Guided Endodontic Access in a Calcified Central Incisor: A Conservative Alternative for Endodontic Therapy.

Guided endodontic access is a promising method to treat teeth with pulp calcification. This report aimed to describe a case of root canal treatment performed through guided endodontic access in a calcified anterior tooth with apical periodontitis. A 23-year-old female with a history of trauma 10 years ago in the anterior maxilla was referred to the dental office. Her chief complaint was discolouration of the left central incisor crown. The tooth was sensitive to percussion and responded negatively to pulp sensitivity tests. The periapical radiography showed pulp calcification and periapical radiolucency. Cone-beam computed tomography (CBCT) was obtained to allow a more detailed view of the pulp canal and the periapical area. An intraoral scan was performed and the standard tessellation language (STL) archive was combined with digital imaging and communications on medicine (DICOM) images from CBCT in the Implant Viewer software. Subsequently, a 3D model was designed and printed to guide the endodontic access in position and appropriate angulation for dental instrumentation. The mold was positioned on the patient's tooth and the root canal treatment was performed. After two years, complete healing of periapical tissues was observed. This method facilitates the drill targeting during access, reducing the risk of deviations and perforations.

Influence of Cone Beam Computed Tomography Settings on Implant Artifact Production: Zirconia and Titanium.

PURPOSE: This in vitro study assessed the artifact production related to titanium and zirconia implants in cone beam computed tomography (CBCT) and compared the effect of different protocol settings on image quality for both materials. MATERIALS AND METHODS: A titanium implant and a zirconia implant were placed in a dry mandible. CBCT scans were obtained separately for each implant using the ProMax 3D (Planmeca) unit; 20 protocols were tested with varying kilovoltage (70 to 90 kVp) and resolution (high and low), and with and without a metal artifact reduction tool. Standard deviation and contrast-noise ratio were calculated in regions of interest adjacent and distant to the implant. RESULTS: The zirconia produced more artifacts and its images were more affected by the different protocols than titanium. High kVps and an activated metal artifact reduction tool decreased the standard deviation values related to both implants. Activation of the metal artifact reduction tool also increased contrast-noise ratio values for both implants, whereas increasing kVp improved them only on titanium images. The standard deviation and contrast-noise ratio were not affected by resolution. CONCLUSION: The zirconia implant generated more image artifacts than the titanium implant. Increasing kVp and the metal artifact reduction tool are efficient in decreasing the CBCT artifacts for both implants, whereas resolution does not affect their production.