1
|
Puri A, Abraham D, Gupta A. Impact of Guided Endodontics on the Success of Endodontic Treatment: An Umbrella Review of Systematic Reviews and Meta-Analyses. Cureus 2024; 16:e68853. [PMID: 39381454 PMCID: PMC11459592 DOI: 10.7759/cureus.68853] [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: 08/17/2024] [Accepted: 09/07/2024] [Indexed: 10/10/2024] Open
Abstract
Endodontic treatment, essential for preserving teeth affected by pulp or periapical diseases, often encounters challenges such as complex root canal anatomies and calcifications that can hinder success. Traditional techniques, although effective, are limited in addressing these complexities. Guided endodontics, which utilizes advanced imaging and navigation technologies, promises enhanced accuracy and precision, potentially improving treatment outcomes. Thus, this umbrella review aims to assess whether guided endodontics influences the outcome of endodontic treatment by synthesizing evidence from multiple systematic reviews and meta-analyses. Comprehensive searches were conducted in PubMed, Scopus, EBSCOhost, and Cochrane databases to identify relevant studies. Additionally, grey literature was searched. The umbrella review protocol was developed and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024564150). Inclusion criteria comprised randomized controlled trials (RCTs), randomized clinical trials, case series, and case reports. Exclusion criteria included reviews, non-English language articles, in vitro studies, ex vivo studies, randomized experimental (in vitro) studies, narrative reviews, and expert opinions. Studies involving patients undergoing guided endodontic treatment with dynamic and static navigation systems were included. The interventions aimed at improving the accuracy and precision of endodontic procedures, particularly in challenging cases such as locating calcified canals and performing microsurgery. The study involved three reviewers who independently appraised the systematic reviews for eligibility, data extraction, and review quality. The quality of the systematic reviews was evaluated using the "A Measurement Tool to Assess Systematic Reviews 2" (AMSTAR2) assessment tool. The methodological quality of the systematic reviews was assessed. A pooled review of the studies showed that guided endodontics demonstrated more precise and better results than conventional endodontic procedures.
Collapse
Affiliation(s)
- Aakansha Puri
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad, IND
| | - Dax Abraham
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad, IND
| | - Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad, IND
| |
Collapse
|
2
|
Khare MV, Sivarajan RK, Venkatesh V. Comparative Evaluation of Three Access Cavity Preparation Techniques on Root Canal Instrumentation Using Micro-CT: An In Vitro Study. Cureus 2024; 16:e66424. [PMID: 39246971 PMCID: PMC11380629 DOI: 10.7759/cureus.66424] [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: 07/20/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Background Access cavity preparation is a crucial step in nonsurgical root canal treatment. Recent advancements in access cavity designs focus on preserving maximum tooth structure while ensuring sufficient access to canal orifices for effective cleaning and shaping, resulting in minimally invasive procedures. However, there is limited information on the impact of three-dimensional (3D)-guided access cavity preparation in molars. A literature review found no prior studies comparing the effects of various access cavity preparation techniques on apical transportation, untouched surfaces, and debris formation within the canal. Objective The objective of this study is to compare and evaluate the effects of three different access cavity techniques on apical transportation, untouched surfaces, and debris formation within the root canal. Material and methods Thirty extracted permanent mandibular first molars were selected and randomly assigned to three groups for this study: Group I received 3D-printed static guided cavity preparation, Group II underwent conservative access cavity preparation, and Group III was subjected to traditional access cavity (TAC) preparation. The mesial canals in all samples were cleaned and shaped using TruNatomy files. Preoperative and postoperative micro-CT imaging was performed on each sample to assess the effects of the different access cavity preparation techniques on apical transportation, untouched surfaces, and debris formation within the root canal. Results The study found that Group I, which used 3D-printed static guided cavity preparation, exhibited significantly less apical transportation compared to Groups II and III, with mean differences of -0.1677 and -0.2079, respectively. Debris accumulation was similar across all groups, with mean values of 0.928 ± 0.824 for Group I, 0.751 ± 0.495 for Group II, and 0.938 ± 0.681 for Group III, indicating no significant impact of cavity preparation type on debris levels. For untouched canal surfaces, Group III (TAC preparation) had the fewest untouched surfaces, with mean differences of 3.0380 and 3.9020 compared to Groups II and I, respectively. Conclusions While TAC preparation reduces substantial tooth structure, it shows higher instrumentation efficacy and better cleaning of the root canal system. However, in complex cases where tooth structure preservation is crucial, guided access cavity preparation provides an effective balance between structural conservation and adequate canal access. This approach offers a tailored solution, optimizing treatment outcomes based on the specific clinical scenario.
Collapse
Affiliation(s)
- Mrunmayee V Khare
- Department of Conservative Dentistry and Endodontics, Sri Ramaswamy Memorial (SRM) Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology (SRMIST), Chennai, IND
| | - Ranjith Kumar Sivarajan
- Department of Conservative Dentistry and Endodontics, Sri Ramaswamy Memorial (SRM) Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology (SRMIST), Chennai, IND
| | - Vijay Venkatesh
- Department of Conservative Dentistry and Endodontics, Sri Ramaswamy Memorial (SRM) Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology (SRMIST), Chennai, IND
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Mota ME, Schroter GT, Moreira MS, Alves FA, Jaguar GC, Lopes RN. 3D printing technology to produce intraoral stents for head and neck radiotherapy: A scoping review. SPECIAL CARE IN DENTISTRY 2024; 44:636-644. [PMID: 37909799 DOI: 10.1111/scd.12936] [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: 09/28/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Radiotherapy remains one of the main treatments for head and neck cancer; however, it is accompanied by acute and chronic adverse effects. Use of three-dimensional (3D) oral stents to modulate radiation intensity to specific target areas have been developed to minimize these adverse effects. This study aimed to present a scoping review of studies published on 3D printing of oral stents and their clinical applicability. METHODS MEDLINE/Pubmed, Scopus, Web of Science and CENTRAL Cochrane data bases were searched, studies selected, and data collected by three independent reviewers up to December 2022. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis-Extension for Scoping Reviews (PRISMA-ScR). RESULTS The search resulted in 404 studies and 5 articles fulfilled the eligibility criteria and were considered for this review. Three-dimensional printed intraoral stents were produced for 56 patients with indication for radiotherapy. 3D-printed stents were well-tolerated by all tested patients and demonstrated great reproducibility of maxillomandibular relation, required less time for production and lower cost to manufacture. Two studies showed great protection of healthy tissues with 3D-printed stents during radiotherapy. CONCLUSIONS Three-dimensional printing is promising for production of intraoral stents, however, more studies are needed to improve the technique and further investigate the safety and prevention of oral toxicities from radiotherapy.
Collapse
Affiliation(s)
- Maria Emília Mota
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Gabriella Torres Schroter
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Maria Stella Moreira
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Stomatology, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Fábio Abreu Alves
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Stomatology, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | | | | |
Collapse
|
5
|
Huth KC, Borkowski L, Liebermann A, Berlinghoff F, Hickel R, Schwendicke F, Reymus M. Comparing accuracy in guided endodontics: dynamic real-time navigation, static guides, and manual approaches for access cavity preparation - an in vitro study using 3D printed teeth. Clin Oral Investig 2024; 28:212. [PMID: 38480541 PMCID: PMC10937753 DOI: 10.1007/s00784-024-05603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES To assess root canal localization accuracy using a dynamic approach, surgical guides and freehand technique in vitro. MATERIALS AND METHODS Access cavities were prepared for 4 different 3D printed tooth types by 4 operators (n = 144). Deviations from the planning in angle and bur positioning were compared and operating time as well as tooth substance loss were evaluated (Kruskal-Wallis Test, ANOVA). Operating method, tooth type, and operator effects were analyzed (partial eta-squared statistic). RESULTS Angle deviation varied significantly between the operating methods (p < .0001): freehand (9.53 ± 6.36°), dynamic (2.82 ± 1.8°) and static navigation (1.12 ± 0.85°). The highest effect size was calculated for operating method (ηP²=0.524), followed by tooth type (0.364), and operator (0.08). Regarding deviation of bur base and tip localization no significant difference was found between the methods. Operating method mainly influenced both parameters (ηP²=0.471, 0.379) with minor effects of tooth type (0.157) and operator. Freehand technique caused most substance loss (p < .001), dynamic navigation least (p < .0001). Operating time was the shortest for freehand followed by static and dynamic navigation. CONCLUSIONS Guided endodontic access may aid in precise root canal localization and save tooth structure. CLINICAL RELEVANCE Although guided endodontic access preparation may require more time compared to the freehand technique, the guided navigation is more accurate and saves tooth structure.
Collapse
Affiliation(s)
- Karin Christine Huth
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany.
| | - Lukas Borkowski
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany
| | - Anja Liebermann
- Department of Prosthetic Dentistry, Faculty of Medicine, University of Cologne, University Hospital Cologne, Kerpener Str. 32, 50931, Cologne, Germany
| | - Frank Berlinghoff
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany
| | - Falk Schwendicke
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany
| | - Marcel Reymus
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany
| |
Collapse
|
6
|
Abella Sans F, Alatiya ZT, Val GG, Nagendrababu V, Dummer PMH, Durán-Sindreu Terol F, Olivieri JG. A laboratory study comparing the static navigation technique using a bur with a conventional freehand technique using ultrasonic tips for the removal of fibre posts. Int Endod J 2024; 57:355-368. [PMID: 38204195 DOI: 10.1111/iej.14017] [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: 05/15/2023] [Revised: 11/01/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
AIM There are currently no high-quality studies comparing the static navigation technique with conventional methods of fibre post removal. The aim of this ex vivo study was to compare the effectiveness of fibre post removal between a static navigation technique and a conventional freehand technique using ultrasonics by experienced and inexperienced operators. METHODOLOGY Forty-eight extracted single-rooted human premolars were root-filled. A fibre post was cemented in all 48 teeth, which were then divided randomly into the following groups: static navigation group using burs; static navigation-ultrasonic group; and non-guided group using ultrasonic tips. The following parameters were evaluated for both experienced operators and inexperienced operators: reaching the gutta-percha root filling successfully, the time required to remove the entire post, the occurrence of lateral root perforations, and the amount of root dentine removed. The Kolmogorov-Smirnov test was used to examine the normality of the data; the anova test was used to compare the significant differences among groups; and Tukey tests were used for all two-by-two comparisons. The significance level was set at 0.05. RESULTS In the static navigation group, the gutta-percha was reached significantly more frequently than in the non-guided group (p < .05). The static navigation approach required significantly less time than the non-guided approach to reach the gutta-percha (p < .05). The total removal of posts was significantly different between groups (p < .05), but there was no significant difference between experienced and inexperienced operators in the static navigation group (p > .05). More perforations were associated with the non-guided group than with the other two groups. The total mean loss of dentine in the non-guided group in all directions was 0.39 (±0.17) mm, with 0.25 (±0.09) mm for experienced, and 0.42 (±0.16) mm for inexperienced operators. CONCLUSION When compared to a conventional ultrasonic technique for the removal of fibre posts, the static navigation method using burs resulted in less dentine removal, more rapid access to the gutta-percha root filling, less overall time to remove the posts, and fewer complications. When using static navigation, there was no difference in performance between experienced and inexperienced operators.
Collapse
Affiliation(s)
- Francesc Abella Sans
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Zeena Tariq Alatiya
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Gonzalo Gómez Val
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Venkateshbabu Nagendrababu
- University of Sharjah, College of Dental Medicine, Department of Preventive and Restorative Dentistry, Sharjah, United Arab Emirates
| | | | | | | |
Collapse
|
7
|
Rajnics Z, Mandel I, Nagy Á, Turzó K, Mühl A, Marada G. Effect of different parameters utilized for image guided endodontic root canal preparation on temperature changes: an in vitro study. BMC Oral Health 2024; 24:76. [PMID: 38218822 PMCID: PMC10787981 DOI: 10.1186/s12903-023-03799-x] [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: 10/05/2023] [Accepted: 12/18/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Navigated endodontics is a cutting-edge technology becoming increasingly more accessible for dental practitioners. Therefore, it is necessary to clarify the ideal technical parameters of this procedure to prevent collateral damage of the surrounding tissues. There is a limited number of studies available in published scientific literature referencing the possible collateral thermal damage due to high-speed rotary instruments used in guided endodontic drilling. The aim of our study was to investigate the different drilling parameters and their effect upon the temperature elevations measured on the outer surface of teeth during guided endodontic drilling. METHODS In our in vitro study, 72 teeth with presumably narrow root canals were prepared using a guided endodontic approach through a 3D-printed guide. Teeth were randomly allocated into six different test groups consisting of 12 teeth each, of which, four parameters affecting temperature change were investigated: (a) access cavity preparation prior to endodontic drilling, (b) drill speed, (c) cooling, and (d) cooling fluid temperature. Temperature changes were recorded using a contact thermocouple electrode connected to a digital thermometer. RESULTS The highest temperature elevations (14.62 °C ± 0.60 at 800 rpm and 13.76 °C ± 1.24 at 1000 rpm) were recorded in the groups in which drilling was performed without prior access cavity preparation nor without a significant difference between the different drill speeds (p = 0.243). Access cavity preparation significantly decreased temperature elevations (p < 0.01) while drilling at 800 rpm (8.90 °C ± 0.50) produced significantly less heating of the root surface (p < 0.05) than drilling at 1000 rpm (10.09 °C ± 1.32). Cooling significantly decreased (p < 0.01) temperature elevations at a drill speed of 1000 rpm, and cooling liquid temperatures of 4-6 °C proved significantly (p < 0.01) more beneficial in decreasing temperature elevations (1.60 °C ± 1.17) than when compared with room temperature (21 °C) liquids (4.01 °C ± 0.22). CONCLUSIONS Based on the results of our study, guided endodontic drilling at drill speeds not exceeding 1000 rpm following access cavity preparation, with constant cooling using a fluid cooler than room temperature, provides the best results in avoiding collateral thermal damage during navigated endodontic drilling of root canals.
Collapse
Affiliation(s)
- Zsolt Rajnics
- Dental School, Medical Faculty, University of Pécs, Tüzér u. 1, Pécs, H-7623, Hungary
| | - Iván Mandel
- Dental School, Medical Faculty, University of Pécs, Tüzér u. 1, Pécs, H-7623, Hungary
| | - Ákos Nagy
- Dental School, Medical Faculty, University of Pécs, Tüzér u. 1, Pécs, H-7623, Hungary
| | - Kinga Turzó
- Dental School, Medical Faculty, University of Pécs, Tüzér u. 1, Pécs, H-7623, Hungary
| | - Attila Mühl
- Dental School, Medical Faculty, University of Pécs, Tüzér u. 1, Pécs, H-7623, Hungary.
| | - Gyula Marada
- Dental School, Medical Faculty, University of Pécs, Tüzér u. 1, Pécs, H-7623, Hungary
| |
Collapse
|
8
|
Lima TO, Rocha ADO, Dos Anjos LM, Meneses Júnior NS, Hungaro Duarte MA, Alcalde MP, Cardoso M, Vivan RR. A Global Overview of Guided Endodontics: A Bibliometric Analysis. J Endod 2024; 50:10-16. [PMID: 37838017 DOI: 10.1016/j.joen.2023.10.002] [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: 09/14/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION This review aimed to analyze the trend and main characteristics of articles related to guided endodontics (GE). METHODS The search was conducted in May 2023 on Web of Science. GE-related articles were included, and conferences were excluded. Three researchers selected the articles and extracted: the number of citations; year and journal; design and study theme; authorship and institutions; country and continent. Collaborative networks were generated in the Visualization of Similarities Viewer software. The relationship between data was determined by Spearman's correlation. Google Trends was used to investigate the global popularity of GE research. RESULTS The search resulted in 135 articles, of which 85 were included. The most cited article totaled 116 citations. The studies were published between 2016 and 2023, most frequently in 2022 (n = 22). The most prevalent journal was the Journal of Endodontics (n = 28). Case report (n = 38) was the most frequent study design. The most studied theme was the use of static GE for calcified canals (n = 27). Connert T was the author with the highest number of articles (n = 13). The University of Basel (n = 9) stood out. The most prevalent country was Brazil (n = 13). Europe was the most frequent continent (n = 38). Visualization of Similarities Viewer demonstrated an interaction between authors. There was a moderate positive correlation between citations and the impact factor (rho = .483). According to Google Trends, the United States was the country that most researched GE. CONCLUSIONS Based on this review, a more significant research interest in GE was observed in Europe, addressing the application of GE in locating severely calcified root canals.
Collapse
Affiliation(s)
| | - Aurélio de Oliveira Rocha
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
| | - Lucas Menezes Dos Anjos
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | | | | | | | - Mariane Cardoso
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Rodrigo Ricci Vivan
- Department of Endodontics, University of São Paulo, Bauru, São Paulo, Brazil
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Choi S, Choi J, Peters OA, Peters CI. Design of an interactive system for access cavity assessment: A novel feedback tool for preclinical endodontics. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:1031-1039. [PMID: 36655941 DOI: 10.1111/eje.12895] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/04/2022] [Accepted: 01/15/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION A software program was developed to provide visual, guided feedback to students for access cavity preparations in preclinical learning. The specific aim of the study was to investigate students' overall experiences with the new learning method and compare their experiences with traditional teaching. MATERIALS AND METHODS A workflow based on freely available software was designed to interactively register three-dimensional models of molars with access cavities, and to metrically compare these to instructor-prepared standard cavities. Third-year students practicing molar endodontics access cavity preparation in the preclinical course were then surveyed. A total of 44/79 students completed self-administered questionnaires prior and after the use of the feedback software to gauge their learning experience. RESULTS The results of the post-training questionnaire illustrated that all surveyed students agreed/strongly agreed that the software assisted their learning in access cavity preparation. In addition, 86 and 89%, respectively, of students agreed that the use of the software improved their skills of access cavity preparation and felt more confident about their access cavity preparation skills after using the software package, 3D Dental Align. DISCUSSION The presented software solution permitted setting and comparing access cavity preparations by students against a standard access prepared by an instructor. The process of data acquisition and registration was fast and straightforward. Student feedback was very positive and suggested the integration of this type of experiential learning into the preclinical curriculum. CONCLUSION This feasibility study demonstrated the utility of the new technology to assist dental students' access cavity preparation learning.
Collapse
Affiliation(s)
- Seongwon Choi
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Jiwon Choi
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Ove A Peters
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Christine I Peters
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| |
Collapse
|
11
|
Hildebrand H, Leontiev W, Krastl G, Weiger R, Dagassan-Berndt D, Bürklein S, Connert T. Guided endodontics versus conventional access cavity preparation: an ex vivo comparative study of substance loss. BMC Oral Health 2023; 23:713. [PMID: 37794361 PMCID: PMC10552426 DOI: 10.1186/s12903-023-03436-7] [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: 06/21/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND To compare the outcomes of conventional access cavity preparation (CONV) versus guided endodontics (GE) for access cavity preparation in anterior teeth with pulp canal calcification (PCC) regarding root canal detection, substance loss, procedural time, and need for additional radiographs. METHODS Extracted, sound human teeth with PCC (n = 108) were matched in pairs, divided into two groups and used to produce 18 models. An independent endodontist and a general dentist performed access cavity preparation under simulated clinical conditions on nine models each (54 teeth). The endodontist used the conventional technique and the general dentist GE. Time needed to access the root canals and the number of additional radiographs were recorded. Pre- and postoperative cone-beam computed tomography scans were obtained to measure substance loss. Statistical significance was tested by examining the overlap of 95% confidence intervals (CIs) between the groups. RESULTS All root canals were successfully accessed by both methods. There were no significant differences in substance loss (CI: CONV 15.9-29.6 mm3 vs. GE 17.6-27.5mm3) or procedural time (CI: CONV 163.3-248.5 s vs. GE 231.9-326.8 s). However, 31 additional radiographs were required for GE compared to none for CONV. CONCLUSIONS For access cavity preparation in teeth with PCC, both CONV by a specialist and GE by a general dentist produce good results in terms of substance loss and time requirements.
Collapse
Affiliation(s)
- Hauke Hildebrand
- 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
| | - 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
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Sebastian Bürklein
- Interdisciplinary Ambulance in the School of Dentistry, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Thomas Connert
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Bittar E, Binvignat P, Villat C, Maurin JC, Ducret M, Richert R. Assessment of guide fitting using an intra-oral scanner: An in vitro study. J Dent 2023; 135:104590. [PMID: 37327983 DOI: 10.1016/j.jdent.2023.104590] [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: 01/01/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the capacity of an intra-oral scanner (IOS) to assess the position of an endodontic guide in vitro. METHODS Fourteen extracted human teeth were placed into a maxillary model and scanned using computed tomography and a reference laboratory scanner. An ideal endodontic guide was then created and modified by adding defects of different thicknesses to simulate incorrect positions: 50 μm, 150 μm, 400 μm, and 1000 μm. For each thickness, guides were printed three times and each guide was scanned by three experimented operators using a Trios 4 IOS (3Shape, Copenhagen, Denmark). The 36 scans were compared using a best-fit alignment to the master model without defect to define the accuracy of the method and the positioning error. RESULTS The IOS presented a mean trueness of 1.28 μm (SD= 12.70) and a mean precision of 11.52 μm (SD= 62.17). Considering all sizes of defect, the mean measured position of the endodontic guide was highly correlated (R>0.99) with the expected position. Compared to the ideal guide, there was a mean linear deviation of 46.11 μm (SD= 23.21) and a mean angular deviation of 5.9° (SD= 1.2); this deviation was not influenced by the operator. CONCLUSION The present study found that an IOS had good performance to detect a positioning error of the endodontic guide in vitro. CLINICAL SIGNIFICANCE This new application of IOS has a promising potential in clinical practice to assist practitioners during the fitting of guides.
Collapse
Affiliation(s)
- Elias Bittar
- Hospices Civils de Lyon, PAM Odontologie, Lyon 69007, France
| | | | - Cyril Villat
- Hospices Civils de Lyon, PAM Odontologie, Lyon 69007, France; Laboratoire des Multimatériaux et Interfaces, UMR 5615 CNRS/UCBL, Lyon 69008, France
| | - Jean-Christophe Maurin
- Hospices Civils de Lyon, PAM Odontologie, Lyon 69007, France; Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR 5305 CNRS/UCBL, Lyon 69008, France
| | - Maxime Ducret
- Hospices Civils de Lyon, PAM Odontologie, Lyon 69007, France; Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR 5305 CNRS/UCBL, Lyon 69008, France
| | - Raphaël Richert
- Hospices Civils de Lyon, PAM Odontologie, Lyon 69007, France; Laboratoire de Mécanique des Contacts et structures, UMR 5259 CNRS/INSA/Univ, Villeurbanne, Lyon 69100 France.
| |
Collapse
|
15
|
Kamburoğlu K, Sönmez G, Koç C, Yılmaz F, Tunç O, Isayev A. Access Cavity Preparation and Localization of Root Canals Using Guides in 3D-Printed Teeth with Calcified Root Canals: An In Vitro CBCT Study. Diagnostics (Basel) 2023; 13:2215. [PMID: 37443609 DOI: 10.3390/diagnostics13132215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Pulp canal obliteration (PCO) is a significant complication in endodontics that can occur due to various factors. Cone beam computed tomography (CBCT) is a useful diagnostic tool for identifying root canal anatomy and variations, and guided endodontics is emerging as an alternative treatment solution for teeth with partially or entirely obliterated pulpal canals. However, the accuracy of CBCT-guided 3D-printed guides on different materials and layer thicknesses is not well understood. Therefore, this study aimed to evaluate the accuracy of guides prepared using CBCT images on 3D-printed teeth with stereolithography (SLA) using three different materials and two different layer thicknesses. This study found that 3D-printed guides were accurate and reliable for accessing 3D-manufactured obliterated teeth and reaching the apical area. No significant differences in distance or angle measurements were found when different guide materials were used, suggesting that materials can be selected based on availability and cost. These findings contribute to the knowledge base regarding the effectiveness of 3D printing technology in guided endodontics and can help to identify the most suitable materials and techniques for this application.
Collapse
Affiliation(s)
- Kıvanç Kamburoğlu
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, 06560 Ankara, Turkey
| | - Gül Sönmez
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ada Kent University, 33010 Mersin, Turkey
| | - Cemre Koç
- Department of Endodontics, Faculty of Dentistry, Adnan Menderes University, 09010 Aydın, Turkey
| | - Funda Yılmaz
- Department of Endodontics, Faculty of Dentistry, Ankara University, 06500 Ankara, Turkey
| | - Osman Tunç
- BTech Innovation, Teknokent METU, 06800 Ankara, Turkey
| | - Abulfaz Isayev
- School of Dental Medicine, Boston University, Boston, MA 02118, USA
| |
Collapse
|
16
|
Torres A, Dierickx M, Coucke W, Pedano MS, Lambrechts P, Jacobs R. Ex-vivo and in-vivo validation of a novel measuring protocol for guided endodontics. J Dent 2023:104566. [PMID: 37263407 DOI: 10.1016/j.jdent.2023.104566] [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: 10/21/2022] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES To (1) validate the use of a post-operative intraoral scan (IOS) versus Cone Beam Computed Tomography (CBCT), gold standard, on its ability to measure the accuracy of guided endodontics, and (2) present clinical data on the accuracy of guided endodontics. METHODS Four models, including 10 extracted teeth each, were created. Forty guided access cavities were planned on dentin to simulate pulp canal obliteration (PCO). Two operators performed guided access cavities. A post-operative CBCT and IOS were acquired. The deviation coronally, apically, and angular deviation was measured with CBCT and IOS. Clinical accuracy was measured using an IOS acquired immediately after drilling the access cavity with the aid of a guide. Data analysis was performed using multiway Anova and corrected for simultaneous hypothesis testing according to Tukey. P ≤ 0.05 was considered statistically significant. Descriptive statistics on the clinical accuracy of guided endodontics were performed. RESULTS Thirty-eight cavities were assessed with a mean length of 13.8 mm. No statistical difference between operators and methods was found for all parameters (P > 0.05). Thirty-three patients were treated with guided endodontics and measured using an IOS. Results show an average coronal, apical, and angular deviation of 0.2 mm, 0.45 mm, and 1.91° respectively. The average length of the access cavities was 12.5 mm. CONCLUSIONS An IOS can be used to measure the accuracy of guided endodontics. Clinical data showed high accuracy of guided endodontics with a mean apical deviation smaller than 0.5 mm and a mean angular deviation of less than 2°. CLINICAL SIGNIFICANCE The use of an IOS does not involve additional radiation exposure. A safety margin of at least 1 mm around the planned trajectory should be respected when planning the case to minimize the possibility of root perforation.
Collapse
Affiliation(s)
- A Torres
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - M Dierickx
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - W Coucke
- Certified Freelance Statistician, Heverlee, Belgium.
| | - M S Pedano
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - P Lambrechts
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - R Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
17
|
Singh S. From the Desk of the Editor: Guided Endodontics - A Paradigm Step Forward into the Future. J Conserv Dent 2023; 26:247-248. [PMID: 37398851 PMCID: PMC10309134 DOI: 10.4103/jcd.jcd_291_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- Shishir Singh
- Department of Conservative Dentistry and Endodontics, Terna Dental College, Navi Mumbai, Maharashtra, India
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Torres A, Dierickx M, Coucke W, Pedano MS, Lambrechts P, Jacobs R. In vitro study on the accuracy of sleeveless guided endodontics and treatment of a complex upper lateral incisor. J Dent 2023; 131:104466. [PMID: 36804580 DOI: 10.1016/j.jdent.2023.104466] [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: 11/18/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 02/21/2023] Open
Abstract
PURPOSE The present study aims to assess the accuracy of sleeveless guided endodontics for root canal treatment of severe pulp canal obliteration (PCO) in 3D printed jaws. Additionally, the treatment of a complex lateral incisor is presented to illustrate the use of sleeveless guides in a clinical situation. METHODS Two cone-beam computed tomography (CBCT) volumes of an upper and lower jaw were selected to design 3D printed models with PCO. Virtual planning of the access cavities was performed from right to left second premolar. Then, the models were mounted into a phantom head to simulate an actual patient. Two operators with different levels of experience in endodontics performed guided access cavities. The handpiece was guided by guiding rails placed against each other on the sides of the tooth. A post-operative CBCT scan was taken for analysis. RESULTS Eighty-eight guided access cavities (44 per operator) were drilled on eight 3D printed models. The mean length of the access cavities was 15.3 mm, with a mean coronal and apical deviation of 0.5 mm and 0.7 mm respectively. The mean angular deviation was 1.5°. No statistically significant difference was found between operators for the three measured parameters. CONCLUSIONS This study demonstrates, within its limitations, that sleveless guides represent an accurate method for guided endodontic treatment. No statistically significant difference between operators was found when using the guide. CLINICAL SIGNIFICANCE This method offers a valuable alternative to conventional endodontic guides with similar accuracy results.
Collapse
Affiliation(s)
- A Torres
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - M Dierickx
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - W Coucke
- Certified Freelance Statistician, Heverlee, Belgium.
| | - M S Pedano
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - P Lambrechts
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - R Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
20
|
Novel method for augmented reality guided endodontics: an in vitro study. J Dent 2023; 132:104476. [PMID: 36905949 DOI: 10.1016/j.jdent.2023.104476] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the accuracy in endodontics of a novel augmented reality (AR) method for guided access cavity preparation in 3D-printed jaws. METHODS Two operators with different levels of experience in endodontics performed pre-planned virtually guided access cavities through a novel markerless AR system developed by a team among the authors on three sets of 3D-printed jaw models using a 3D printer (Objet Connex 350, Stratasys) mounted on a phantom. After the treatment, a post-operative high-resolution CBCT scan (NewTom VGI Evo, Cefla) was taken for each model and registered to the pre-operative model. All the access cavities were then digitally reconstructed by filling the cavity area using 3D medical software (3-Matic 15.0, Materialise). For the anterior teeth and the premolars, the deviation at the coronal and apical entry points as well as the angular deviation of the access cavity were compared to the virtual plan. For the molars, the deviation at the coronal entry point was compared to the virtual plan. Additionally, the surface area of all access cavities at the entry point was measured and compared to the virtual plan. Descriptive statistics for each parameter were performed. A 95% confidence interval was calculated. RESULTS A total of 90 access cavities were drilled up to a depth of 4 mm inside the tooth. The mean deviation in the frontal teeth and in the premolars at the entry point was 0.51 mm and 0.77 mm at the apical point, with a mean angular deviation of 8.5° and a mean surface overlap of 57%. The mean deviation for the molars at the entry point was 0.63 mm, with a mean surface overlap of 82%. CONCLUSION The use of AR as a digital guide for endodontic access cavity drilling on different teeth showed promising results and might have potential for clinical use. However, further development and research might be needed before in vivo validation to overcome the limitations of the study.
Collapse
|
21
|
Xue Y, Zhang L, Cao Y, Zhou Y, Xie Q, Xu X. A three-dimensional printed assembled sleeveless guide system for fiber-post removal. J Prosthodont 2023; 32:178-184. [PMID: 36545759 DOI: 10.1111/jopr.13634] [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: 08/16/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
This report describes a technique to develop a three-dimensional printed assembled sleeveless guide system to aid the fiber-post removal in a safe and efficient way. The surface and volume data of the dentition containing the targeted tooth were acquired with optical scanners and cone-beam computed tomography. The virtual path of the fiber-post removal was determined and integrated with a guide prototype with a cylindrical passage. The prototype data was split into two separate parts, combined with the matched pin and jack structures to facilitate the assembly. A guide tube was generated based on the axis of the cylindrical passage, split into three units, and combined with the previously processed data with connectors to form the finalized guide system. The adaptor for the head of handpiece was designed to facilitate the guidance. All the finalized data were printed with titanium alloy. The fiber-post of the upper right central incisor was successfully removed with the aid of this assembled sleeveless guide system that guides the handpiece rather than the rotary instrument.
Collapse
Affiliation(s)
- Yang Xue
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & 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, PR China
| | - Lei Zhang
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & 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, PR China
| | - Ye Cao
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & 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, PR China
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & 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, PR China
| | - Qiufei Xie
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & 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, PR China
| | - Xiaoxiang Xu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & 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, PR China
| |
Collapse
|
22
|
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.
Collapse
|
23
|
Panithini DB, Sajjan GS, Kinariwala N, Medicharla UD, Varma KM, Kallepalli M. Real-time guided endodontics: A case report of maxillary central incisor with calcific metamorphosis. J Conserv Dent 2023; 26:113-117. [PMID: 36908734 PMCID: PMC10003280 DOI: 10.4103/jcd.jcd_506_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 12/12/2022] Open
Abstract
Dental trauma results in various complications and poses an enigma to the practitioner. Calcific metamorphosis is one of the sequelae of trauma. A female patient of 35 years visited the specialty clinic of endodontics for the management of a discolored tooth. Clinically, discolored 21 was observed with no pain on palpation and percussion. The pulp sensibility test revealed a negative response. Radiographic examination revealed pulp canal obliteration with an apical radiolucency of Peri Apical Index (PAI 4). The tooth was diagnosed as necrotic pulp with asymptomatic apical periodontitis. Attempt to negotiate the canal under a Dental Operating Microscope (LABOMED, Los Angeles, CA, USA) and ultrasonics (Satelec, Acteon, France) was futile. Cone-beam computed tomography image revealed a patent canal in the apical third. Using real-time guided endodontics with a dynamic navigation system (Navident, ClaroNav, Toronto, ON, Canada), the protocol of plan, trace, and place was followed, and successful canal negotiation was achieved. After radiographic confirmation, root canal treatment was completed.
Collapse
Affiliation(s)
- Durga Bhavani Panithini
- Department of Conservative Dentistry and Endodontics, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh, India
| | - Girija S. Sajjan
- Department of Conservative Dentistry and Endodontics, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh, India
| | - Niraj Kinariwala
- Department of Conservative Dentistry, Karnavati University, Gandhinagar, Gujarat, India
| | - Uma Devi Medicharla
- Department of Conservative Dentistry, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh, India
| | - K. Madhu Varma
- Department of Conservative Dentistry and Endodontics, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh, India
| | - Meghana Kallepalli
- Department of Conservative Dentistry and Endodontics, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh, India
| |
Collapse
|
24
|
Chaves GS, Silva JA, Capeletti LR, Silva EJNL, Estrela C, Decurcio DA. Guided Access Cavity Preparation Using a New Simplified Digital Workflow. J Endod 2023; 49:89-95. [PMID: 36375649 DOI: 10.1016/j.joen.2022.11.004] [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: 07/18/2022] [Revised: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study evaluated the precision of a simplified workflow using only preoperative cone-beam computed tomographic (CBCT) scans to gain guided access to root canals of extracted mandibular molars. A workflow using CBCT scanning associated with 3-dimensional oral scanning was used as a reference for comparison. The influence of the presence of coronal restoration in the simplified workflow was also evaluated. METHODS Forty-five mandibular molars were randomized into 3 groups: a control group in which digital planning was performed with CBCT and oral scanning and 2 experimental groups in which digital planning was performed only with CBCT examination. In experimental group 1, teeth had no coronal restorations, whereas in group 2 teeth presented with coronal composite restorations. After digital planning, the teeth were accessed using the guides, and a new CBCT scan was made to overlap the pre- and postoperative examinations. Precision was measured by calculating the deviation between the planned and prepared cavities in millimeters and angle. Data were compared using 1-way analysis of variance (P < .05). RESULTS All root canals were accessible after access preparation in all tested groups. Deviations of the planned and prepared access cavities were low, with a mean value of 0.55, 0.58, and 0.47 mm and 1.98°, 2.45°, and 1.43° for the control group, group 1, and group 2, respectively. No significant differences in millimeters or angle were observed among the 3 tested groups (P > .05). CONCLUSIONS The simplified digital workflow using only CBCT examination allowed a high level of precision in obtaining access in extracted molars with and without coronal restoration, presenting similar results compared with the digital workflow using CBCT and 3-dimensional oral scanning.
Collapse
Affiliation(s)
- Gustavo S Chaves
- School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil; School of Dentistry, Alfredo Nasser University Center, Aparecida de Goiânia, Goiás, Brazil
| | - Julio A Silva
- School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Lucas R Capeletti
- School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Emmanuel J N L Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil; Department of Endodontics, Grande Rio University, Rio de Janeiro, Brazil
| | - Carlos Estrela
- School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Daniel A Decurcio
- School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil.
| |
Collapse
|
25
|
Mo S, Xu Y, Zhang L, Cao Y, Zhou Y, Xu X. Accuracy of a 3D printed sleeveless guide system used for fiber post removal: An in vitro study. J Dent 2023; 128:104367. [PMID: 36402258 DOI: 10.1016/j.jdent.2022.104367] [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: 08/21/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The removal of fiber post is often a challenging task. A 3D printed assembled sleeveless system that guides the head of the handpiece instead of the drill was developed to address this issue. This study aimed to evaluate the accuracy of this novel guide system using an in vitro approach. METHODS A standard maxillary typodont was digitized. The right first molar, the right central incisor, the left first premolar, and the left second molar in the digitized dentition were virtually crown-amputated. Four cylinders (diameter: 6 mm, height: 12 mm) were positioned along the directions of the main roots of these teeth to establish the virtual test model. Ten copies of the test model were printed using light-polymerizing resin. Four assembled sleeveless guide systems targeting the cylindrical axes were designed and printed using titanium alloy. One senior prosthodontist performed the drilling task targeting each cylindrical axis aided by the guide system or freehand (20 teeth each). The drilled models were scanned. The coordinates of the centers of all perforations and circular bases on the coronal and apical surfaces were obtained. The linear and angular deviations between the actual drilling path and the cylindrical axis for each tooth were calculated and analyzed. RESULTS The guided group exhibited significantly smaller linear and angular deviations than the freehand group (coronal linear deviation: 0.19 ± 0.09 mm vs. 0.35 ± 0.18 mm, p = 0.0012; apical linear deviation: 0.54 ± 0.19 mm vs. 1.71 ± 0.51 mm, p < 0.001; angular deviation: 2.67 ± 1.07° vs. 8.48 ± 2.86°, p < 0.001). CONCLUSION The accuracy of the 3D printed assembled sleeveless guide system used for fiber post removal is superior to that of the freehand method within the limits of an in vitro design. CLINICAL SIGNIFICANCE For the removal of fiber posts, the present 3D printed sleeveless guide system can provide better accuracy that the conventional freehand method. This may justify the diffusion of the guided technique for fiber post removal.
Collapse
Affiliation(s)
- Siyi Mo
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA key Laboratory for Dental Materials, Zhongguancun South Avenue 22, Beijing 100081, China
| | - Yongwei Xu
- Department of dentistry, Peking University People's Hospital, Xizhimen South Street 11, Beijing 100044, China
| | - Lei Zhang
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA key Laboratory for Dental Materials, Zhongguancun South Avenue 22, Beijing 100081, China
| | - Ye Cao
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA key Laboratory for Dental Materials, Zhongguancun South Avenue 22, Beijing 100081, China
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA key Laboratory for Dental Materials, Zhongguancun South Avenue 22, Beijing 100081, China
| | - Xiaoxiang Xu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA key Laboratory for Dental Materials, Zhongguancun South Avenue 22, Beijing 100081, China.
| |
Collapse
|
26
|
Zhang C, Zhao X, Chen C, Wang J, Gu P, Ma J, Wu D, Li J. The accuracy of using guided endodontics in access cavity preparation and the temperature changes of root surface: An in vitro study. BMC Oral Health 2022; 22:504. [PMID: 36384556 PMCID: PMC9670633 DOI: 10.1186/s12903-022-02548-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background Guided endodontics is a successful technique that has been gradually applied to endodontic therapy in recent years without being affected by the operator’s experience. However, the guided bur produces excessive heat during continuous rotation and friction with root canal walls, it is not clear whether the degree of temperature increase may lead to the periodontal ligament and alveolar bone damage. Methods A total of 58 teeth were used, of which 40 teeth were not grouped, all used to evaluate the accuracy. 40 single-rooted premolars were scanned using CBCT and an intra-oral scanner, and 3D-printed guided plates were made with the pre-designed access. A custom-made guided bur was used to prepare the access cavities. The postoperative CBCT data and pre-designed pathways were matched to evaluate the deviation between the planned and virtual paths. The other 18 teeth were randomly divided into three groups (ET20 and ProTaper F3 as the control group, guided endodontics as the test group), with 6 teeth in each group. The temperature changes on the root surfaces were inspected with a thermocouple thermometer. Results The average deviation on the tip and the base of the bur was 0.30 mm and 0.28 mm (mesial/distal), and 0.28 mm and 0.25 mm (buccal/lingual). The average angle deviation was 3.62°. The mean root surface temperature rise of the guided endodontics group was the lowest (5.07 °C) (P < 0.05). Conclusions The access cavity preparation performed with guided endodontics has feasible accuracy and low-temperature rise on the root surfaces. Due to the limitations of the study, whether it has high reliability and safety in clinical applications needs to be further studied in vivo.
Collapse
|
27
|
3D-printed titanium surgical guides for extraction of horizontally impacted lower third molars. Clin Oral Investig 2022; 27:1499-1507. [PMID: 36374352 DOI: 10.1007/s00784-022-04769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This prospective study introduced a digitally designed sectioning guide and evaluated its feasibility for the extraction of horizontally impacted lower third molars. MATERIALS AND METHODS This study included 38 horizontally impacted lower third molars, randomly divided into experimental and control groups. The teeth were extracted using a 3D-printed titanium surgical guide in the experimental group; free-hand extractions were performed in the control group. The surgical duration, tooth sectioning duration, cortical bone perforation, and postoperative complications, including pain, swelling, trismus, dry socket, infection, and hemorrhage, were evaluated. RESULTS Although not statistically significant, guided surgery tended to reduce the number of tooth sectioning steps compared to free-hand extractions. There were no cases of cortical bone perforation in the experimental group. Although the surgical duration was greater in the experimental group (p < 0.05), there were no differences in postoperative pain, swelling, and trismus. There were no cases of postoperative infection and hemorrhage in either group. CONCLUSIONS 3D-printed titanium surgical guides had superior accuracy and safety compared to free-hand surgery. Further studies with larger sample sizes are required to verify these findings. CLINICAL RELEVANCE The template improved the safety of tooth sectioning during impacted lower third molar surgery and resulted in a more predictable extraction. The narrow sectioning groove could fit comfortably with hypertrophic soft tissues in the posterior mandible.
Collapse
|
28
|
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: 32] [Impact Index Per Article: 16.0] [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.
Collapse
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
| |
Collapse
|
29
|
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; 12:1516. [PMID: 36143301 PMCID: PMC9501573 DOI: 10.3390/jpm12091516] [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: 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.
Collapse
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
| |
Collapse
|
30
|
Dąbrowski W, Puchalska W, Ziemlewski A, Ordyniec-Kwaśnica I. Guided Endodontics as a Personalized Tool for Complicated Clinical Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9958. [PMID: 36011600 PMCID: PMC9408804 DOI: 10.3390/ijerph19169958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
The aim of this paper is to present a technique to individualize root canal localization in teeth with calcified root canals using a digitally planned, 3D-printed endodontic guide. Root canal calcification is characterized by the apposition of tertiary dentin along the canal wall. The endodontic treatment of teeth with calcified canals is often challenging. However, digital dentistry meets these challenges. Merging CBCT images with an intraoral scan allows a clinician to prepare an endodontic guide. This article describes the clinical and digital workflow of the guided endodontic access approach in teeth with difficulties in terms of root canal localization due to post-traumatic pulp canal obliteration (PCO) and canal calcification in elderly patients. The path of entry into the root canal system was planned using cone-beam computed tomography (CBCT). The template was printed on a 3D printer using transparent resin. During root canal treatment (RCT), the endodontic tool was inserted through the sleeve until the desired location was reached. The use of an endodontic guide allowed for minimally invasive RCT, avoiding the excessive loss of tooth structures. Navigated endodontics enables clinicians to perform RCT in a more predictable manner and allows clinicians to avoid iatrogenic complications, which improves the treatment prognosis.
Collapse
Affiliation(s)
- Wojciech Dąbrowski
- Department of Dental Prosthetics, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Wiesława Puchalska
- Department of Paediatric Dentistry, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
- Private Practice Impladent Medical & Dental Clinic, 80-125 Gdansk, Poland
| | - Adam Ziemlewski
- Private Practice Impladent Medical & Dental Clinic, 80-125 Gdansk, Poland
| | - Iwona Ordyniec-Kwaśnica
- Department of Dental Prosthetics, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| |
Collapse
|
31
|
Wu M, Liu M, Cheng Y, Tang W, Yan P, Jiang H. Treatment of Pulp Canal Obliteration Using a Dynamic Navigation System: Two Case Reports. J Endod 2022; 48:1441-1446. [PMID: 35963323 DOI: 10.1016/j.joen.2022.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/15/2022] [Accepted: 07/31/2022] [Indexed: 10/31/2022]
Abstract
Endodontic treatment of calcified canals presents a major challenge because of the high incidence of complications, such as perforation, canal geometry alteration, and loss of dental hard tissue. The dynamic navigation technique uses an optical tracking system for real-time navigation to guide the operator to drill according to the preoperative plan and obtain access to the calcified canals. This article describes in detail the use, advantages, disadvantages, and limitations of a novel dynamic navigation system (DNS) in two cases with severely calcified canals. The findings in these cases demonstrate that DNS is a promising technique for the location of calcified root canals.
Collapse
Affiliation(s)
- Mengyan Wu
- 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, 237 Luoyu Road, Wuhan 430079, China; Department of Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Mingwen Liu
- 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, 237 Luoyu Road, Wuhan 430079, China; Department of Geriatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Yue Cheng
- 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, 237 Luoyu Road, Wuhan 430079, China; Department of Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Weilong Tang
- 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, 237 Luoyu Road, Wuhan 430079, China; Department of Preventive Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Ping Yan
- 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, 237 Luoyu Road, Wuhan 430079, China; Department of Geriatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Han Jiang
- 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, 237 Luoyu Road, Wuhan 430079, China; Department of Preventive Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China.
| |
Collapse
|
32
|
Bordone A, Ciaschetti M, Perez C, Couvrechel C. Guided Endodontics in the Management of Intracanal Separated Instruments: A Case Report. J Contemp Dent Pract 2022; 23:853-856. [PMID: 37283022 DOI: 10.5005/jp-journals-10024-3395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM The aim of this case report is to describe the removal of a fractured file in mandibular right first premolar through the application of an endodontic template to guide a trephine until the file. BACKGROUND The fracture of an endodontic instrument is a rare complication that requires therapeutic management. Removal procedures often cause excessive dentine loss. To limit this inconvenience, several techniques describing the removal of fractured files in the coronal third of the canal have been proposed. The guide facilitates the use of the Zumax removal kit (Zumax Medical Co. Ltd., Suzhou, China). CASE DESCRIPTION A 30-year-old patient was referred to dental office for the endodontic retreatment of his mandibular right first premolar. The tooth was painful to percussion and buccal palpation. The periapical radiograph showed a periapical lesion, a defective root canal treatment, and the presence of a fractured file. It was decided to use the Zumax kit in order to remove the instrument. By using digital implantology software, a guide was constructed with a tube to guide a trephine and achieve straight-line access. The trephine was later driven by the resin guide. After completing the drilling, the instrument was removed with the Zumax extractor and the canal was then prepared, disinfected, and filled. CONCLUSION The current case describes the removal of a separated instrument by use of a new approach that is planned on computer software and guided by a resin guide. CLINICAL SIGNIFICANCE The guided endodontic technique avoids excessive loss of dental structure and simplifies the procedure by reducing chair time and increasing the operator's confidence.
Collapse
Affiliation(s)
| | | | - Cyril Perez
- Private Practice, 14 Rue des Capucines, Paris, France, Phone: +33 627717742, e-mail:
| | | |
Collapse
|
33
|
Fiber Post Removal Using a Conservative Fully Guided Approach: A Dental Technique. Case Rep Dent 2022; 2022:3752466. [PMID: 35909436 PMCID: PMC9337978 DOI: 10.1155/2022/3752466] [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: 04/12/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022] Open
Abstract
This report describes the usefulness of an endodontic template for the removal of a fiber post. A 40-year-old man presented with discomfort in the maxillary left canine. Clinical and radiographic examinations showed tooth #23 with a permanent core material retained with fiber post along with a persistent apical radiolucency. Among the various treatment modalities, nonsurgical root canal retreatment with fiber post removal using a conservative fully guided approach was proposed. After obtaining both the cone-beam computed tomographic images and the cast surface scan, their data were merged using implant planning software (ImplaStation for Windows x64 Bit Beta Version, ProDigiDent, Miami, Florida, USA) and superimposed. The drilling space was planned based on the location, diameter, and apical extent of the fiber post and was virtually overlapped and transferred clinically using a resin template to drill through the fiber post. With guides in position over the rubber dam, drilling was made with increments of 2 mm using a size 4 long-shank round bur (Thomas, Bourges, France) until it exposed the coronal gutta-percha. As soon as the canal was located, K3 rotary files (Sybron Endo, Orange, USA) were used along with chloroform to remove the old obturating materials. Then, additional shaping and cleaning were done with ProTaper Next rotary files (Dentsply Sirona, Ballaigues, Switzerland), sizes X2 and X3, and 5.25% NaOCl irrigation, respectively. The root canal was then dried with paper points and obturated with gutta-percha and AH Plus sealer (Dentsply Sirona, Ballaigues, Switzerland) using the continuous-wave compaction technique. Finally, the tooth was temporarily restored using the double seal technique with zinc oxide and zinc sulfate-based temporary material (Cavit W; 3M ESPE, St. Paul, MN, USA) and resin-modified glass ionomer material (Photac Fil; ESPE, Norristown, PA, USA) filling materials and referred for the final restoration.
Collapse
|
34
|
Cehreli ZC, Unverdi GE, Serdar Eymirli P. 10-Year Follow-up of Previously-Traumatized Immature Permanent Incisors Sustaining Second and Third Traumatic Injuries After Revascularization Treatment: Case reports. Dent Traumatol 2022; 38:534-538. [PMID: 35766130 DOI: 10.1111/edt.12773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
The long-term prognosis of previously traumatized immature permanent teeth treated with guided endodontic repair is well documented, but little is known about how these teeth respond to further traumatic injury after treatment. This case report presents the 10-year clinical and radiographic findings of two patients with traumatized maxillary incisors who underwent guided endodontic repair treatment and sustained two further traumatic injuries. Three crown-fractured maxillary central incisors with pulp necrosis were treated with a protocol that used 2.5% NaOCl irrigation, 3-4 week medication with calcium hydroxide or ciprofloxacin-metronidazole paste, induction of apical bleeding, and coronal sealing with mineral trioxide aggregate. One tooth sustained subluxation and a crown fracture after 20 months and 7 years, respectively. Two other teeth had a luxation injury at 9 months and subluxation 6.5 years after the regenerative treatment. One subluxated and one luxated tooth remained free of symptoms for 10 years with radiographic evidence of progressive root canal calcification, while the other luxated incisor required root canal treatment after 7.5 years. Although teeth treated with the so-called "regenerative" endodontic techniques do not possess true pulp tissue, the reparative tissue may respond to traumatic injuries in a similar manner to teeth with normal pulps.
Collapse
Affiliation(s)
- Zafer C Cehreli
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Gizem Erbas Unverdi
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Pinar Serdar Eymirli
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| |
Collapse
|
35
|
Lahoud P, Jacobs R, Boisse P, EzEldeen M, Ducret M, Richert R. Precision medicine using patient-specific modelling: state of the art and perspectives in dental practice. Clin Oral Investig 2022; 26:5117-5128. [PMID: 35687196 DOI: 10.1007/s00784-022-04572-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/30/2022] [Indexed: 12/25/2022]
Abstract
The dental practice has largely evolved in the last 50 years following a better understanding of the biomechanical behaviour of teeth and its supporting structures, as well as developments in the fields of imaging and biomaterials. However, many patients still encounter treatment failures; this is related to the complex nature of evaluating the biomechanical aspects of each clinical situation due to the numerous patient-specific parameters, such as occlusion and root anatomy. In parallel, the advent of cone beam computed tomography enabled researchers in the field of odontology as well as clinicians to gather and model patient data with sufficient accuracy using image processing and finite element technologies. These developments gave rise to a new precision medicine concept that proposes to individually assess anatomical and biomechanical characteristics and adapt treatment options accordingly. While this approach is already applied in maxillofacial surgery, its implementation in dentistry is still restricted. However, recent advancements in artificial intelligence make it possible to automate several parts of the laborious modelling task, bringing such user-assisted decision-support tools closer to both clinicians and researchers. Therefore, the present narrative review aimed to present and discuss the current literature investigating patient-specific modelling in dentistry, its state-of-the-art applications, and research perspectives.
Collapse
Affiliation(s)
- Pierre Lahoud
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Periodontology and Oral Microbiology, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Philippe Boisse
- Laboratoire de Mécanique Des Contacts Et Structures, UMR 5259, CNRS/INSA, Villeurbanne, France
| | - Mostafa EzEldeen
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Leuven, Belgium
| | - Maxime Ducret
- Hospices Civils de Lyon, PAM d'Odontologie, Lyon, France.,Faculty of Odontology, Lyon 1 University, Lyon, France.,Laboratoire de Biologie Tissulaire Et Ingénierie Thérapeutique, UMR5305 CNRS/UCBL, Lyon, France
| | - Raphael Richert
- Laboratoire de Mécanique Des Contacts Et Structures, UMR 5259, CNRS/INSA, Villeurbanne, France. .,Hospices Civils de Lyon, PAM d'Odontologie, Lyon, France. .,Faculty of Odontology, Lyon 1 University, Lyon, France.
| |
Collapse
|
36
|
Koch GK, Gharib H, Liao P, Liu H. Guided Access Cavity Preparation Using Cost-Effective 3D Printers. J Endod 2022; 48:909-913. [PMID: 35421408 DOI: 10.1016/j.joen.2022.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE This in vitro study aimed to evaluate the accuracy and precision of desktop 3D printers when fabricating stents for guided endodontics. MATERIALS AND METHODS A stent was designed using planning software for guided endodontic access on a typodont model. Four different 3D printers were used to fabricate an identical stent, one per printer. Each stent was then used to gain access to the artificial endodontic canal on a typodont tooth, and was repeated ten times per stent by the same operator. Each of the accessed typodont teeth were scanned by a reference scanner and then imported into the inspection software. Inspection software utilized a best-fit alignment to automatically calculate absolute deviation at the base and tip of the bur. RESULTS The mean distance between the planned and actual position of the bur were low, ranging from 0.31 to 0.68mm. Statistically significant differences were found among the four groups (F (3, 36) = 10.67, p <.05). Post-hoc comparison revealed that Group Form2 significantly varied with Groups Form3 and Carbon (p <.05 and p <.05, respectively). Group Form3 obtained the most accurate and most precise axial deviation both coronally and apically. CONCLUSION All of the printers tested produced stents for guided access that allowed for a high level of accuracy in obtaining access to the artificial endodontic canal, which would justify the trial of cost-effective 3D printers for guided endodontic access and necessitates further clinical research on teeth with pulp canal obliteration.
Collapse
Affiliation(s)
- George K Koch
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts; Department of Endodontics, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts.
| | - Hisham Gharib
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts; Department of Restorative Sciences & Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Peixi Liao
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts; Department of Restorative Sciences & Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Hongsheng Liu
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts; Department of Endodontics, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| |
Collapse
|
37
|
Chaves GS, Capeletti LR, Miguel JG, Antônio Z Loureiro M, Silva EJNL, Decurcio DA. A novel simplified workflow for guided endodontic surgery in mandibular molars with a thick buccal bone plate: a Case report. J Endod 2022; 48:930-935. [DOI: 10.1016/j.joen.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
|
38
|
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.
Collapse
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.
| |
Collapse
|
39
|
Silva EJNL, De-Deus G, Souza EM, Belladonna FG, Cavalcante DM, Simões-Carvalho M, Versiani MA. Present status and future directions - Minimal endodontic access cavities. Int Endod J 2022; 55 Suppl 3:531-587. [PMID: 35100441 DOI: 10.1111/iej.13696] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
In the last decades, the move of Medicine towards minimally invasive treatments is notorious and scientifically grounded. As Dentistry naturally follows its footsteps, minimal access preparation also became a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue, backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key-points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection, and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make it clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach like minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws, but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in-situ laboratory model or a large and well-controlled clinical trial to solve this matter.
Collapse
Affiliation(s)
- Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão
| | | | | | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | | |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Nazar A, George L, Mathew J. Guided endodontics: Management of calcified tooth with a large periapical lesion using cone beam computed tomography and three-dimensional printed guide: A case report. ENDODONTOLOGY 2022. [DOI: 10.4103/endo.endo_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
42
|
Sundar S, Varghese A, Datta KJ, Natanasabapathy V. Effect of guided conservative endodontic access and different file kinematics on debris extrusion in mesial root of the mandibular molars: An in vitro study. J Conserv Dent 2022; 25:547-554. [PMID: 36506635 PMCID: PMC9733558 DOI: 10.4103/jcd.jcd_273_22] [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: 05/10/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background Guided conservative endodontic access is a novel technique and the influence of such access cavities on apical debris extrusion (ADE) can have a significant effect on postoperative pain. Objective This study compared ADE and preparation time (PT) in the mesial canals of the mandibular first permanent molars in different access cavity designs and the amount of sodium hypochlorite in the extruded debris using attenuated total reflection-Fourier transform infrared spectrometer (ATR-FTIR). Materials and Methods Human mandibular first permanent molars (N = 72) were selected and randomly divided into six groups (n = 12) based on type of cavity design and files used: Group 1, Conservative Access Cavity [ConsAC])-WaveOne Gold; Group 2, ConsAC-Mtwo; Group 3, ConsAC-XP-endo shaper; Group 4, Traditional Access Cavity [TradAC])-WaveOne; Group 5, TradAC-Mtwo; and Group 6, TradAC-XP-endo shaper. All the ConsAC were prepared with a customized template fabricated using cone beam computed tomography. ADE evaluation was done using the Myers and Montgomery set up. All the instruments were used according to the manufacturers' instructions, followed by a final irrigation using Endoactivator. The time taken for preparation was calculated using a digital watch. Five samples in each group was taken and subjected to ATR-FTIR analysis. Results There was no significant difference between the groups with respect to ADE (P > 0.05). Whereas, a statistically significant difference was seen in PT between the TradAC and ConsAC (P < 0.05). Using ATR-FTIR, it was found that all the samples of extruded debris had the presence of sodium hypochlorite. Conclusions All instrumentation systems produced ADE irrespective of access cavity design. The time taken for preparation of canals in ConsAC was significantly longer compared to TradAC. Clinical Relevance ADE can translate clinically as postoperative pain. Assessing the ADE in ConsAC could shed light on the type of file systems that can be used in such cavities in order to minimize postoperative pain clinically.
Collapse
Affiliation(s)
- Sathish Sundar
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Sathish Sundar, Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, No. 1, Alapakkam Main Road, Maduravoyal, Chennai - 600 095, Tamil Nadu, India. E-mail:
| | - Aswathi Varghese
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Chennai, Tamil Nadu, India
| | - Krithika J. Datta
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Chennai, Tamil Nadu, India
| |
Collapse
|
43
|
Cho C, Jo HJ, Ha JH. Fiber-reinforced composite post removal using guided endodontics: a case report. Restor Dent Endod 2021; 46:e50. [PMID: 34909414 PMCID: PMC8636079 DOI: 10.5395/rde.2021.46.e50] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/20/2021] [Accepted: 06/15/2021] [Indexed: 12/02/2022] Open
Abstract
Although several techniques have been proposed to remove fiber-reinforced composite (FRC) post, no safe and efficient technique has been established. Recently, a guided endodontics technique has been introduced in cases of pulp canal obliteration. This study describes 2 cases of FRC post removal from maxillary anterior teeth using this guided endodontics technique with a dental operating microscope. Optically scanned data set from plaster cast model was superimposed with the data set of cone-beam computed tomography. By implant planning software, the path of a guide drill was selected. Based on them, a customized stent was fabricated and utilized to remove the FRC post. Employing guided endodontics, the FRC post was removed quickly and safely with minimizing the loss of the remaining tooth structure. The guided endodontics was a useful option for FRC post removal.
Collapse
Affiliation(s)
- Changgi Cho
- Department of Conservative Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Hyo Jin Jo
- Department of Conservative Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Jung-Hong Ha
- Department of Conservative Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| |
Collapse
|
44
|
Decurcio DA, Bueno MR, Silva JA, Loureiro MAZ, Damião Sousa-Neto M, Estrela C. Digital Planning on Guided Endodontics Technology. Braz Dent J 2021; 32:23-33. [PMID: 34877975 DOI: 10.1590/0103-6440202104740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 12/17/2022] Open
Abstract
The aim of this review is to discuss the digital planning and the use of guided technology in Endodontics. The complexity of the root canals anatomy and the challenges in the microorganism's control represent risk factors for failure after the infected root canal's treatment. Scientific improvements associated with technological advances have enabled better predictability of therapeutic procedures results. The development of efficient and modern devices provided safer root canal treatments, with shorter clinical visits and greater patient comfort. Digital endodontics incorporated different tools and developed its own, advancing even further in resolving complex cases. The faithful copy of the internal anatomy provided by the advancement of CBCT devices and software's, associated with the digital resources of 3D planning and printing, enabled the advent of guided endodontics. This technique is used at different stages of endodontic treatment, with specific indications and greater result predictability. Therefore, this study critically reviewed the potential clinical application of this guided access technique, and the operative steps for its safe performance in managing complex endodontic cases. The main indications are accessing calcified root canals, performing endodontic surgeries in difficult access areas, removing fiberglass posts, and accessing teeth with developmental anomalies. In summary, guided endodontics has been a precise strategy, effective, safe, and clinically applicable. This procedure represents incorporating technological resources and digital planning in the Endodontist clinical practice, increasing predictability to complex cases.
Collapse
Affiliation(s)
- Daniel A Decurcio
- Department of Stomatology Sciences, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Mike R Bueno
- Department of Radiology, School of Dentistry, University of Cuiabá, Cuiabá, MT, Brazil
| | - Julio A Silva
- Department of Stomatology Sciences, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Marco A Zaiden Loureiro
- Department of Stomatology Sciences, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Manoel Damião Sousa-Neto
- Department of Endodontics, School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Carlos Estrela
- Department of Stomatology Sciences, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| |
Collapse
|
45
|
Effects of the COVID-19 Pandemic on Physical Activity in Chronic Diseases: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312278. [PMID: 34886002 PMCID: PMC8657177 DOI: 10.3390/ijerph182312278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 01/25/2023]
Abstract
The management of chronic diseases (CD) includes physical activity (PA). It is necessary to determine the effects of COVID-19 restrictions in CD. The aim was to review the research related to PA levels before and during the COVID-19 pandemic in people with CD. This review was designed according to PRISMA guidelines and registered in PROSPERO: CRD42020218825. The search was performed in CINAHL, Medline, Scopus, and Web of Science up to January 2021. The PICOS recommendations were applied. The search was conducted by two reviewers, who completed the data extraction of included articles. Methodological quality was assessed using the STROBE checklist, and a meta-analysis was conducted. The literature search strategy identified 227 articles. Five studies remained and were included. Only three studies were included in the meta-analysis. Two articles used accelerometers to objectively compare PA levels before and during the pandemic. Three studies made this comparison using an online survey. All articles showed a decrease in PA levels during the COVID-19 pandemic. The meta-analysis showed a significant reduction in PA levels during pandemic. PA levels during the COVID-19 pandemic have been reduced with respect to previous levels of PA in patients with CD.
Collapse
|
46
|
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.
Collapse
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
| | | |
Collapse
|
47
|
Liu R, Xie C, Sun M, Yu H. Guided removal of a fractured fiber post and immediate restoration with a digitally prefabricated titanium post-and-core and zirconia crown: A clinical report. J Prosthet Dent 2021; 129:684-689. [PMID: 34481671 DOI: 10.1016/j.prosdent.2021.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 02/08/2023]
Abstract
A completely digital workflow is described for the immediate restoration of a fractured fiber post with a digitally prefabricated definitive restoration using 3-dimensionally printed guides. The geometric morphology and axis of the root canal were digitally determined by using cone beam computed tomography to localize the 3-dimensional position of the fractured fiber post. A virtual drill modeled on the shape of the fractured post was fabricated and customized for removal of the post by using a guide to facilitate the intraoral transfer of the drilling procedure. A titanium post-and-core and crown had been virtually predesigned and fabricated before the procedure, and 2 digital guides were designed for their placement. All guides were 3-dimensionally printed. By following this workflow, the removal of the fractured fiber post and immediate definitive restoration were completed in 1 visit, facilitating a more efficient, predictable, and straightforward treatment.
Collapse
Affiliation(s)
- Ruolan Liu
- Graduate student, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Chenyang Xie
- Graduate student, Department of Dental Technology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Manlin Sun
- Graduate student, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Haiyang Yu
- Professor, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China.
| |
Collapse
|
48
|
Wang D, Wang W, Li YJ, Wang YR, Hong T, Bai SZ, Tian Y. The effects of endodontic access cavity design on dentine removal and effectiveness of canal instrumentation in maxillary molars. Int Endod J 2021; 54:2290-2299. [PMID: 34459005 DOI: 10.1111/iej.13621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate in a laboratory setting, the impact of three designs of endodontic access cavities on dentine removal and effectiveness of canal instrumentation in extracted maxillary first molars using micro-computed tomography (micro-CT). METHODOLOGY A total of 30 extracted intact maxillary first molars were selected and scanned by micro-CT with a voxel size of 24 µm and randomly distributed into three groups: the traditional endodontic cavity (TEC) group, the conservative endodontic cavity (CEC) group and the guided endodontic cavity (GEC) group. The pulp chambers of teeth in the groups were accessed accordingly. After root canal preparation, the teeth were rescanned. The volume of dentine removed after canal preparation, the noninstrumented canal areas, canal transportation and centring ratio were analysed. Data were analysed statistically using one-way analysis of variance. Tukey's post hoc test was used for multiple comparisons. The significance level was set at p < .05. RESULTS The total volume of dentine removed was significantly greater in the TEC group after root canal preparation (p < .05). No significant differences in the volume of dentine removed occurred between the CEC and GEC groups (p > .05). The volume of dentine removed in the crown, pericervical dentine and coronal third of the canal was significantly lower in CEC and GEC groups when compared to that in the TEC group (p < .05), no difference was observed in the middle third of the canal and apical third of the canal amongst the three groups (p > .05). There was no significant difference in noninstrumented canal area, canal transportation and centring ratio amongst the TEC, CEC and GEC groups (p > .05). CONCLUSIONS In extracted maxillary molars tested in a laboratory setting, CEC and GEC preserved more tooth tissue in the crown, pericervical dentine and coronal third of the canal compared with TEC after root canal preparation. The design of the endodontic access cavity did not impact on the effectiveness of canal instrumentation in terms of noninstrumented canal area, canal transportation and centring ratio.
Collapse
Affiliation(s)
- Dan Wang
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Wei Wang
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Yu-Jiao Li
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Yi-Rong Wang
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Tao Hong
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Shi-Zhu Bai
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Yu Tian
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| |
Collapse
|
49
|
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.
Collapse
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
| |
Collapse
|
50
|
Torres A, Boelen GJ, Lambrechts P, Pedano MS, Jacobs R. Dynamic navigation: a laboratory study on the accuracy and potential use of guided root canal treatment. Int Endod J 2021; 54:1659-1667. [PMID: 33991122 DOI: 10.1111/iej.13563] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 01/20/2023]
Abstract
AIM To evaluate 3D accuracy and outcome of a dynamic navigation method for guided root canal treatment of severe pulp canal obliteration (PCO) in 3D printed jaws. METHODOLOGY Three operators with different levels of experience in Endodontics performed navigated access cavities, using the Navident system (ClaroNav), in two sets (maxillary and mandibular) of 3D-printed jaw models with teeth presenting severe PCO. Models were mounted on a phantom to mimic a real clinical situation. After treatment, a postoperative high resolution Cone-Beam Computer Tomography (CBCT) scan (NewTom) was taken for each model and registered to the preoperative model. All access cavities were then segmented using 3-Matic Medical software 15.0 (Materialise). Length and volume of each access cavity were measured, and a comparison was done by measuring the distance deviation in mm at the coronal entry point, apical point, vertical deviation, total deviation and angular deviation of the access cavity in comparison with the virtual planning. Additionally, all access cavities were scouted with a size 10 K-file and inspected on the CBCT to confirm that the canal was located. Descriptive statistics for each parameter were performed. Normality of the data was assessed; data were transformed if needed to make it normally distributed. One-way analysis of variance (anova) was applied to assess differences between parameters for tooth type, jaw, and operators and corrected for simultaneous hypothesis testing according to Tukey. Significance level was set at .05. RESULTS After training with the system (28 cavities per operator), a total of 132 teeth and 168 access cavities (56 per operator) were prepared. All operators located a total of 156 canals, obtaining an overall success of 93% without a difference between operator experience (p > .05). The mean deviation at the apical point was 0.63 mm (SD 0.35) and was significantly lower in anterior teeth in comparison with molars (p < .05). The mean angular deviation from the planning was 2.81° (SD 1.53). CONCLUSION Dynamic navigation was an accurate approach for root canal treatment in teeth with severely calcified canals. However, the technique has a learning curve and requires extensive training prior to its use clinically.
Collapse
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, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Gerd-Jan Boelen
- Department of Oral Health Sciences, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Paul Lambrechts
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Mariano Simon Pedano
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, 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
| |
Collapse
|