Fiber-reinforced composite post removal using guided endodontics: a case report

Impact of Guided Endodontics on the Success of Endodontic Treatment: An Umbrella Review of Systematic Reviews and Meta-Analyses

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.

Removal of fiber post under the guidance of digital guide plate and one-piece glass fiber posts-and-cores repair: a clinical report

This study explores the potential application of computer aided design (CAD)/computer aided manufac-turing (CAM) for one-piece glass fiber posts and cores in restoring tooth defects post-removal of a broken fiber post using a digital guide plate. This paper reports a fractured left upper incisor fiber post removed using a customized needle and digital guide plate. Following root canal retreatment, CAD/CAM integrated fiber post-core and zirconia full crown restoration were completed. The occlusion testing was conducted using the T-Scan Ⅲ system. This study offers insights for managing secondary repair after fiber post fractures.

Removal of fiber posts using conventional versus guided endodontics: a comparative study of dentin loss and complications

OBJECTIVES

To compare the efficacy of fiber post removal using conventional (CONV) versus guided endodontics (GE) in terms of dentin loss, residual resin material, procedural errors, and working time in vitro.

MATERIAL AND METHODS

Ninety human central incisors were root-filled and scanned by micro-computed tomography (CT), then restored with fiber posts and composite. Twenty-four sets of teeth with up to four human maxillary central incisors were fabricated and divided into three groups: conventional post removal by a general dentist (CG) or endodontology specialist (CS) and guided endodontics (GE) by a general dentist, yielding 30 teeth per operator and group. After treatment, the prepared access cavities were volumetrically assessed by micro-CT. Statistical significance was evaluated by one-way analysis of variance followed by post hoc comparisons with Tukey's HSD test and Pearson's chi-squared test for independence.

RESULTS

Both CONV and GE resulted in dentin loss and residual resin material. CS resulted in more dentin loss and less residual resin material than CG and GE (p < .05). All groups had some deviations from the original root canal but no perforations. The shortest working time was observed in the GE group.

CONCLUSIONS

Compared to the conventional freehand technique, GE resulted in significantly less radicular dentin loss, a few deviations but no perforations.

CLINICAL RELEVANCE

Guided endodontics can improve the speed and safety of fiber post removal without root perforation.

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

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.

Expert consensus on digital guided therapy for endodontic diseases

Digital guided therapy (DGT) has been advocated as a contemporary computer-aided technique for treating endodontic diseases in recent decades. The concept of DGT for endodontic diseases is categorized into static guided endodontics (SGE), necessitating a meticulously designed template, and dynamic guided endodontics (DGE), which utilizes an optical triangulation tracking system. Based on cone-beam computed tomography (CBCT) images superimposed with or without oral scan (OS) data, a virtual template is crafted through software and subsequently translated into a 3-dimensional (3D) printing for SGE, while the system guides the drilling path with a real-time navigation in DGE. DGT was reported to resolve a series of challenging endodontic cases, including teeth with pulp obliteration, teeth with anatomical abnormalities, teeth requiring retreatment, posterior teeth needing endodontic microsurgery, and tooth autotransplantation. Case reports and basic researches all demonstrate that DGT stand as a precise, time-saving, and minimally invasive approach in contrast to conventional freehand method. This expert consensus mainly introduces the case selection, general workflow, evaluation, and impact factor of DGT, which could provide an alternative working strategy in endodontic treatment.

A three-dimensional printed assembled sleeveless guide system for fiber-post removal

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.

Accuracy of a 3D printed sleeveless guide system used for fiber post removal: An in vitro study

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.