Palma
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Correspondence: ; Tel.: +351-239-249-151
| | - João C. Ramos
- Institute of Operative Dentistry, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (A.V.); (C.C.); (J.C.R.)
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
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Connert T, Leontiev W, Dagassan-Berndt D, Kühl S, ElAyouti A, Krug R, Krastl G, Weiger R. Real-Time Guided Endodontics with a Miniaturized Dynamic Navigation System Versus Conventional Freehand Endodontic Access Cavity Preparation: Substance Loss and Procedure Time. J Endod 2021; 47:1651-1656. [PMID: 34310979 DOI: 10.1016/j.joen.2021.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/18/2022]
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.
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Affiliation(s)
- Thomas Connert
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, University of Basel, Basel, Switzerland.
| | - Wadim Leontiev
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Sebastian Kühl
- Department of Oral Surgery, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Ashraf ElAyouti
- Division of Endodontology, Department of Conservative Dentistry, School of Dental Medicine, University of Tübingen, Tübingen, Germany
| | - Ralf Krug
- Department of Conservative Dentistry and Periodontology, University Hospital of Würzburg, Würzburg, Germany
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, University Hospital of Würzburg, Würzburg, Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, University of Basel, Basel, Switzerland
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Choi Y, Jeon WS, Cho JM, Jeong HG, Shin Y, Park W. Access opening guide produced using a 3D printer (AOG-3DP) as an effective tool in difficult cases for dental students. J Dent Educ 2021; 85:1640-1645. [PMID: 34131924 DOI: 10.1002/jdd.12705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 04/19/2021] [Accepted: 05/23/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effectiveness of using an access opening guide in teaching ideal access opening shape and preventing excessive tooth loss, with a focus on predoctoral dental students. METHODS Ninety teeth that were mounted in a box just below the level of the cementoenamel junction using tray resin were randomly divided into two study groups. An access opening guide produced using a 3D printer (AOG-3DP) was designed using cone-beam computed tomography (CBCT). The AOG-3DP was applied in the test groups, while no aid was used in the control group. Access preparations in both groups performed by predoctoral dental students were scanned using CBCT to detect overpreparation. The preparation time and access cavity volume were evaluated. RESULTS The mean times required for achieving access opening were 327.2 and 97.4 s in the control and AOG-3DP groups, respectively, for premolars, and 547.4 and 104.5 s for molars. The mean volumes for premolars and molars differed from the ideal cavities by 38.1 and 72.2 mm3 , respectively, in the control group, and by -2.0 and -8.7 mm3 the AOG-3DP group. CONCLUSIONS Using the AOG-3DP significantly reduced the access opening time for premolars and molars. However, there is a limitation in that CBCT DICOM images must be converted to stereolithographic .stl files in order to be printed via 3D technology. This requires additional preclinical treatment time for imaging and subsequent printing. It could be considered that this can be a useful method in difficult cases.
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Affiliation(s)
- Yiseul Choi
- Department of Advanced General Dentistry and Human Identification Research Institute, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Woo Seok Jeon
- Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jung Min Cho
- Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Ho-Gul Jeong
- Imaging Dentistry Research Center, InVisionLab Inc., Seoul, Republic of Korea
| | - Yooseok Shin
- Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Wonse Park
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Republic of Korea
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Effect of Computer-Aided Navigation Techniques on the Accuracy of Endodontic Access Cavities: A Systematic Review and Meta-Analysis. BIOLOGY 2021; 10:biology10030212. [PMID: 33802134 PMCID: PMC7999608 DOI: 10.3390/biology10030212] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 02/07/2023]
Abstract
The present systematic review and meta-analysis aims to determine the effect of computer-aided navigation techniques on the accuracy of endodontic access cavities. MATERIALS AND METHODS A systematic literature review and meta-analysis of clinical studies, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, was performed that evaluated the root canal location rate of computer-aided navigation techniques applied to endodontic access cavities. Four different databases were used to consult the literature: PubMed-Medline, Scopus, Cochrane, and Web of Science. After discarding duplicate articles and applying inclusion criteria, 14 articles were selected for qualitative analysis and 13 for quantitative analysis. RESULTS the root canal location success rate started at 98.1% (CI: 95.7-100%) of the cases performed through a computer-aided navigation technique. The prediction interval ranged from 93.3% to 100%. The meta-analysis did not detect heterogeneity between the combined studies (Q-test = 17.3; p = 0.185; I2 = 25%). No statistically significant differences were found between computer-aided static navigation techniques (success rate: 98.5%) and computer-aided dynamic navigation techniques (success rate: 94.5%) (Q test = 0.57; p = 0.451), nor between in vitro studies (success rate: 96.2%) and in vivo studies (success rate: 100%) (Q test = 2.53; p-value = 0.112). An odds success ratio of 13.1 (CI: 95%; 3.48, 49.1) encourages the use of computer-aided navigation techniques over conventional endodontic access cavity procedures. CONCLUSIONS the endodontic access cavities created using static and dynamic computer-aided navigation techniques are highly accurate in locating the root canal system.
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Loureiro MAZ, Silva JA, Chaves GS, Capeletti LR, Estrela C, Decurcio DA. Guided endodontics: The impact of new technologies on complex case solution. AUST ENDOD J 2021; 47:664-671. [PMID: 33660403 DOI: 10.1111/aej.12498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022]
Abstract
Discuss the impact of new diagnostic and planning technologies on the resolution of a clinical case of an upper central incisor with lateral perforation, root canal calcification and apical periodontitis. A 44-year-old woman sought treatment because of a colour change in an anterior tooth. The tooth had already been endodontically accessed, and she reported that two different clinicians had failed to locate the root canal. A Cone Beam Computed Tomography scan showed excessive wear and root perforation in the middle third, as well as pulp canal obliteration in the apical third. The perforation was treated using a biomaterial, and the root canal was located using guided endodontics. This treatment protocol was used to access, prepare, medicate with calcium hydroxide for 21 days and fill the root canal. Treatment results were satisfactory at 6-month follow-up.
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Affiliation(s)
| | - Julio A Silva
- School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Gustavo S Chaves
- School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | | | - Carlos Estrela
- School of Dentistry, Federal University of Goiás, Goiânia, Brazil
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Loureiro MAZ, Elias MR, Capeletti LR, Silva JA, Siqueira PC, Chaves GS, Decurcio DA. Guided Endodontics: Volume of Dental Tissue Removed by Guided Access Cavity Preparation—An Ex Vivo Study. J Endod 2020; 46:1907-1912. [DOI: 10.1016/j.joen.2020.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022]
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Kostunov J, Rammelsberg P, Klotz AL, Zenthöfer A, Schwindling FS. Minimization of Tooth Substance Removal in Normally Calcified Teeth Using Guided Endodontics: An In Vitro Pilot Study. J Endod 2020; 47:286-290. [PMID: 33245970 DOI: 10.1016/j.joen.2020.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/18/2020] [Accepted: 10/26/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study evaluated the success rate of and tooth substance removal required for computer-guided preparation of endodontic access cavities. METHODS Thirty acrylic typodont teeth with root canals (10 each of tooth numbers 11, 14, and 17) were randomly allocated to a study or control group (15 teeth per group). In the study group, teeth were fixed in acrylic resin and subsequently digitized using a laboratory scanner. A cone-beam computed tomographic scan was then taken. Access cavity preparations were planned virtually, and a template was 3-dimensionally printed. In the control group, access cavities were prepared using the conventional access technique. Tooth substance removal was assessed by weighing teeth before and after preparation. Volume loss was analyzed statistically by use of the Wilcoxon-Mann-Whitney test at a significance level of P < .05. RESULTS Using guided endodontics, 93.3% of root canals were located successfully compared with 100% of root canals using the conventional technique. In the control group, the mean tooth substance removal was 16.1 ± 3.7 mm³ for incisors, 44.2 ± 8.9 mm³ for premolars, and 99.3 ± 3.1 mm³ for molars. In the study group, significantly less tooth substance was removed; substance loss was 10.3 ± 1.1 mm³ for incisors, 29.3 ± 4.2 mm³ for premolars, and 51.8 ± 5.3 mm³ for molars. CONCLUSIONS The use of guided endodontics in normally calcified teeth enables the preservation of a significant amount of tooth substance. However, this advantage must be carefully balanced against a greater radiation burden and risk of perforation, higher costs, and more difficult debridement and visualization of the pulp chamber and root canals.
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Affiliation(s)
- Jana Kostunov
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany.
| | - Peter Rammelsberg
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna-Luisa Klotz
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Zenthöfer
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
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Krug R, Volland J, Reich S, Soliman S, Connert T, Krastl G. Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report. Head Face Med 2020; 16:27. [PMID: 33203420 PMCID: PMC7672920 DOI: 10.1186/s13005-020-00240-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background To report the outcome of guided endodontic treatment (GET) of a case of dentin dysplasia with pulp canal calcification (PCC) and apical periodontitis based on the use of a 3D-printed template designed by merging cone-beam computed tomography (CBCT) and surface scan data. Case presentation A 12-year old female with radicular dentin dysplasia type I (DD-1) presented for endodontic treatment. Radiography revealed PCC in all teeth and apical radiolucency in seven teeth (12, 15, 26, 31, 32, 36 and 46). Tooth 36 had the most acute symptoms and was thus treated first by conventional access cavity preparation and root canal detection. Despite meticulous technique, the distal and mesiolingual canals were perforated. The perforations were immediately repaired with mineral trioxide aggregate, and the decision was made to switch to guided endodontic treatment for the remaining 6 teeth. CBCT and intraoral surface scans were acquired and matched using coDiagnostix planning software (Dental Wings Inc.), the respective drill positions for root canal location were determined, and templates were virtually designed and 3D-printed. The template was positioned on the respective tooth, and a customized drill was used to penetrate the calcified part of the root canal and perform minimally invasive access cavity preparation up to the apical region. All root canals were rapidly and successfully located with the templates. At 1-year follow-up, clear signs of apical healing were present in all treated teeth. Conclusions In patients with dentin dysplasia, conventional endodontic therapy is challenging. GET considerably facilitates the root canal treatment of teeth affected by dentin dysplasia.
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Affiliation(s)
- Ralf Krug
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
| | - Julian Volland
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Sebastian Reich
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Sebastian Soliman
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Thomas Connert
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Mattenstraße 40, 4058, Basel, Switzerland
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
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Accuracy and Efficiency of a Dynamic Navigation System for Locating Calcified Canals. J Endod 2020; 46:1719-1725. [DOI: 10.1016/j.joen.2020.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022]
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Torres A, Lerut K, Lambrechts P, Jacobs R. Guided Endodontics: Use of a Sleeveless Guide System on an Upper Premolar with Pulp Canal Obliteration and Apical Periodontitis. J Endod 2020; 47:133-139. [PMID: 33045264 DOI: 10.1016/j.joen.2020.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/27/2022]
Abstract
Guided endodontics has been used for the treatment of anterior teeth with a successful outcome. This approach is not only limited to anterior teeth because it can also be used for the treatment of premolars and molars. However, in such cases, space may be a limitation because a long bur has to be used in addition to the guide being placed on top of the teeth. The aim of this case report was to present a novel guided endodontics technique using a sleeveless 3-dimensional-printed guide. This design can reduce vertical space, allowing an open view of the tooth and irrigation during drilling. A 46-year-old female patient consulted the endodontic department with intermittent pain around tooth #5. Tooth #5 presented pain upon percussion and responded negative to a cold test. The initial periapical radiograph revealed an apical radiolucency with pulp canal obliteration. Clinically, there was no sinus tract. The tooth was diagnosed with pulp necrosis and symptomatic apical periodontitis. Guided endodontic treatment was performed with a sleeveless 3-dimensional-printed guide and long neck carbide bur with a head diameter of 1 mm to drill a minimally invasive access cavity up to the root canal. A completely healed apical area of tooth #5 was visible after 1 year on periapical radiographs. This technique seems to be a promising alternative in comparison with the conventional guided endodontic guide design for the negotiation of pulp canal obliteration in cases in which vertical space is limited.
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Affiliation(s)
- Andres Torres
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium; Department of Oral Health Sciences, University Hospitals Leuven, Endodontology, KU Leuven, Leuven, Belgium.
| | - Kathleen Lerut
- Department of Oral Health Sciences, University Hospitals Leuven, Endodontology, KU Leuven, Leuven, Belgium
| | - Paul Lambrechts
- Department of Oral Health Sciences, University Hospitals Leuven, Endodontology, KU Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Zhang T, Chen D, Miao LY, Xie SJ, Tang XN. [Guided endodontic access of calcified root canal by laser melting templates]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:525-531. [PMID: 33085236 DOI: 10.7518/hxkq.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study is to treat calcified root canal and assess the accuracy of guided endodontics using laser melting templates. METHODS Two cases with calcified anterior teeth were treated with laser melting templates. Cone beam computed tomography (CBCT) was used to scan the maxillary teeth of patients before surgery to establish the root canal system model. The maxillary impression of the patient was made and it was scanned by a 3D scanner. The CBCT scans were matched with surface scans of plaster model. Mimics 19.0 and 3-matic 11.0 software were used to design the virtual planning to access cavities. The templates were produced by laser melting 3D printing. Access cavity was prepared under the guidance of laser melting template. Then the deviations of planned and prepared cavities in three dimensions and angle were measured. RESULTS The two teeth obtained satisfactory results. The first case had a angle deviation of 1.77°, a drilling base deviation of 0.403-0.497 mm, and a tip of 0.433-0.537 mm. The second case had a angle deviation of 3.26°, a drill base deviation of 0.18-0.347 mm, and a tip of 0.310-0.463 mm. CONCLUSIONS Laser melting template-guided endodontics is an effective technique for the treatment of calcified root canal and can be used as a new strategy for the treatment of calcified canal.
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Affiliation(s)
- Ting Zhang
- Dept. of Cariology and Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China; Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China
| | - Du Chen
- Dept. of Prosthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China
| | - Lei-Ying Miao
- Dept. of Cariology and Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China; Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China
| | - Si-Jing Xie
- Dept. of Cariology and Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China; Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China
| | - Xu-Na Tang
- Dept. of Cariology and Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China; Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, China; State Key Lab. for Novel Software Technology, Nanjing University, Nanjing 210000, China
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Tavares WLF, Ferreira MVL, de Carvalho Machado V, Braga T, Amaral RR, Cohen S. Antimicrobial photodynamic therapy and guided endodontics: A case report. Photodiagnosis Photodyn Ther 2020; 31:101935. [DOI: 10.1016/j.pdpdt.2020.101935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022]
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Ishak G, Habib M, Tohme H, Patel S, Bordone A, Perez C, Zogheib C. Guided Endodontic Treatment of Calcified Lower Incisors: A Case Report. Dent J (Basel) 2020; 8:dj8030074. [PMID: 32650552 PMCID: PMC7558261 DOI: 10.3390/dj8030074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/27/2022] Open
Abstract
A 52-year-old female patient was diagnosed with chronic periapical periodontitis associated with severely calcified lower central incisors. Radiographic examination revealed no visible root canal in the coronal-third of the root. After choosing the guided endodontic treatment, an intraoral scan (Trios, 3shape, Copenhagen, Denmark), in conjunction with a cone beam computed tomography (CBCT) scan, was taken in order to design and fabricate a printed guide. Virtual implant software was used to visualize the surgical access into the sclerosed root canals. After locating the canals, the guide was removed, and the teeth were treated under a rubber dam. The guided approach allows predictable, efficient endodontic treatment of teeth presenting calcified canals, with minimal removal of sound dentine and less risk of root perforations.
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Affiliation(s)
- Georges Ishak
- Department of Endodontics, Saint Joseph University of Beirut, Beirut 1107-2180, Lebanon; (G.I.); (M.H.); (H.T.)
| | - Marc Habib
- Department of Endodontics, Saint Joseph University of Beirut, Beirut 1107-2180, Lebanon; (G.I.); (M.H.); (H.T.)
| | - Hani Tohme
- Department of Endodontics, Saint Joseph University of Beirut, Beirut 1107-2180, Lebanon; (G.I.); (M.H.); (H.T.)
| | - Shanon Patel
- Department of Restorative Dentistry, King’s College, London SE5 9RS, UK;
| | | | - Cyril Perez
- Université de Strasbourg, 6700 Strasbourg, France;
| | - Carla Zogheib
- Department of Endodontics, Saint Joseph University of Beirut, Beirut 1107-2180, Lebanon; (G.I.); (M.H.); (H.T.)
- Correspondence:
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Silva AS, Carvalho Santos AC, de Sousa Caneschi C, Machado VC, Moreira AN, Dos Santos Alves Morgan LF, Tavares WLF. Adaptable fiberglass post after 3D guided endodontic treatment: Novel approaches in restorative dentistry. J ESTHET RESTOR DENT 2020; 32:364-370. [PMID: 32378339 DOI: 10.1111/jerd.12589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The rehabilitation of extensively damaged teeth with great structural loss and calcified root canals represents a challenge for dentistry. Classically, this restorative procedure of endodontically treated teeth involves intraradicular post placement. Retentive function post that can closely adapt to the root canal without the excessive wear of intraradicular dentin has a fundamental importance to ensure the longevity of the restoration. CLINICAL CONSIDERATIONS This report presents a clinical case of 3D guided access to a severely calcified pulp canal followed by the cementation of a fiberglass post that is adaptable to the root canal and prosthetic rehabilitation with full ceramic crown. CONCLUSIONS 3D guided access allowed conservative and safe root canal treatment. The adaptable fiberglass post meets the specific needs of the described case and has a simple technique and low cost. CLINICAL SIGNIFICANCE Guided endodontics is a minimally invasive approach for teeth with calcified root canals. The post used in this study meets the demands of teeth endodontically treated with conservative techniques. The professional should not need to adapt the anatomy of the root canal to the anatomical reality of the post. This one adapts itself to the shape of the canal.
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Affiliation(s)
- Amanda Stephanie Silva
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alice Cecília Carvalho Santos
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Camila de Sousa Caneschi
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vinícius Carvalho Machado
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Allyson Nogueira Moreira
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Patnana AK, Chugh A, Chugh VK, Kumar P. The incidence of nickel-titanium endodontic hand file fractures: A 7-year retrospective study in a tertiary care hospital. J Conserv Dent 2020; 23:21-25. [PMID: 33223636 PMCID: PMC7657430 DOI: 10.4103/jcd.jcd_254_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/07/2020] [Accepted: 07/14/2020] [Indexed: 12/29/2022] Open
Abstract
Aim: The present retrospective cross-sectional study aims to evaluate the incidence and factors associated with nickel-titanium hand file fractures in root canal-treated teeth in a tertiary care hospital of western India. Methodology: The diagnostic records of intraoral periapical (IOPA) radiographs were analyzed to check for file fractures in the root canal-treated teeth. As a part of standardized departmental protocol, Hand ProTaper Universal file system (Dentsply, India) was used for chemomechanical preparation for root canal treatment. The file fractures were analyzed with reference to age group, type of teeth, curvature of the canal, site of file fracture in the canal, length of file fracture, level of file fracture, distance of the file fracture from the apex, and obturation status of the file-fractured tooth. Chi-square test was applied to assess the significance difference between the tested groups. Results: A total of 19,810 IOPA X-rays were screened and 2728 root canal-treated teeth were found and of these 2728 cases, 109 file-fractured teeth were observed. Conclusion: The total incidence of file fractures was 3.9/100 root canal-treated cases, and mandibular molars with severely curved canals (>25°) had shown the maximum incidence of file fractures.
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Affiliation(s)
- Arun Kumar Patnana
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankita Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vinay Kumar Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Tavares WLF, Fonseca FO, Maia LM, de Carvalho Machado V, França Alves Silva NR, Junior GM, Ribeiro Sobrinho AP. 3D Apicoectomy Guidance: Optimizing Access for Apicoectomies. J Oral Maxillofac Surg 2019; 78:357.e1-357.e8. [PMID: 31743656 DOI: 10.1016/j.joms.2019.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
When conventional endodontic treatment resources are depleted, endodontic surgery becomes an alternative treatment for apical periodontitis to remove unreachable infected areas and seal the root canal. Digital workflows have been used more frequently in many dental applications in recent years. In endodontics, virtual 3-dimensional (3D) planning and endodontic guidance are new aspects important for the treatment of complex cases. This report aimed to present 3D Apicoectomy Guidance, a novel method of performing guided ultraconservative endodontic surgery with conventional implant-guided drills, and to describe its application in a case with a complex anatomic scenario and intimate contact with the maxillary sinus. Implantology computer software, as well as cone-beam computed tomography images and a digital scanning 3D impression, enabled virtual planning of the surgical procedure. Subsequently, a 3D template was produced to guide the instruments used in the osteotomy and root resection. The patient was completely asymptomatic at the 1-week follow-up visit. Cone-beam computed tomography scans were performed at 1 and 6 months after surgery and showed that resection of the apex of the root was performed accurately and that a thin dentin slice remained distally, preventing the rupture of the sinus membrane. The patient remained asymptomatic, and the tissue healed normally. The method used was shown to be very straightforward and reliable. This method allowed the patient to be treated expeditiously with very precise tissue removal.
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Affiliation(s)
- Warley Luciano Fonseca Tavares
- Professor, Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Francielen Oliveira Fonseca
- Resident, Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas Moreira Maia
- Resident, Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Nelson Renato França Alves Silva
- Professor, Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Antônio Paulino Ribeiro Sobrinho
- Department Head, Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Moreno‐Rabié C, Torres A, Lambrechts P, Jacobs R. Clinical applications, accuracy and limitations of guided endodontics: a systematic review. Int Endod J 2019; 53:214-231. [DOI: 10.1111/iej.13216] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/06/2019] [Indexed: 12/28/2022]
Affiliation(s)
- C. Moreno‐Rabié
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven LeuvenBelgium
| | - A. Torres
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven LeuvenBelgium
- Department of Oral Health Sciences Endodontology University Hospitals Leuven Leuven Belgium
| | - P. Lambrechts
- Department of Oral Health Sciences Endodontology University Hospitals Leuven Leuven Belgium
| | - R. Jacobs
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven LeuvenBelgium
- Department of Oral and Maxillofacial Surgery University Hospitals Leuven LeuvenBelgium
- Department of Dental Medicine Karolinska Institutet Stockholm Sweden
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Buchgreitz J, Buchgreitz M, Bjørndal L. Guided Endodontics Modified for Treating Molars by Using an Intracoronal Guide Technique. J Endod 2019; 45:818-823. [DOI: 10.1016/j.joen.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/07/2019] [Accepted: 03/16/2019] [Indexed: 02/08/2023]
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Case Reports in Maxillary Posterior Teeth by Guided Endodontic Access. J Endod 2019; 45:214-218. [DOI: 10.1016/j.joen.2018.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/10/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022]
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