Guided Endodontics in Root Canals with Complex Access: Two Case Reports

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.

Effectiveness of guided endodontics when accessing root canals containing fiberglass posts: an in vitro study

The present study aimed to compare the performance of a 3D-endodontic guide (EG) and a conventional technique on the access of root canals containing fiberglass posts. Thirty single-canal lower human premolars were endodontically treated, filled using the single-cone technique, and prepared for fiberglass post luting. The teeth were positioned in the alveoli of human mandibles and cone beam computed tomography (CBCT) examination was performed. The specimens were randomly distributed (n = 10) according to the root canal access technique: control group (GC)-no access; conventional access group (GCA)-root canal accessed with spherical diamond burs and ultrasonic inserts; and EG group (GEG)-root canal accessed with bone graft/anchorage drills and EG. At the end of the root canal access, new CBCT examination was performed to assess the root canal walls' thickness and the volume of dental tissue removed during the fiberglass post removal. The time required for the access was also recorded. The data were submitted to statistical analysis (Kruskal-Wallis and Mann-Whitney tests, α = 0.05). GCA promoted greater deviation than the GEG (p < 0.05) and resulted in greater removal of the root canal walls. The volume of dental tissue/fiberglass post removed, deviations promoted, and the time spent were significantly lower (p < 0.05 and p < 0.001, respectively) in GEG than in GCA. The use of the EG provided a lower volume of dental tissue removed, less deviation from the original root canal path, and less time for endodontic access when compared to conventional access technique.