RESUMEN
AIM: To present a new treatment approach for teeth with pulp canal calcification (PCC) which require root canal treatment. CASE: A 15-year-old male patient presented with pain of his upper right central incisor. The tooth showed signs of apical periodontitis. Due to PCC, location of the root canal was judged to be difficult and associated with a high risk of perforation. A cone beam computed tomography (CBCT) and an intra-oral surface scan were performed and matched using software for virtual implant planning. After planning the position of the drill for root canal location, a virtual template was designed, and the data were exported as an STL file and sent to a 3D printer for template fabrication. The template was positioned on the anterior maxillary teeth. A specific drill was used to penetrate through the obliterated part of the root canal and obtain minimally invasive access to the apical part. The root canal was accessible at 9 mm distance from the apex. Further root canal preparation was carried out using an endodontic rotary instrumentation system. After an interappointment dressing for 4 weeks, the root canal was filled with vertically condensed gutta-percha using an epoxy sealer. The access cavity was restored with a composite material. After 15 months, the patient was clinically asymptomatic with no pain on percussion. The radiograph showed no apical pathology. CONCLUSIONS: The presented guided endodontic approach seems to be a safe, clinically feasible method to locate root canals and prevent root perforation in teeth with PCC.
RESUMEN
INTRODUCTION: The aim of this study was to assess the accuracy of guided endodontics in mandibular anterior teeth by using miniaturized instruments. This technique is designed to treat teeth with pulp canal calcifications and narrow roots by using a printed template that guides a bur to the calcified root canal. METHODS: Sixty sound mandibular anterior teeth were used in 10 mandibular models. Preoperative surface and cone-beam computed tomography scans were matched by using the coDiagnostix software. Virtual planning was performed for the access cavities, and templates were used for guidance. The templates were produced by a three-dimensional printer. Two operators performed the access cavities. A postoperative cone-beam computed tomography scan was superimposed on the virtual plan, and the deviation was measured in 3 dimensions and angles. Descriptive statistical analyses were performed, and 95% confidence intervals were calculated for both operators and each measured aspect. RESULTS: The deviations between the planned- and prepared-access cavities were low, with means ranging from 0.12 to 0.13 mm for different aspects at the base of the bur and 0.12 to 0.34 mm at the tip of the bur. The mean of angle deviation was 1.59°. A considerable overlap of the 95% confidence intervals indicated no significant difference between the operators. The mean treatment time, including planning and preparation, was approximately 10 minutes per tooth. CONCLUSIONS: Microguided endodontics provides an accurate, fast, and operator-independent technique for the preparation of apically extended access cavities in teeth with narrow roots such as mandibular incisors.